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Today I want to talk about multi-tier medical systems.
As of December 31, 2016, I was no longer eligible for Covered California commercial insurance subsidy. As of February 1, 2016 (note the gap, which was structurally my fault for believing the letters I got from Blue Shield and Covered California saying that if I did nothing during open enrollment season I would roll over into an identical plan to the one I was already in), I was enrolled in Medi-Cal (California's own [much better] version of Medicaid/Medicare). This should be wonderful: no fees, no copays, everything goes like clockwork. For me, anyway, because I have that rare situation--I already have a primary care doctor who accepts Medi-Cal (it pays less than commercial insurance so many doctors feel they must limit their Medi-Cal patients or not accept Medi-Cal at all. I am saying this neutrally because the payments are very low and it is very expensive to run a doctor's office on the one hand, but doctors expect a significant degree of wealth on the other).
There is, of course, a problem.
I don't remember whether I complained about this here, but last year Blue Shield spent the last five months denying everything--including things that had gotten pre-approval letters--saying I "wasn't covered," though my fees were promptly deducted from my checking account every month. Every time I called it turned out this was not true. The call center worker would say, first "Hmm, it looks like you're covered in one place and not covered in another place, but the one that says you're covered is the correct one. I'll fix it." The excuse that was given to me was that the Blue Shield computers and the Covered California computers were "out of synch" and the IT department was working on it--two years after the system was inaugurated. My own suspicion is that Blue Shield administration knows about this, understands the implications of it (that many baffled people will end up with effectively no coverage as they pay bills they do not owe), and has allocated their resources in such a way as to let it go on--deniably, of course.
So now that I'm not covered by Blue Shield, they seem remarkably un-eager to let me go. Or Medi-Cal seems remarkably un-eager to accept me. Well, no, they've added me as a patient, but as an "administrative member" who has another entity--Blue Shield--as a primary carrier. This is causing no end of trouble. Palo Alto Medical Foundation, who provides my main health care, has no issue with it, though it does mean they're going to have to do everything twice. But the radiation oncologist and the hand clinic I'll be going to don't belong to Palo Alto, so they want things clear from the get.
People, I have spent hours on this. Never mind that it took me a month to even understand that there was a problem and what it was. I finally got Covered California and Blue Shield in the same phone call at the same time and Covered California told Blue Shield that they did not in fact have me as a client, and Blue Shield took an incident number, and Covered California told me to call the Central Coast Health Alliance who administers Medi-Cal for my area, and I did, (the second time that day), and they said that was fine and I should also call my own county's Health Resources Department. I couldn't get through to them so I left it to another day.
That day was today. They are still showing me-- according to them, the state is still showing me--as a Blue Shield primary. Then they told me that I had to get hold of a paper copy of a termination letter from Blue Shield and fucking FAX it to them and I fell apart and cried and screamed and I am not proud of this but I have cancer and I should not be doing this. I said:this is not fair. Why is it my job? Why don't YOU call Blue Shield? And he said, I'm not allowed. As soon as I'm done with this phone call, I have to take another call. In other words, he's not a benefits worker, he's a call center worker--I thought: so I asked to talk to an actual benefits worker. Nope, he's what I get: he's the benefits worker: there is nobody whose job it is to actually make sure the benefits are correct.
This is one consequence of a multi-tiered health care system. Some people just flash their card and get their care. Other people have to spend hours on the phone and wait for letters that will not come with the prospect of finding a fax machine (do they have those at copy shops? I don't even know where a copy shop is anymore: both the ones I used to go to have closed). I've called the Palo Alto oncology department social worker but I won't hear from her till Tuesday and the surgery's Thursday. Fortunately the radiation won't start till two or three weeks after that at the earliest.
But you know? There's worse consequences.
Imagine if I had been living in one of the states that refused the Affordable Care Act right now.
I might be covered on the Federal Exchange, but I might not be effectively covered. If I was in certain states, I might not have been able to afford the monthly fees, and there would be no kind of version of Medicaid waiting for me. I might be looking for charity health care.
I might die.
So it's a good thing I'm in a blue state, right? Hell of a way to run a country.
As of December 31, 2016, I was no longer eligible for Covered California commercial insurance subsidy. As of February 1, 2016 (note the gap, which was structurally my fault for believing the letters I got from Blue Shield and Covered California saying that if I did nothing during open enrollment season I would roll over into an identical plan to the one I was already in), I was enrolled in Medi-Cal (California's own [much better] version of Medicaid/Medicare). This should be wonderful: no fees, no copays, everything goes like clockwork. For me, anyway, because I have that rare situation--I already have a primary care doctor who accepts Medi-Cal (it pays less than commercial insurance so many doctors feel they must limit their Medi-Cal patients or not accept Medi-Cal at all. I am saying this neutrally because the payments are very low and it is very expensive to run a doctor's office on the one hand, but doctors expect a significant degree of wealth on the other).
There is, of course, a problem.
I don't remember whether I complained about this here, but last year Blue Shield spent the last five months denying everything--including things that had gotten pre-approval letters--saying I "wasn't covered," though my fees were promptly deducted from my checking account every month. Every time I called it turned out this was not true. The call center worker would say, first "Hmm, it looks like you're covered in one place and not covered in another place, but the one that says you're covered is the correct one. I'll fix it." The excuse that was given to me was that the Blue Shield computers and the Covered California computers were "out of synch" and the IT department was working on it--two years after the system was inaugurated. My own suspicion is that Blue Shield administration knows about this, understands the implications of it (that many baffled people will end up with effectively no coverage as they pay bills they do not owe), and has allocated their resources in such a way as to let it go on--deniably, of course.
So now that I'm not covered by Blue Shield, they seem remarkably un-eager to let me go. Or Medi-Cal seems remarkably un-eager to accept me. Well, no, they've added me as a patient, but as an "administrative member" who has another entity--Blue Shield--as a primary carrier. This is causing no end of trouble. Palo Alto Medical Foundation, who provides my main health care, has no issue with it, though it does mean they're going to have to do everything twice. But the radiation oncologist and the hand clinic I'll be going to don't belong to Palo Alto, so they want things clear from the get.
People, I have spent hours on this. Never mind that it took me a month to even understand that there was a problem and what it was. I finally got Covered California and Blue Shield in the same phone call at the same time and Covered California told Blue Shield that they did not in fact have me as a client, and Blue Shield took an incident number, and Covered California told me to call the Central Coast Health Alliance who administers Medi-Cal for my area, and I did, (the second time that day), and they said that was fine and I should also call my own county's Health Resources Department. I couldn't get through to them so I left it to another day.
That day was today. They are still showing me-- according to them, the state is still showing me--as a Blue Shield primary. Then they told me that I had to get hold of a paper copy of a termination letter from Blue Shield and fucking FAX it to them and I fell apart and cried and screamed and I am not proud of this but I have cancer and I should not be doing this. I said:this is not fair. Why is it my job? Why don't YOU call Blue Shield? And he said, I'm not allowed. As soon as I'm done with this phone call, I have to take another call. In other words, he's not a benefits worker, he's a call center worker--I thought: so I asked to talk to an actual benefits worker. Nope, he's what I get: he's the benefits worker: there is nobody whose job it is to actually make sure the benefits are correct.
This is one consequence of a multi-tiered health care system. Some people just flash their card and get their care. Other people have to spend hours on the phone and wait for letters that will not come with the prospect of finding a fax machine (do they have those at copy shops? I don't even know where a copy shop is anymore: both the ones I used to go to have closed). I've called the Palo Alto oncology department social worker but I won't hear from her till Tuesday and the surgery's Thursday. Fortunately the radiation won't start till two or three weeks after that at the earliest.
But you know? There's worse consequences.
Imagine if I had been living in one of the states that refused the Affordable Care Act right now.
I might be covered on the Federal Exchange, but I might not be effectively covered. If I was in certain states, I might not have been able to afford the monthly fees, and there would be no kind of version of Medicaid waiting for me. I might be looking for charity health care.
I might die.
So it's a good thing I'm in a blue state, right? Hell of a way to run a country.
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I'm so sorry we live in this horrible country.
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This is why I support single-payor for primary health insurance. The amount of bureaucracy is just crazy-making to deal with if you understand it all and are healthy. It's absolutely terrible to expect sick people and people on heavy meds and people who just don't understand this stuff for whatever reason to try to sort it out.
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Still, cancer is something that happens. like it or not. If it happens to you, you have to deal with it. Making it worse is just pointless.
I have no word for what you describe, so I'm going to paraphrase Bujold's Iselle (The Curse of Chalion). "It is not malice, but it might as well be."