2. American Health "Care" Strikes Again

The Squeaky Hamster-Wheel of Doom gets me nowhere

CONTINUED FROM:

February 7 - WTF WEDNESDAY

I get my latest TMJ splint adjustment and look forward to the immediate uptick in sleep seizures that always ensues. This is one of the biggest things we’ll be trying to catch on the EEG. I’ve already captured it on my own video. It shocked me how many times it happens but doesn’t actually wake me up from my teeth slamming together or from biting my tongue, so I am super interested in what this continuous 5-day EEG will tell us about this aggravating—sometimes agonizing—and damaging phenomenon.

On the way home, we stop at the post office to do certified return-receipts to Social Security Admin for the 2-inch thick waiver request packet and the payment stub that says, “I’m paying you $0.00 of $5000- see the Waiver request.”

Once home, I realize that I’ve lost my prescription reading glasses at the post office because…

Dain Bramage on too many G-Men and Medical Fiascos.

I finally blow gaskets.

I then perform rapid corpse impression.

😵‍💫🥴☠️

2:50 p.m.

I’m finally cognizant enough to realize that Pre-Cert never called me back. So I call her and ask her exactly what she needs me to do. She explains that I need to call Central Scheduling and tell them exactly where I’ll be doing the procedure, because the Pre-Cert system can’t find me, so she can’t give me any information.

I call Central Scheduling and give her my ID info, then tell her who has sent me to her and why. Naturally, it’s somebody totally different from the sweet gal I had the day before. This one is not so sweet. “Uh…we don’t schedule EEGs.”

Yes. I know. I reiterate in more details what Pre-Cert told me that I need from her. She’s still baffled, so I reiterate the whooooooooole hoop-jumping monkey dance. Again.

Central Scheduling: Hold please.

She comes back after trying to get me the number of who can tell me how much this EEG would cost out of pocket.

Me: Wait—

🎶 On hold music… 🎶

Grrrrrr…

When she comes back, I inform her that I really don’t need to know how much it’ll cost out of pocket, because at this point a $20 copay would be beyond my budget. What I really need to know is if Medicaid will pay for this procedure or not—BEFORE I go have it in five days.

She has to send a bunch of emails. Then she has to call me back.

*Le-heeeeeave of sigh*

👍🤪👍

As I wait, I try to get on the portal to see if my neurologist has at least replied.

Naturally, the portal is down.

Of course it is.

So all I can do is wait for my callback. Again.

🦗🦗🦗

Business hours end. I feed the Beastie. I try to read some of my library book that I’ve gotten for the EEG. My brain can’t function enough for reading. I try to chill with some ‘Flix. Even that is too much sensory overstimulation.

Joy.

Silence & Solitude Mode: ENGAGE.

Besides, I figure the portal being down is probably the Fates saving me from a few more bulging brain vessels and more short-circuiting neurons, so I tap out for the rest of the night in the hopes of retrieving some more Spoons.

February 8 - THUCKALICIOUS THURSDAY

In the morning, I see that the cackling old biddies of Fate have thrown me a bone.

From: Hospital Patient Relations Email

Hello. Thank you for contacting Hospital Patient Relations. I sent your concerns to leadership, and the team will be working with EEG to make sure the correct expectations are set with you regarding insurance. They are currently working on the pre-authorization and will contact you with updates when they are available. If you still need help, please let me know. Thank you.

From: Me

Thank you so much, and for such a fast reply!

My neurologist’s office also replied on the portal while it was down. My procedural questions are totally misunderstood, so I have to reiterate it all and ask in a different way. I also ask about when I can tell my dad to drive up from out of state and pick me up to take me home.

Everything about my inability to find out if Medicaid will pay for this is ignored.

From: Neuro Portal

I don’t have an answer for you on when you will be able to check out, as Doc ordered your test for a full 5 days for 120 hour of testing.

From: Me

Ah! Perfect. So if my check in is Monday at 8 a.m. 120 hours puts me at Saturday morning checkout at the latest. That’s what I needed to know. Thank you so much! Am I still waiting from Doc to get the yay or nay on if I will be allowed to do my PT exercises during the test?

🦗🦗🦗

As of drafting this post, these things still have never been answered. I figure screw it. I will do my PT carefully without jostling or sweating, and if the techs don’t like me doing it, they can tell me themselves and I won’t do it anymore.

From: Patient Relations Portal
To: Me
9:42 a.m.

I had a message from our patient relations team that you were having difficulties getting more information on where our auth team were at with getting your EEG authorized for 2/12. They have ran your insurance and your insurance dows not require authorization. for this service. You are good to go to proceed with your EEG on Monday. Let me know if you have any questions. Thank you.

From: Me
10:30 a.m.

Thank you thank you thank you! So they’ll pay for the whole thing?

From: Patient Relations Portal
10:38 a.m.

Prior authorization is not a guarantee of payment.

From: Me
12:57 p.m.

Oh. How do I get that guarantee? Because I can’t even pay my electric bill right now so if they don’t cover it, I have ZERO means to pay a dime.

From: Patient Relations Portal
1:25 p.m.

That would need to be a conversation between you and your insurance company.

Sidenote in Hindsight:
Uhhhh…FALSE.
MEDICAID COULDN’T HELP ME WITH THIS AT ALL BECAUSE I HADN’T HAD THE PROCEDURE YET.

This should have been the moment to tell me that I need to ask the hospital’s Insurance Verification Department to send written notification that this procedure is usually covered in full by my insurance, and my “estimated cost for this procedure.” It also should have been the time to recommend that I apply for Hospital Financial Aid if I happen to be one of those people who gets payment denied from Medicaid.

But they didn’t.

From: Stress Monkey
2:03 p.m.

I have talked to Medicaid. They said I need to talk to Hospital people. Everybody keeps pushing me off on everobyd else and I just need to know who can actually give me this answer. I’ve been back and forth with them and you guys for 2 weeks.

From: Patient Relations Portal
2:17 p.m.

Unfortunately outside of the prior authorization process, Hospital has no control over what your insurance company will or will not pay. Insurance companies tell us the same thing that getting a prior authorization does not guarantee payment from them. I would direct you back to your insurance.

SPOONS: FAILING
BREATHING EXERCISES: ENGAGE
WOO-SAAAAAAAAAH…

From: Me
2:58 p.m.

Sounds good. Pant pant pant. Thanks.

3:00 p.m.

Called Medicaid for these questions. Also asked why I still haven’t received my welcome packet from my new insurance company, now that my reapplication with DHS has gone through. I learn that, actually, I’ve been on this new plan since October when SSI booted me for that math loophole.

Blink…blink…?

Huh.

That was nice of anyone to inform me. Nice of anyone to send me the welcome packet explaining how this plan works, too.

BONUS: since I have been on this plan through the whole CT scan, MRI, 2 hour EEG, mammogram, chest X-ray, all the optometrist visits, PCP visits, blood work and the whole shebang, and since the billing team agrees that my annual exam should have been covered, it just didn’t get billed correctly, maybe there is hope that this new insurance company will also pay for the 5 day EEG. Wahooo!

But after 23 years of this dance, I have learned to ASSume nothing and get everything in writing or on a live recording.

To: Patient Relations Portal
From: Me
3:16 p.m.

All righty. Per Medicaid: someone on the provider end (my neurologist keeps saying they have nothing to do with EEG except order it and see me at check in, then read results) needs to call the “Medicaid Provider Line” and ask if this is going to be paid in full. Because they can’t give me that info. They can’t even give me the number.

So. I don’t know who can/needs to be the person doing it. But I’ve been at this for 2 weeks actively for HOURS getting the run-around all this week. On 6 brain traumas. I only have about 24 hours and 45 minutes left to have this done. I hope somebody there can please help me and speed this up faster than I can do as the patient. Thanks!

🦗🦗🦗

My working memory completely collapses. Every time I go into a different room or switch tasks, I have 1-2 seconds before I forget what I was doing and have to backtrack. Sometimes I forget in the middle of it. This is why we write everything down the second it happens. Including all symptoms.

Uptick in sleep seizures, dizzy spells, meltdowns, tinnitus, headaches, confusion, stammering, and inability to speak. Having to sleep multiple times a day.

Also.

My hair starts falling out like rain. I don’t really realize it amidst the neuro-storm. But suddenly…within the next weeks, I’ll notice that hairs are everywhere. Like…everywhere! All day and all night. And that they have been for weeks. As of writing this post, I’ve lost 1/3 of it and it hasn’t stopped yet. That’s attractive for a professional dancer.

Bella haz left buildingzzzzzzzzzzz…

February 9 - DO OR DIE FRIDAY

To: Patient Relations Portal
From: Squeaky Wheel
8:30 a.m.

Morning! (Ain’t I just a sweet li’l McSqueaker?) Just checking in on the status of this conversation so I know what I need to do with my last day of working hours.

🦗🦗🦗

To: Patient Relations Email
From: Squeaky Wheel
10:28 a.m.

Hi there! Have been working with {PR Guy} over on the portal. He told me yesterday that we don’t need pre-authorization for this but in order to get 100% confirmation that Medicaid will pay for all of this, other things have to happen on Hospital’s end. After speaking with Medicaid yet again, I sent the info to PR Guy. Since he was super fast at replying to me until this message, I just want to make sure this is still being handled, and that’s the reason for the sudden silence. Not that I’m on hold in cyberspace with nobody working on it while my last few hours before Friday 4:00 p.m. pass me by.

Here is the last message I sent to him:
MESSAGE ABOUT MEDICAID TELLING ME TO HAVE MY ORDERING PHYSICIAN CALL THE PROVIDER LINE TO GET THIS INFO FOR ME.

So. Are you able to tell me who needs to make this call? Because my neurologist—the “ordering physician” that Medicaid needs—keeps saying they have nothing to do with it until she reads the results. Better yet, can someone on your end make this call? Because I’ve been waiting for this test for 20 years and need to not cancel it for fear of more billing snafus. Thanks so much!

From: Patient Relations Email
10:21 a.m.

I will check with him for you and get back to you.

✨BING!✨ Like McSquirrel Squeaker Magic, I get a response from him.

From: Patient Relations Portal
11:01 a.m.

I spoke with Arkansas medicaid this morning. The first representative I spoke with said that they cannot give a guarantee of payment. They would need the claim for the procedure before they can process anythign from a billing perspective. From a prior authorization stand point through your procedure does not require authorization.

From: Me
11:12 a.m.

That’s what they told me too. Until I informed them that I can’t even pay all my utility bills right now and that, if they don’t cover it all, somebody is gonna have to eat it, because you can’t get blood from a turnip. :P Which is when they finally put me through to a totally different department who gave me the info I sent you yesterday. So…I guess now everybody knows that when I do this procedure nobody is allowed to destroy my credit over this bill if Medicaid won’t cover it all.

Thank you so much for trying so hard against a system designed to make disabled and chronically ill people quit. Have a great day!

🦗🦗🦗

To: Me
From: Patient Relations Email
11:15 a.m.

Thank you. {PR Guy} called me as well and stated that Hospital has done everything needed on our end. He did say that Medicaid was not able to guarantee that the procedure would be fully covered. Thank you for letting me follow up!

From: Me
11:25 a.m.

Cool Here is what I sent him:

REITERATION OF MESSAGE

🦗🦗🦗

Hindsight sidenote:
Any time during these portal and email messages would have also been a fantabulous moment to send me to Financial Aid because Medicaid is apparently notorious for denying stuff they supposedly routinely cover, so the hospital has to cover their butts by only giving “ESTIMATED” cost, not 100% guaranteed cost. That’s why Financial Aid then covers the patient’s butt for those who qualify.

It also should have been the moment to send me to Insurance Verification for that estimate in writing.

But they didn’t.

Bonus round: 6:32 p.m.

I wake up from my afternoon corpse impression. I’ve crashed out for 3 hours this time. Trudge into the shower. Water gets stuck in my left ear. I try to swipe it out with a finger. My entire ear plugs. Like…I can’t hear anything out of it. WTF?! I have only had ear problems once in my life: right after my jaw and neck got knocked off kilter when I was hit by a drunk driver and all of this started 23 years ago.

Spock eyebrow. Fascinating…

Because for the past two weeks, that TMJ splint has been working miracles. My jaw and upper cervical vertebrae have been working gangbusters to realign! The muscles have been trying to drag that mandible up on the left side and close the gap that’s been there since 2000. Coincidence that suddenly my ear can’t clean out the wax?

No clue.

Either way, I can’t turn my head to the right because those muscles are so bound up from working overtime to pull vertebrae where they belong, and now I suddenly can’t hear out of my left ear. It’s itching, and the pressure is becoming painful. Why wouldn’t this happen on a Friday night after everything is closed except the emergency room?

At least I’ll be in a hospital first thing on Monday.

😵‍💫🙉🥴☠️

February 10 - SILENT SATURDAY

Bella haz left building—

Crap. Nope.

Oh, yeah, I actually have a 5-day hospital stay that I need to pack for!

Hopefully.

I mean…we might drive all the way up to Missouri and, when I tell them that I can’t sign my name to secondary financial responsibility, they might do what they’ve done to me when I informed them of my lack of income prior to an X-ray and CT scan during the 4 Year Dental Fiasco: entirely change gears, cancel my tests, and shuffle me off with more antibiotics that wreaked havoc on my system but kept me breathing long enough to become someone else’s problem.

Everything finally starts to catch up with me.

I have the classic stake jammed through the back of my skull. I’m stammering, stuttering, stumbling around, cracking inappropriate jokes. During midday, I pass out for three hours straight. Again.

Yup. This is always a bad sign. Good thing they’re about to scan my scrambled brains.

I finally remember that I’ve had that dance post sitting in my drafts folder and I should probably post something before the contents of my skull start dribbling down my nose from strobe lights, sleep deprivation, the weight of an electrode-helmet on my head, infernal scalp itching I’m not allowed to scratch, an uncomfy hospital bed, uncomfy hospital noises, crappy hospital food, and an EEG team’s attempts to induce seizures.

February 11: SUNDAY - DAY BEFORE EEG

12:50 p.m.

After doing more packing, I try to nap. My jaw slams down on my tongue and jolts me awake. I have five more of these sleep-seizures over the next hour, and give up on sleeping.

Instead, I sit down at my computer.

Curious Monkey looks up the out-of-pocket cost of a 5-day in-hospital continuous EEG with video monitoring. I can’t find 5-day. I can only find 3-day.

People report anywhere from $200 to $178,000.

Uh-huh.

No surprise there.

To: Department of Human Services website portal
From: Mary Hail, The Wyld Hare 🤘
2:53 p.m.

Reiterate…reiterate…reiterate everything I’ve been through for the past 2 weeks, everybody I’ve talked to, where they’ve sent me, what I’m trying to find out, and why. I explain my financial and medical situation, too, and the fact that I’m really hoping we won’t drive up through a snowstorm, only to be turned away because I can’t sign secondary financial responsibility.

…So what am I supposed to do now? Go another 23 years not knowing what’s wrong with my brain until it kills me? Or risk yet another bill that should have been paid hanging over my head like I’ve got with my last annual exam? I’m at the end of my rope. Thank you.

6:19 p.m.

Try to nap again. Have another sleep seizure and say fuck it. Doing another EEG sleep deprived will not be a bad thing.

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Up Next: THE DAY OF MY EEG, and all the fallout that fell in its wake.

© 2024 Hartebeast

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Why do I have this problem in the first place? Drunk Driver:

You can find all the posts about the initial TBI as well as the current fallout in the Section dedicated to these topics. Here’s a handy Table of Contents for your bookmarking ease:

Or start at the beginning: