Texas Medicaid
By Milehimama on Feb 4, 2010 in Health
This post is a dire warning. Imagine that the entire nation has their healthcare run by the government!
My children qualified for Medicaid along with the foodstamps. This is good, because my husband’s current employer does not offer insurance of any kind.
So far it has been a debacle.
First, we had issues because of typos. Our caseworker, the one with a bad attitude who “didn’t have time” to actually talk to us, entered in 08 for the birth year instead of the birth month. He was born in ‘02 and it would be a major problem if I showed up at the doctor’s with a 7 year old instead of a 2 year old. Three different people have told me that they fixed it. It wasn’t actually corrected until our third month (6 months after we applied.)
They left Mr. P off altogether. Oh, they assigned him a number, but they didn’t bother to certify him. This was a major problem because he’s the one with brain cysts who needs an MRI. Finally, as of Feb.1, he is certified and can go to the doctor.
If we can find one. In Texas, when you qualify for Medicaid you actually have to sign up for an HMO. You have a choice of four different plans. A guy called me to give me instructions. He has a twenty minute speech and got irritated when I asked questions.
Ok. So I have to sign up for an HMO and pick a name out of the book to be our Primary Care Physician. I don’t like just picking a name, but I found one that seemed perfect for our family. She had special training in pediatric nephrology, and my two youngest have high blood pressure and are followed by a nephrologist at the UT Medical Center. She was close. A mom in my homeschooling group recommended her. English was her first language. Perfect!
So I filled out my paperwork, called it in, and selected our doctor.
Then Mr P hurt his head. Suddenly we needed to see the doctor quickly (well, it turns out, not too quickly. Medicaid didn’t authorize the MRI for two weeks, even though it was ordered by an emergency room physician.) Call up the doctor. Our Primary Care. The one who is our gateway for any and all treatment; Medicaid won’t pay for anything she doesn’t sign off on.
This doctor is not accepting new Medicaid patients. Oh, they’ll take new patients, just not Medicaid. Even though she was listed in the directory. Even though her office does take Medicaid as payment. Just so long as you are not new.
Now I’m in a pickle. Everything has to be okayed by this woman who won’t see us. I call. There’s a holiday. A glitch in the paperwork. Days and more phone calls pass. Finally a woman tells me that I can’t change my PCP until I get my official card, which won’t even be sent for processing until Feb. 1. They hold all new accounts until the first of the month then send them as a batch.
Meanwhile, I manage to find a doctor who will take new Medicaid patients. I make an appointment, which I promptly cancel since Medicaid hadn’t approved the MRI at that point. A week later I make another appointment, after our MRI gets the green light. Now new doctor can’t see us unless they are listed as our PCP which I can’t change right now.
Also, I find out that this new doctor is unable to check my little one’s blood pressure – one of the main reasons I take them to the doctor in the first place. But I have no choice. There aren’t many doctors taking new patients.
The icing on the cake? Today I get an insurance card for Baby A (only her, I don’t know what happened to the other 7 children’s.) It is for a completely different Medicaid HMO (that I did not select) and some random doctor listed as her PCP- again, someone I didn’t pick. I checked online. This doctor is not going to work. She has a very low rating at HealthGrades (1 star for “would recommend to others). Another ranking site says they have long waits and the office is dirty. She graduated from an Indian medical school 40 years ago. (Does it make me racist to say I prefer my physicians to be trained at modern facilities in America? Or at least somewhere that is not a third world country?)
I suppose it’s true that beggars can’t be choosers. But we already, in general, stay out of the doctor’s office unless someone needs to be seen (we always seem to get sick during well child checkups). I can’t imagine how detrimental waiting for hours in a dirty clinic would be.
I am a medical snob. And I’m okay with that.
I guess we’ll just consider Medicaid as catastrophic insurance for broken legs or something. I’ll have to work something out about Mr. P’s MRI though. I just need a doctor who can receive the results and pass them on to me. Nothing major.
On the other hand, they did approve the MRI. So that’s a plus.
We have paid thousands of dollars into this system- and so have you. It’s shocking to see what a shoddy product we are getting. (That amount taken out of your check, for OASDI – that’s SS and Medicaid. Medicaid is part of the Social Security Act. If you live in a no-income tax state, the remainder/state portion most likely comes from property taxes or sales tax.)
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WOW! Sounds just as bad as Medicaid here in Alabama! I have a child with CP, who cannot do anything for himself w/o help, although he us very bright, it’s just physically his body doesn’t work. Anyway, in our state a child can ONLY be on Medicaid if they receive SSI, which we don’t qualify for, barely, or if they are “institutionally deemed.” That just means he can’t care for himself and if we weren’t here to care for him, he would be in an institution. In order to get it we have to have someone come into our home for unwanted “respite care” a minimum of 2 hrs per week. I feel like we are being spied on and I hate it but we HAVE to have the medicaid because private insurance will not pick carry him, my BIL’s company where my husband works cannot afford to supply health insurance to the employees and if forced to will have to close up and my husband will be out of a job. Luckly we do have a GREAT PCP provider who even makes house calls for my son. She lives next door, goes to our church and is a distant relative of my husband so we lucked out there!
Jennifer | Feb 4, 2010 | Reply
Oh, a good doctor that you trust is worth their weight in GOLD!
It would be so much better if instead of taking $300-400 out of our paycheck each week, we were allowed to use that to buy private insurance.
Milehimama | Feb 4, 2010 | Reply
We have insurance but can’t take the kids to a doctor because we can’t find one who takes children who aren’t vaccinated. And whenever I get pregnant I have to go to another state to actually give birth because VBACs are “banned” here.
Our medical system is so frustrating, I can’t imagine if the government had their hands in it
Becky | Feb 4, 2010 | Reply
Becky, I had the same problem. I actually got letters in the mail from doctors informing us they were dropping us from their practice. And the reason we delay/selectively vax is because of bad reactions! IMO, that’s medical discrimination.
Milehimama | Feb 4, 2010 | Reply
Did you have a primary care doctor or pediatrician before going on Medicaid? When our children were on Medicaid for a few years we just kept our same doctor who (fortunately) accepts that coverage. Aside from hassles with dealing with getting/keeping coverage related to an inept worker, we had few problems with the actual coverage itself since we saw the same doctor we’d gone to for years.
Our kids did lose coverage at one point after we thought things were sorted out with re-certification. We went without for three months until my husband was able to work enough hours to get three months of coverage, after which we paid the full premiums for about six more months before going back on Medicaid. Paying the full shot ate up almost all of our savings, but it was almost worth it not to have to deal with the workers!
Anyway, if you did have a doctor previously, maybe their office could offer some advice for getting your kids the specific care they need?
Jessica | Feb 4, 2010 | Reply
I had an awesome dr that I loved, but she doesn’t accept Medicaid. I may still go to her and just pay cash.
Milehimama | Feb 4, 2010 | Reply
Well, that does sound just like typical government bureaucracy. I cannot, for the life of me, imagine why ANYONE would want more of it.
Birdie | Feb 4, 2010 | Reply
I’ve dealt with the Medicaid/Food Stamps “office” for about two years. Call the state office. They are the ones with the power to get something done *today*. Keep on the phone till you actually get something done.
I’m in the Houston area as well. Have you looked on mothering.com? They have lists of pediatricians that are no-vax friendly. One is at Texas Children’s clinic at Greenbriar and Shephard.
If Baby A is your only one under 1, she’ll be on her own card because she’s got a different type of Medicaid. Other kids 1-6 will be on their own, and then 7-18.
Kristin | Feb 4, 2010 | Reply
I’m not arguing for government health insurance – but I have to say that “back in the day” – standard/regular HMO’s operated in exactly the same way. I fought for two years to get a surgery covered, one that was pre-approved by the HMO and I used the HMO specialist, surgeon and my PCP was in the HMO. Problem? The hospital wasn’t! The hospital both the surgeon and PCP were directly associated with. In the midst of the fiasco, the PCP left his practice and I had to find a new one. No one would accept new patients in that HMO that I would trust. When I finally chose one, just to deal with the mess – forget actually seeing said Dr., I just wanted the surgery paid for and off my credit report – since the new PCP had not given a referral for the specialist, it became yet another reason for payment to be denied. And, the card thing – that caused so many delays because every time I called to try to deal with them, my card was invalid because it had an invalid PCP on it. I had to wait for the new one with the new PCP listed, and that took months. When I got it, there was a typo in my account info and the PCP told the HMO that I was not their patient.
It was, in no uncertain terms, an unmitigated disaster that took lawyers to resolve.
And, this was an HMO through the ex’s employer.
The day they finally chucked that entire health care plan was one of the happiest days of my medical life. Really. HMO’s suck. Period. Government run or not. Of course, the government adds to the mess, but even without their hands in the pot, HMO’s need to be eliminated from existence.
tia | Feb 5, 2010 | Reply
I absolutely agree that HMOs suck. We had Kaiser, and a doc there (you just show up and see whichever doc happens to be around) misdiagnosed Miss V TWICE. She had impetigo, highly contagious, and the treatment he prescribed made it worse. I had to go to the clinic director and threaten a lawsuit (an empty threat, but STILL) to get a referral to a dermatologist. Then the clinic director sent me a letter telling me he was sorry for my care, the doc that misdiagnosed was a TEMP covering summer vacations. How bad of a dr. do you have to be to be a TEMP?
I HATED the referral thing. I had an infection while pregnant with Miss C. My OB/GYN wouldn’t treat it, referred me to the internist. The internist wouldn’t treat it because I was pregnant, referred me to the OB/GYN. Finally, the OB called the internist, consulted, and got the internist to call in a prescription to the in-house pharmacy. Really? For a simple antibiotic? But the OB only did OB stuff and it was a UTI.
Milehimama | Feb 5, 2010 | Reply
You used Mr. P’s real name in the final paragraph here–guessing you’d like to remove that since you usually don’t?
ycw | Feb 5, 2010 | Reply
Oops! Thanks!
Milehimama | Feb 5, 2010 | Reply
I resent the assumption that “temps” are somehow automatically bad doctors. My husband is board certified in 2 specialties and is a military physician right now. We are planning on moving to Maine after retirement because we just love it. Now we knew that he would likely not be able to get a job in medicine there because there aren’t many hospitals/practices in his specialty and has done some locum tenens work to get his foot in the door and will likely have to do this all over the country so we can live on the farm. Some physicians do locum tenens because it pays well enough to only have to work 1/2 the year, it has nothing to do with the quality of their care. The requirements for the firms that place physicians are very strict.
People want to blame doctors, insurance companies, and hospitals for everything that goes wrong, but curiously they don’t want to do without that doctor, insurance, or hospital when they get sick or injured. I’m NOT in favor of Obamacare or Medicare/Medicaid and have worked hard to get it defeated, but I’m a little tired of the indiscriminate trashing of all medical professionals.
kat | Feb 10, 2010 | Reply
Kat, I didn’t know being a temp doctor was a standard career thing! I thought it was for doctors that people didn’t want to hire permanently. I admit to basing this solely on my pesornal experience with Kaiser docs.
I stand corrected, and I should not have painted all temp docs with the same brush. I’m sorry.
I still prefer my doctors to be educated in a first world (is that the right word) country.
Milehimama | Feb 10, 2010 | Reply
Thanks, locum tenens firms have good reason to hire well trained physicians as they cover their liability insurance, they certainly don’t want someone who is incompetent.
I also prefer American trained doctors. The regulation in medical college means that any American trained doctor is pretty darned good, there isn’t a big range between a Harvard trained grad and one from a 2nd tier school. That isn’t the case in other countries. To add to this we are currently undergoing an outsourcing shift in medicine. Radiology is one of the first specialties that sends a great deal of their work to India via email and Pathology is likely to be next. I don’t want my films or smears sent overseas, but to save money the big hospital systems are doing this.
I also agree that the costs to pay out of pocket are now out of control. A standard well baby check now costs over $300. I wish we could pay for health insurance in the same way we do auto insurance- all on an individual basis rather than it being through an employer. Tort reform and being able to buy out of state unsurance would reduce costs significantly. I feel for everyone who is stuck in this mess, but single payer is not the solution and Obamacare which wants to deny treatment for many to save money is certainly not the answer either.
kat | Feb 11, 2010 | Reply
Oh, absolutely I agree. I think a partial answer to the health insurance mess is more competition (i.e., get rid of the out of state ban, as you mentioned). Single payer will just amplify the problems with no incentive to make things better – do we really want to literally have to have an Act of Congress to make our healthcare more efficient?
When we had a PPO, we tried a doctor and he was definitely NOT a good fit. So I chose another doctor, whom we love. She really goes the extra mile for us (unfortunately, she doesn’t take Medicaid, so we can’t go to her now.) If we had single payer – and indeed, on Medicaid – it’s a very long process to change docs. I picked a doc out of their book who won’t see us, and I can’t even pick a new one for 45 days because the paperwork hasn’t been processed so there’s no way to change it! Fortunately, because the paperwork hasn’t been processed, I can go to a THSteps doc and don’t have to see my PCP (yet).
What is your husband’s specialty? The best doc I ever had was military trained, then went into family practice. (He also went to our church, we loved him!)
Milehimama | Feb 11, 2010 | Reply
Tim is currently a pathologist, he was a FP before we married. (he really didn’t like it and wouldn’t want to go back to it)
kat | Feb 14, 2010 | Reply
Oh, but I bet having a FP in the house comes in handy! LOL I think it’s fascinating what makes doctors specialize. I can see becoming a ped, an OB, or an internist, or a surgeon. But what makes people become podiatrists or nephrologists or orthopedists? Just interesting to my nerdy self, I guess.
Milehimama | Feb 14, 2010 | Reply