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.
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.