this is why you don’t privatize medicaid, people

on

part of my on-going pregnancy saga has revolved around securing health insurance for the baby. i looked into healthwave, the kansas state medicaid program, back when i was pregnant. i detailed the complications with that whole mess in a previous post, but a brief synopsis: if i was approved for healthwave myself, as a pregnant woman, my baby would automatically be enrolled upon birth. & if healthwave only considered my income, i would be approved, no problem. but they consider the entire household income, & when jared’s income is added to mine, we made like $10 too much per month for me to qualify. however, ramona would still qualify because the income restrictions are higher for children. we just wouldn’t be able to apply for her until after she was born, & then we would have to sit & wait for approval & then call all of her care providers after the fact & give them her insurance details.

i had more or less decided to apply for myself anyway, just to see what happened (the income restrictions are also different for pregnant women–if a pregnant lady is approved under the pregnancy lady provision, her insurance coverage would end two months post-partum), but i needed jared’s financial information in order to do that & because he has this weird fellowship from KU, his financial info isn’t as straightforward as “makes $1500 a month” or whatever. he’s paid bi-monthly when he’s teaching, but only during the school year. during his research year, he is paid once at the start of each semester. but the healthwave application is set up to accept weekly, bi-monthly, or monthly incomes only, because who the hell is paid twice a year? & then he was out of town doing research for seven weeks & obviously i thought we had more time to get all this shit together before she would be born so i didn’t hound him about getting pay stubs to me the second he got home…& then i was put on hospital bed rest & gave birth to a premature infant.

so. that’s how we wound up in the patient advocate office at overland park regional medical center, belatedly applying for healthwave like two weeks after ramona was born. & wouldn’t you just know, when we showed up for our patient advocate appointment & asked the nurses on the floor to direct us to the correct office, & i even provided them with the office number & details about which hallway it was in (we just didn’t know how to get to that hallway because that hospital is a damn labyrinth–i seriously think a minotaur took my blood pressure at one point while i was there), they were like, “i’ve never heard of such a place, & we don’t have any offices back there.” they did, of course. it was just my first little taste of the health care bureaucracy that would go on to haunt me for the rest of my days.

anyway, ramona & i were both approved for healthwave thanks to the helpful ministrations of the patient advocate, brooke, who figured out how to submit jared’s financial details to the application office. we did have to jump through one ridiculous hoop when they wrote to me, requesting “proof of identity” for ramona. “we can accept driver’s licenses, student ID cards…”. i had to explain that she’s not even two months old yet & as such, is not yet a licensed driver. they accepted her kansas state immunization card. which seemed like it would be easy enough to fake–it’s just a piece of cardstock with her name scrawled on it in ballpoint pen. but whatever. moving on.

once i had our cards, i had to call around to all of our care providers to give them our new info. that meant my ob-gyn, her pediatrician, her pediatric dentist, the anesthesia people who did my c-section, the radiology people who did all the chest x-rays on me while i was on bed rest, the pathologists that examined our labwork, the ambulance company that transported me to overland park, the surgeons that did my c-section, the hospital that transferred me & the hospital i was transferred to, etc etc etc.

& to top the whole mess off, the state of kansas privatized medicaid as of january 1, so although we applied for healthwave, we were approved for kancare, & we were funneled into a managed care provider called sunflower state insurance. WHO THE HELL thought it was a good idea to privatize medicaid?! i can choose between three different plans, but obviously no one plan covers all the nine gazillion providers ramona & i have seen in the last two months. unlike with medicaid, which covered everything. & half the providers don’t know what the fuck i’m talking about when i say “kancare”. i’ve lost count of the number of medical billing specialists that have said to me, “kancare? what’s that? it replaced healthwave? when did that happen?” nice work, kancare transition team. way to conduct outreach.

the kancare website is also practically unnavigable. i tried to use it to look up which providers are covered under our assigned plan, but the search feature is really tricky & confusing. if you say you live in douglas county (where lawrence is), it will only search for providers in douglas county, but ramona was born in johnson county (where kansas city, kansas is) & some of the providers that were involved in her birth/care are based in other counties, or in missouri (because kansas city spans both states). 

so. this has been really fun. it’s a good thing i don’t have phone anxiety or else this would be a complete disaster. one provider i called was all, “let me put you on hold & make sure your coverage is active.” then she came back & was like, “no, your coverage is inactive. you better call your case worker.” i was like, “i…don’t have a case worker.” she just kept repeating, “you need to call your case worker & see why your coverage is inactive.” so i called kancare & they were like, “um, no, you’re totally active.” so i called the provider back & was like, “what’s up, dawg, my shit is active,” & she was like, “oh, i just had never heard of kancare before.” so what database was she supposedly looking me up in? obviously i don’t have a ton of faith that she is going to follow through on submitting my insurance claim.

even more fun, though, was when i called this hotline that purports to specialize in matching women up with breast pumps covered by their insurance under obamacare. because i’m exclusively pumping (i swear i’ll write a post about that one day), i could maybe use a breast pump of my own rather than renting a hospital pump for the next year or whatever. so i called & was on hold for twenty minutes, which is especially fun when you have a screaming baby to contend with. someone finally picked up & was like, “medicare, you say? yes, you can get the medela personal advanced, which comes with a bag.” i was like, “is that an electric pump?” & she was all, “…i don’t know.” i was like, “tell me the name again? i can just look it up online & see.” she repeated, “medela personal advanced,” which is not a thing. i was like, “okay, the medela pump in style advanced? or the freestyle?” & she was like, “…i don’t know.” why are you answering phones at a breast pump hotline if you don’t know this shit? i was reminded of that episode of “the simpsons” where homer tries to impersonate mr. burns at the post office:

so i was like, “okay, so how does this work? what exactly will medicare cover?” & she was like, “…i don’t know.” what the hell, woman? she elaborated, “i’m actually just the answering service, but i could have someone who knows the answers to your questions call you back.” SOUNDS GREAT, why couldn’t we have done this fifteen minutes ago? so she’s all, “what’s your name?” & i say, “ciara,” & she says, “S-I-E-R-R-A?” & i’m wondering why the fuck it matters how to spell my name just to leave a message for someone to call me back. then she wants my last name. & my phone number (of course). &…my zip code? & my e-mail address? finally i was like, “why is all of this necessary just to have someone return my call?” i mean, what’s next? a fax of a retina scan? just get someone halfways competent to call me! it’s not that hard!

& then, of course, we have the exciting matter of wondering exactly how much of ramona’s hospital bill her insurance will cover. because i finally got an estimate from the hospital & we’re talking nearly $250,000! yes, just shy of a QUARTER OF A MILLION DOLLARS, before insurance. can you handle the heat, kancare? supposedly you are designed to help low-income kansas families, right? hook us up & cover that bill, because even if jared’s student insurance comes through & covers the 80% it claims to cover, we’re still looking at a hospital bill of nearly $50,000. i have maybe 10% of that amount, & that is literally all the money i have in the world, with no assets to liquidate or safety net in the form of family or wealthy friends to borrow from. thankfully, all of ramona’s care was performed before the kancare switchover, so i’m hoping regular old healthwave will be in effect & we’ll be good to go. because, as far as i can tell, kancare is just a way to funnel low-income kansas residents into crappy managed care programs with limited coverage & fool them into thinking they’re getting something good because of the lame “extras” the insurance companies provide. sunflower health, for example, has a special program to get kids involved with the boys & girls club or girl/boy scouts. you know, those awesome children’s programs that are FREE & READILY ACCESSIBLE ANYWAY. i don’t need my health insurance provider telling me when the next brownie meeting is, what the fuck.

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