I keep meaning to tell you this story, and what better time than during a government shutdown? Er, slowdown. Or whatever we’re supposed to call it. It just seemed like a good time to reaffirm what every American already knows, which is that our medical system and government are—SURPRISE!—not actually operating as smoothly as they’re supposed to.
Try to contain your shock.
So! Perhaps you remember that about a year ago, I took to the blog to detail how we’d finally gotten Chickadee qualified for Medicaid coverage while she was hospitalized. That was a really big deal, both because the process is crazymaking and because if she hadn’t, we would’ve been on the hook for medical bills we had no reasonable way to pay. At the time, I thought getting the Medicaid approval would be the end of our financial issues related to her illness.
Haaaaaaaaaaahahahahahahaha! Yeah. Pull up a chair!
Medicaid approval, it turns out, is often slow, and to mitigate that pain a little, it’s usually approved with a retroactive date back to the first of the month when you applied. That’s excellent news; in our case, she was approved back to August 1st of 2012, and we were notified of such mid-September that same year. (It’s worth noting that this is positively speedy by Medicaid standards, too.)
We notified the hospital, and they explained that in order to submit for her expenses to be billed to Medicaid, there’s some sort of pre-certification thing that has to be done, and they would order it, but it could take up to a month for the pre-cert to happen. We said that was fine (what else could we say?).
Meanwhile… Chickie was discharged the first week of October. (This Friday actually marks one year since she left the hospital. WOOP WOOP!) She was discharged BEFORE the pre-cert took place. And then someone in billing at the hospital tried to tell me that part of pre-certification involves an independent evaluation of the patient, and without her there, it couldn’t be completed, and therefore the pre-cert couldn’t be obtained.
Think about that for a minute.
I countered that Medicaid ALMOST ALWAYS takes forever to process, and is then enacted retroactive to application date, and that I was no expert or anything, but I was PRETTY SURE that they could find a way to get the pre-cert and do the billing even without her there. I was told they would “look into it” and get back to me.
For weeks we heard nothing. I finally called the hospital to see what was going on, and was told that they’d gotten the pre-cert, but Medicaid had rejected the claim. I’d been warned that Medicaid often rejects claims the first time, so I stayed calm, and asked if they’d appealed the rejection. Yes, they had. It had been rejected a second time. We would simply have to pay. I asked for all relevant case information so that we could mount an independent appeal—I was ready to hire a lawyer, if necessary, because that would still be cheaper than being stuck with the bills that were supposed to be covered—and they said no, no, that’s okay, we’ll handle it, we can appeal one more time, let us see what we can do.
I’m not going to lie; I was worried. It seemed like a bad dream. All that time and effort to get her approved, and now they weren’t going to pay? This was crazy.
While all of this was happening (this next part is going to seem unrelated but stick with me), Chickie had gone back up north to stay with her dad, and he was looking into applying for the kind of Medicaid you can get for a disabled, non-hospitalized kid in his home state. In order to do that, his state needed an official letter from our state that said when her coverage here had been discontinued. (Remember, she qualified here as a “household of 1” while hospitalized. As soon as she was discharged, she was no longer eligible.) When I jumped through the necessary hoops to get that letter, it turned out that EVEN THOUGH her Medicaid had already been discontinued, somehow she was due an SSI check for October because she wasn’t hospitalized for the entire month. That seemed… well, stupid, frankly. Our income means she shouldn’t get any SSI funds, but somehow it was determined she was due a check. A check for $384.67 came, and we opened it, laughed, and I put it in my filing cabinet. I wasn’t going to cash it, because I think it was issued on a technicality and I don’t really want to steal from the government, even if they are just handing out money.
Time passed, and I waffled about contacting the hospital. Maybe no news was good news? I would call after the holidays to see what was happening. Yes, that was a reasonable plan.
The holidays came and went and time passed and stuff happened and then Chickadee moved back home. (YAYYYYY!) Finally I got around to calling the hospital, only to discover that the billing person we’d been dealing with all this time was no longer there. Huh. The person I spoke to, instead, said she would look into our account and get back to me.
So I went back to waiting.
And then… the bills started to arrive.
One of the bills was for four days in October. TECHNICALLY, it seems to me that those days in October should’ve been covered, but there’s some rule that if you get the kind of Medicaid attached to SSI and you don’t get an SSI check for more than two months, your Medicaid is discontinued. (It’s unclear to me if this can be changed or stopped, but I knew from my other phone calls that this was what had happened.) The SSI checks hadn’t been issued because she was in the hospital (and we never wanted SSI, anyway, we just wanted the Medicaid). Well, I wasn’t going to quibble over four days, anyway. We could pay for four days.
The other bill was for August and September. That bill made me weak in the knees and a little dizzy. That bill had five digits and a faint aroma of total financial ruin.
I called the hospital. I’ll spare you the play-by-play of the next twenty-seven or so phone calls, but basically I found out that the billing person we’d dealt with before had been fired. I found out that their billing department was in utter shambles. And—perhaps best of all—I found out that Chickadee’s bills had NEVER been submitted to Medicaid. They’d never even done the pre-cert. They’d never even REQUESTED the pre-cert. Also, sorry, I lied. THIS was the best of all: according to their records we had never paid them a single penny, ever. They had no record of the hefty deposit we were required to give them before admittance. No record of the next three payments, either, not even the one where I’d been forced to turn over my child’s life savings so that she’d be eligible for the Medicaid coverage which was apparently useless.
It had all been lies, this running update of how they’d submitted this and that and gotten turned down and appealed and everything else. Made up. All of it. And did I have any proof of all of this prior correspondence? Of course I did not, because it had all been done by phone, and how on earth was I supposed to know that the former employee of the hospital was just stringing me along…? (But yeah, we had proof of the payments we’d made, at least.)
My best guess (no one sue me; I haven’t named the hospital or the person in question and I AM JUST GUESSING) is that this particular person was… shall we say… involved in a great many transgressions, and our account was but the tip of a very disorganized and possibly illegal/embezzling iceberg. SO THAT WAS AWESOME.
Thus began the loooong process of untangling what we’d paid, what Medicaid should’ve covered, and how the hospital was going to handle that. To their credit, once I actually reached the CFO (because yeah, TIME TO GET THE BOSS INVOLVED, FOLKS), they agreed to simply drop any charges that should’ve been covered by Medicaid, given that it was their screw-up that meant they hadn’t gotten that money. We still had to “prove” what we’d already paid, though, and I ended up basically agreeing to pay the October bill on the condition that everything else was (properly) zeroed out. Arrangements were made. I was promised a final bill reflecting no further charges and the account being closed, once that payment was made.
While THAT was happening (because that wasn’t enough fun…), I received a very official-looking envelope from Social Security. It turns out that if you receive any sort of SSI payment, you have to fill out something called a Payee Report. Because Chickadee is a minor and I am in charge of her money, I was required to fill out this form on her behalf to let the government know how we spent the check they’d sent. EXCEPT. I never cashed the check. And of course there’s no way to explain that on the form. Basically your two options are “I spent this money on the child for whom the check was issued” and “I did not spend this money on the child for whom this check was issued” and then you have to sign one of those UNDER PENALTY OF PERJURY BLAH BLAH I TOLD THE TRUTH things, too. So I said I didn’t spend it on her, because I didn’t. BECAUSE I DIDN’T CASH THE CHECK. And then in the tiiiiiny comments area, I noted that the check hadn’t been cashed. And then I returned the form.
And then I made the final payment to the hospital. ALL FINANCIAL CLUSTERFUCKS UNCLUSTERED AND RESOLVED.
Except no.
The next week, I received ANOTHER official-looking envelope from Social Security. This one told me that there was a problem with my Payee Report and I was to call this person at their office immediately. Because of course.
I played phone tag with this guy for a few days and then caused his brain to explode, because apparently I am the first person in the history of America to receive government money and refuse to accept it. (I didn’t point out that this is the second time I’ve tried to give back government money. Maybe I should’ve?) He finally understood what I was trying to explain, and then told me (with great exasperation) that we couldn’t just not cash the check; we had to mail it back. Fine, I said. Tell me where to mail it. Send it to me, he said. Include a note about closing out the Payee Report, too, and I’ll get it resolved. Good, I said! Thank you!
I sent back the check. Now I was done! It was all over!
That was two weeks ago.
This weekend, Social Security sent us another check for $384.67. And I still haven’t gotten confirmation from the hospital that they’ve closed out our account.
I’m not sure I have a moral to close out this tale, yet, but I think it MIGHT be that hospitals are evil and the government is dumb and I really, really need a nap.
I am so impressed that your brain hasn’t liquefied and slowly dribbled out of your ear holes by now. Really, very impressed, you must have a lot of mental fortitude built up.
Holy $&*#.
Stupid gov’t.
Stupid hospital.
Stupid embezzler.
I’m sorry.
An entire floor of university peoples is wondering why I just bust out laughing when I read your next-to last sentence. Because, YES. THAT. My father passed away almost 4 years ago. As his heirs, we just got a Social Security check this summer, out of the blue, for…not sure what.
WHO RUNS THESE THINGS????
What day of the month did your father pass away on? (Ignore grammar.) Our Mom passed on the 1st of the month. Because she was alive for the entire previous month, and her paying-after-the-fact check would have hit the bank on the 3rd, the bank – small town, of course they knew Mom had passed, was not allowed to accept the money. But yet she/her heirs were entitled to that money. Except that – Mom was on assistance by the time she passed, so we needed to get the money to the state. Which we were happy to do, we remain so grateful that the assistance was available for her. At any rate, one of my siblings is a citizen of a different country. She had not used her SS# for many decades! But she had to find it, the gov’t issued the check in equal parts to all heirs, and then we turned it over to the state. Major hassle over peanuts! IRL Mom could be, shall we say, a bit difficult. Seemed fitting that she would pass on one of two possible days that could cause the most ongoing hand wringing. I know you weren’t asking a real question, but depending on what day of the month your father died, and what day of the month his check should have been issued, this might be a bit of the explanation. If these facts are not relevant in his case, I got nothing. Kinda’ like the outfit “running” things.
hoooo leeee shit
I’m so sorry dude. I’ve only had to put up with a fraction of these sorts of phone calls and I know how soul sucking they are.
I will admit it: I did not see NOW WITH BONUS EMBEZZLEMENT coming. *slow clap*
Best. Comment. Ever.
We had the same sort of thing when my husband went on Paternal leave after our daughter was born (I didn’t qualify for maternity leave as I hadn’t worked, so he took some time off to… play video games… for 6 weeks and returned to work).
He squared it up with EI before baby arrived; last day worked, first day going back to work… he started getting cheques (yay!), he got his last cheque which also included an extra week (one week he was at home, the second week of the period he had gone back to work, as previously planned). We did cash that cheque, and I started calling to find out about paying back the second week. Then he received another cheque. I went IN to return it, and to pay back the second week of the oops cheque. They were AMAZED and CONFUSED. Why aren’t you cashing this cheque?! (We TOLD YOU WHEN HE WAS GOING BACK TO WORK HE NO LONGER QUALIFIES) They can’t accept ‘payments’ (WUT?!)
Then we get one of those official-looking letters in the mail claiming we were fraudulent in accepting government money and they were going to seize our blahdey blahs until they got their money back blah blah.
Oh for goodness sakes. Needless to say he didn’t take off ANY time from work after baby #2.
Oh. My. Gosh. Managing insurance payments and billing is a large portion of my job. Yes, sometimes we’re months behind because insurance companies are stupid and full of automations that make it impossible to get anything done correctly the first, second, or even third time. But…to not submit things? To flat out not record payment? I am so furious on your behalf. I think dumbfounding may be the correct word to describe this debacle. Major props to you for not having literally exploded at this point.
Good grief. That is appalling. Come and live in the UK… Our NHS might be slowly being dismantled by the conservatives but it’s still better than that!
nobody wants their money back it messes up their books. once my paycheck was bigger than it should have been and i assumed it was a payment for the other bonuela at my company. nobody would believe me. “we only key in what we are given. are you SURE you didn’t earn any over time?”, um, nope, there aren’t that many hours in one week, even if i worked every one of them. it was months before they finally believed me and asked me to send them a check. i wanted it done through payroll deductions so i didn’t have to worry about taxes or someone pocketing the check. their response to that? “is that because you already spent the money and don’t want to pay it back?” YES, you got me, i spent 3 months trying to do the right thing only to be accused of stealing.
Lord. Talk about adding insult to injury!
It’s confirmed: Money makes people stupid.
I just have to feel badly for those who don’t have the time and (yes) mental resources to deal with all this. I know that many people are effectively cheated because they don’t understand the crazy talk and they just pay.
O. M. G. I think *my* head just exploded. Lots of NO happening here. What a cluster.
“This weekend, Social Security sent us another check for $384.67.”
OK, this doesn’t help, but that’s actually funny, in a dark Kafkaesque kind of way. Of course, you’re going to send that check back, right? And then you’ll get another one and filling out the Payee report, calling back, sending back the check will just be a new recurrent loop you will be in until Chickadee turns 18, and then, it will be a permanent responsibility of Chickadee.
Our travails with payment are much simpler, but are now dealing with a recurrent bill for an ambulance trip that we have already paid.
” I know that many people are effectively cheated because they don’t understand the crazy talk and they just pay.”
That’s us, though it’s more that we don’t want to spend the time on the crazy talk. Fortunately we can afford to “just pay.” I too worry a lot about the people who don’t have the mental resources to deal with this chaos. And honestly, who does, when they are also dealing with difficult medical issues?
This is the point where you send certified letters to EVERYONE and demand written confirmation of resolutions.
Well you don’t have to worry for a while because the toddlers have had a tantrum and shut down the government.
I can, unfortunately, sympathize with every word of that unbelievable tale. It’s complicated, of course, by changing states, and the mix of state and federal funding sources in your case. We finally hired a lawyer – it cost $5000, but he got everything straightened out, I don’t know how. (Maybe there was bribery involved?) And, by the way, I never liked the “smell” of that institution your daughter went to.
This whole things makes my mind hurt… holy heck!
I was once paid for 6 weeks of work at a job that I quit, even though I called them each time I saw a new deposit into my account to say, “Hey, I quit weeks ago and I keep calling to tell you and have emailed you, as well.” It was all direct deposit and laughably, the company filed for bankruptcy shortly afterwards… wonder why…
Wow. I have a headache just reading this! Feeling very lucky tht Australia’s healthcare system is (whilst flawed, of course) free, unless you choose otherwise. Best of luck with unravelling the rest of this…it reminds me of a ball of Christmas tree lights! Will have fingers crossed for you.
My head is spinning! What a nightmare!!
So you win. And for that you awarded a lovely bottle of wine, a truckload of aspirin, and my condolences.
Sweet.
Fancy.
Moses.
I can’t even… I don’t… GAH! I need to send you wine and chocolate.
Whoa. So did not see that one (those ones!) coming. What really infuriates me about this whole cluster-you-know-what is that, of course, it happens to a family with enough stress already. Which, in my experience in Canada, is pretty much how it works – make those already struggling battle hard to get what they are due.
Best Social Security cheque I ever received was for a total of 0.00 euro. When I called them to ask if this was a mistake, I was told no, it is not a mistake, we owe you 0.00 euro. Instant liquefied brain.
I would have been reduced to a gibbering, foaming-at-the-mouth, incoherent loon loooong ago, you are a far stronger woman than me!
You have just described what it’s like to navigate the military health care system. Minus the embezzlement (as far as I know), but all head exploding the same.
Yes! It’s why I pay the premiums through my job for the kids and I to be covered under my health insurance, and use Tricare as a secondary. Doctors that change every time you go in and then want to start again, and endless red tape to get anything done. My employers plan isn’t the easiest to deal with sometimes, but the military system makes it seem like a breeze in comparison.
I say deposit the check into Chickadees savings account. You spent it on the kid, replenishing what she lost because the government is stupid.
Basically what you need as an American living in America is a certified, on-the-up, accountant as part of your life. No one should be allowed to marry anyone without the accountant being part of the ceremony. For the common-law types, an accountant-type has to be made some sort of beneficiary of all financial related papers that enter the house or the common-law relationship is null and void.
What a mess.
I wonder if there’s an app out there that records any and every communication ever made with anything to do with healthcare and stores it in one of those nice clouds up there…
:)
oh my word.
My dad applied back in March for my mom…she died in June..he notified them…they sent him a letter in OCTOBER to say she was approved and explaining the benefits.
um. Let’s just say my dad is getting really tired of repeatedly saying SHE DIED ALREADY.
Also got a weird bill from the institution that housed her for 3 months…four months after her death…after he had gone in and settled up with them and paid every bit of her care out of his own pocket. It almost feels like they are scouring for one more cent they can get from him. blugh.
Good luck, Mir. And, as you have figured out, logic does NOT work, so in a world where 2+2=blue just keep trying to figure out the next step.
Wow – I didn’t see the embezzlement coming and you are a much better person than I am to send the money back. I think I am a good person but the hassle factor of blowing the government’s mind by trying to not take the money is beyond what I could take.
That is amazing.
This is the kind of post I want to show people who talk about moochers and people who game the system (which is really a false argument -in that those people don’t really exist, particularly in any real measurable way -but that’s another story altogether): It shows that the system? Is ridiculously hard to understand, completely and utterly more complicated than it needs to be, and so frustrating that you’d basically do anything to get out of it. People who use ‘the system’ are people who NEED the system, because nobody else is going to go through ALL OF THIS to wind up with less than $400 for their monthly earnings. And as soon as you think you’ve got it figured out? They change something.
Which is to say, as a person in the midst of the system, I completely sympathize: Right now I’m getting the runaround re: a new a wheelchair, a medicine I’ve been on for 4 years, and a specialist who just decided he doesn’t take state insurance anymore (but didn’t tell me that before he treated me). So, sympathetic ugh, and head in hands, and somebody pass me some chocolate, please.
Even without the government the healthcare system is a shambles. Many moons ago I had private insurance that required a phone call, in advance, to be pre-authorized to go to an emergency room. Great logic there.
My current private insurance is just as messed up. The last time I went to an urgent care facility I wanted to pay right then and there. I knew I was nowhere near meeting my very high deductible and just wanted to give them their money.
Hoho! They couldn’t look up any fees anywhere! No, they had to submit the charges to the insurance company, which (of course) denied coverage. Twice.
Over a year later I am still waiting for an actual bill from the urgent care place. Maybe my daughter will inherit it one day.
YES! That’s why I got my boys and I out of the Military Treatment Facility. By using their HMO type plan, which costs us less out of pocket, but we need referrals out the wazoo, I had to call FIRST, and THEN take my kid to urgent care if he broke something or scratched a cornea. OR, we were free to sit for hours and catch who knows what in the ER and rack up and even higher bill. You know, because THAT saves the government money.
Just imagine contracting with the government to provide Medicaid. Let me give you a hint-240 page contract. Just for one program.
That? That used to be my job. Helping people navigate that insane, infuriating maze. To top it off, the people I was helping were themselves actually mentally ill and sometimes psychotic. Imagine those conversations x 10.
I certainly hope you cashed the check this time.
Getting my dad on Medicaid was similar fun, but with no embezzling thank goodness! I say, cash the check, spend it on Chickie (anything else is illegal, btw) and give an EQUAL amount of your own money to charity. Money spent, government happy, karma clean.