A Dawning Awareness: #2

Wednesday Morning Bright & Early

I awakened VERY early with all this weighing on me. I called promptly at 7 am when the Medicaid office opened. That means shorter wait times and less stressed customer service reps. 

What a shock. There are only two My Care Ohio plans offered in Montgomery County. Both companies have a poor reputation.

My heart sunk.

Confusion Reigns

I still did not understand the differences in plans.

I asked if my daughter could stay on her current QMB Green plan. Even though it doesn’t have all the benefits of the plan I heard about last evening, all her doctors take it and everything she needs medically is covered.

Customer Service Reps talk faster than my brain works and faster than my hand can take notes. I had to ask her several times to explain things to me and to talk slower.

When I mentioned the difficulty my doctor’s office has with the plans offered, she quoted how many people in Ohio are on Medicaid. She seemed to want me to choose a My Care Ohio plan. I have since learned that these plans save the state money.

Hearing my hesitancy, she suggested I call Medicare because they have dual advantage plans with some good benefits.

My question at this point is, “Why was this not clearly presented as an option in the first place?”

The Next Wednesday Morning Call

I immediately called the Medicare office. Still confused, I asked about Dual Advantage plans, the language used by the Medicaid rep. The Medicare rep rattled off the names of insurance companies with plans.

I stopped her. “The names of these companies mean nothing to me.”

I told her about the sales rep who was going to sign me up on the spot … for what I thought was Company Blue’s My Care Ohio plan which I just learned is only offered in the Cleveland area.   

Confusion Lifts

It was then that she clarified the difference between the

• My Care Ohio plans through Medicaid and
• Medicare Dual Advantage plans offered through Medicare which are designed for people who have both Medicare and Medicaid.

The plan I researched for two hours wasn’t a My Care Ohio plan. It was a Medicare Dual Advantage Plan.

When I explained my reservations about Advantage plans, the Medicare rep told me Medicaid would cover that $7550 out-of-pocket expense. It wasn’t something I needed to worry about.

I breathed a sigh of relief.

She also cautioned me to check with Nicole’s doctors to make sure they take Company Blue’s plan. She said sometimes the companies say doctors are covered when they are not.

Wednesday Morning Calls to Medical Providers

I immediately began calling Nicole’s list of ten medical providers … a frustrating and time-consuming process! Automated answering machines and pushing buttons to get a human being is the bane of patient’s lives. Listening to music while on hold makes multi-tasking almost impossible … more of my time wasted to save providers time and money.

Despite the mounting frustration, I persevered.

Most of them take Company Blue’s plan. I held my breath as I called the pulmonologist’s office. The receptionist said they take Company Blue. When I told her the customer service rep told me Dr. Pulmonologist was not covered, she agreed to double check with the doctor and call me back. She did. He said, “We’ve never had any problems with that company.”

That was good news, but I worried, with companies having so many plans, if the doctor got the message about the specific plan I asked about.

Unfortunately, Nicole’s respiratory equipment provider (Provider A) is not covered. They gave me the names of company’s they do deal with. Provider B’s name had been mentioned by both Provider A and Company Blue, so I started with them.

My anxiety increased.

How the transition from one respiratory provider to another for equipment my daughter cannot do without concerned me. I needed more information.

Confusion Reigns Again

I called my daughter to get names on her equipment labels. At this time, I thought her equipment was called a bi-pap machine.

Equipment Provider B: A distracted employee answered the phone and didn’t want to spend much time talking to me. “There is a shortage of bi-pap machines, we don’t have any, and don’t know when we will get them.” I asked questions. She sounded frustrated and repeated some information twice.  She seemed to want to get off the phone.

My anxiety level rose.

I called Provider A (Nicole’s current provider) in a panic. How could this be resolved. The good news, Provider A who has serviced Nicole for six years has a heart. They will let her use the equipment she has until a transfer to a new company is made.

My anxiety level decreased.

I called Provider C. “We have bi-pap machines today but don’t know if we will have them when your policy goes into effect.”

My stress level rose. I felt like I was on a roller coaster of ups and downs.

Provider C transferred me to a gruff woman. She said my daughter couldn’t be on a pap machine. “If she has been using it for six years, she would own it by now.”

Confused, I gave her the names of Nicole’s machine.

She proclaimed, “That’s not a bi-pap. That’s a ventilator.”

I called Provider A to clarify. The woman who actually services Nicole’s equipment called back and confirmed this information.

Being totally unfamiliar with this type equipment, Nicole and I both thought her equipment was a bi-pap machine. We have no memory of a switch being made to a non-invasive ventilator about 5-6 years ago by her Myotonic Muscular Dystrophy doctor at Ohio State.

It would have been helpful to have actually known that all along.  It sounds much worse than it is. She has no tube in her throat. She wears a mask attached to a rather large piece of equipment at night when she sleeps. 

The good news is, there is no shortage for non-invasive ventilators.

I Do Have a Life

I just ended a call when the doorbell rang. Oh, it’s 10 am … the time my handyman was to arrive to fix a leaky toilet.

I vented to him. He understood because he recently jumped through these same hoops getting coverage for his aging mother.

Bless his heart, this is the second job he’s done for me recently and he didn’t charge me for either one. When I asked him why, he said the jobs were no big deal and he considers helping people a ministry. I teared up. I felt blessed to be ministered to … especially in the midst of all this frustration and confusion.

While he worked, I continued making calls.

Noon with Jarrod

Jarrod was impressed with all the progress I had already made. He was glad I had contacted providers to double check. He would have advised me to do that. He thinks Company Blue’s Plan is a good one. He has clients on similar plans who love them.

Additionally, he explained that we can try out a plan and if it isn’t working for us, we can change it. We are allowed to do that four times a year. He confirmed that Medicaid picks up out-of-pocket costs. And he explained how insurance companies are reimbursed for these services.

For many reasons, both personal and professional, I very much appreciated Jarrod’s help with understanding this complicated system.

I took a break for lunch and a hair appointment. In my next post, I will pick up the journey with my Wednesday afternoon calls.