A Dawning Awareness Emerges

This is a very long saga. Friends suggested I write it all out because it could be helpful to others. And so, I’m going to post in sections.  

Monday afternoon, October 3 — The Journey Begins

My journey to awareness began on this date in late afternoon when I collected my mail. A letter from Medicaid informed me that my daughter would be enrolled in a My Care Ohio plan on November 1 unless they hear from us by October 30. Apparently, I was supposed to have received a prior communication about this a month before. I did not.

The insurance company (Nickname = My Care Company Red) Medicaid assigned to Nicole was familiar to me. She had been insured by them in the past and it wasn’t a good experience. How would this revamping complicate our lives?

Our experience with Ohio’s Medicaid system has gone relatively smoothly in the past two years. I wasn’t looking forward to the change. All of Nicole’s doctors accept her current plan (Nickname = QMB Plan Green) and there have been no out-of-pocket expenses even during surgery and radiation for breast cancer.

I needed more information. And so, I called. You know what that means. Automated answering machines and punching buttons. Late afternoon calls involve long wait times with unwelcome music playing in my ears (my phone is connected to my hearing aids) before reaching an actual human being.

In addition, the people who work for Medicaid are tired. And so was I. After receiving cursory information, I downloaded the five My Care Ohio plans off the Medicaid website.

Tuesday, October 4

Tuesday was a busy day. Nicole had a mammogram in the morning. While I waited, I hoped to call the companies to see if her doctors are covered. There were no phone numbers on the downloaded plans … something I hadn’t noticed. Wasted time. I hadn’t even brought a book to read.

We had hoped to get a shingles shot for Nicole afterwards, but that didn’t work out. So we had lunch before shopping at Meijer’s for items she needed.

Then we made our way to our Cardiologist office for our 1:20 appointments.

I asked our Cardiologist’s Billing person about the plan Nicole was scheduled to be enrolled in. She didn’t recommend Company Red. “Difficulty getting authorization” was a red flag for me. She gave me a recommendation for Company Blue, saying she has success with them.

After dropping Nicole off at her assisted living facility, I came home and called Company Blue. One very helpful customer service representative went through their list of providers checking to see if Nicole’s doctors are included.

All but her pulmonologists and respiratory provider were included. She gave me the names of other covered providers in our area.  

She connected me with a sales person who went over the benefits. They sounded really good. She would have vision and dental and a generous stipend for prescriptions and other over-the-counter items. These are benefits she lost when moving into assisted living.

In the process of the conversation, I realized the Company Blue representative was talking about a Medicare Advantage Plan.

I’m suspicious of these plans because I got burned by a Medicare Advantage Plan after I retired. I was in good health when the persuasive representative talked me into signing up for it. Then I got lymphoma. I had a LOT of out-of-pocket expenses. And so, I questioned the Company Blue sales person about that.

She said the plan “only has $7550 a year out-of-pocket.” She attempted to downplay the amount … “It would only be needed in a catastrophe.”

I explained that my daughter has a chronic disease and had breast cancer recently. And she has only $50 a month for prescriptions and over-the-counter needs (OTC meds, distilled water, snacks, Kleenex, and anything else).

That $7550 might as well be a million dollars to her.

I asked how the company would deal with that. She couldn’t answer my question and kept emphasizing it would only be needed in a catastrophe, pressuring me to sign up now.

I told her my experience working in a hospital setting when managed care came in. I saw how benefits were denied. Images of my daughter being in a healthcare crisis and being denied benefits marched through my mind.

My anxiety level rose.

After two hours on the phone, I told her I wasn’t ready. In addition to the out-of-pocket costs, I was concerned about those providers not covered.

We ended the conversation with her extending compassion. “Good luck. It sounds like you are dealing with a lot.”

In a text exchange with friends, I told them I was stressed to the max dealing with Medicaid while receiving what felt to me like harassing calls from my internet provider about overcharges I am refusing to pay. One of those friends has a grandson in the insurance business. She wondered if he could help.

I did want to talk with someone I could trust. Jarrod agreed and we set a time to talk at noon on Wednesday. I forwarded him the documents emailed to me by Company Blue’s salesperson.

I will continue my journey in the next post. It takes two more days before the dawning and gifts arrive.