Tag Archive for doctor

On Managed Care — 3 — Upchuck

If you want to continue seeing any of your doctors at UCSD, you’ll have to switch insurance from Molina to HealthNet.”

Uh… what?” My nurse asked the receptionist at the Doctor’s office.

Unfortunately, UCSD doesn’t take Molina. All you have to do is call Medi-CAL and tell them that you want to switch providers*”

I was at the doctor because I’ve been having reflux issues. Whenever I eat, I can feel the food go from my stomach up to my chest. Normally, this isn’t too much of a problem for people. All you have to do is take an antacid and you’re good to go, but, because I eat through my stomach and my food is completely liquid, this poses a huge health risk. The liquid travels up my stomach, through my chest and into my lungs, giving me breathing problems and really bad chest pains. We had agreed with the doctor that I was going to go on an antacid twice a day. It wasn’t going to solve the problem, but it would hold me over until they can take me into surgery and tie my stomach up. It’s not exactly the most ideal solution, but it’s better than what I’m going through right now.

Thank you for calling Medi-Cal, you’ve reached the department with-the-really-long-name-I-can’t-remember. My name is Daisy, how can I help you?”

Yes, I’d like to switch my provider from Molina to Healthnet.”

Sure no problem, it will take 15-45 days and you will receive a letter in the mail notifying you of this action.” I may or may not have abridged that conversation to cut out the part where we were put on hold for 20 minutes. And the part where she made everything more complicated than it had to be.

In the meantime, I had to get my antacid. At least I had that to hold me over, “Oh… Your insurance is not approving it for twice a day. They are only approving it for once a day.”

Do you know why? ” My nurse asked the pharmacist.

No, I’m afraid not.”

What else can we do?”

You can always pay for it out of pocket.”

And how much is that?”

$265” I could hear her wincing on the phone.

I looked at my nurse and shook my head as fast as I could, “Oh, nevermind then. Thank you.”

I couldn’t get my medicine and my reflux was only getting worse. Eating became a chore instead of something that was fast and easy. We ultimately found some antacid that my brother had and used that, but it wasn’t enough. I could still feel food coming up through my airway as if it wanted to suffocate me. I needed to do something lest I end up back in the hospital. So I did, I brought out an old stand-by: the feeding pump.

The feeding pump feeds me at a set rate for a set amount of time. The problem with it is that it’s extremely sloooooooooooow. Like, a turtle running a marathon. Sure, it’ll eventually get there, but everyone might be dead by the time it does. What used to take me 5 minutes now takes all day. If I want to go anywhere I have to meticulously plan my feeding schedule. How long will I be gone? Will it cut in to my eating time? If so, how do I compensate for it? It’s like a fucking algebra problem just to do anything fun.*

As of right now, we’re waiting for the insurance to switch so that the doctor can run a test to see how bad the reflux is. After that, there’s a very good chance that I’ll go into surgery and have the doctors tie my stomach up. Hopefully HealthNet approves it, but I have a sneaking suspicion that it’ll be a battle. The government keeps trying to say that managed care will save money. They’re right, but not because it’s a good program. It’ll save money by denying needed medical care to those that don’t have the energy or health to argue with them about everything. And what they don’t want you to know… What they will never ever say is that, in the end, it’ll save money because people will die.

*Medi-Cal has contracted out Molina and HealthNet

*I may consider drawing up an equation for it, I do kind of love algebra.