Disruptive Women

I periodically check out an organization called Disruptive Women in Healthcare to see what's going on.  Despite the fantastic name, it looks a tad too corporate/non-profitty for me (that's how disruptive I tend to be), so I've never looked into joining it. Anybody out there on the interwebs who's a member of Disruptive Women in Healthcare?

I'll show you disruptive.

I think Sophie's name and persona is being used for MediCal fraud. This weekend I got a stack of papers, including 5 Explanation of Benefits for services rendered three years ago on arbitrary dates for arbitrary amounts of money. The provider is The Department of Children's Services. The insurer is HealthNet. The dates were all in the fall of 2014, and we did not go to a doctor on any of them. We've never used HealthNet, although straight MediCal might have once. The Explanations of Benefits came in a big packet, each one followed by the exact same sequence of nine pages with language translation information and my "rights." That was 45 pieces of paper in the envelope, only 5 of which were the actual business at hand. Bear with me.

Don't be disruptive. Just listen.

Because it was Friday, and because I am disruptive, I decided to call the number on the sheets of paper and ask what the hell was going on. I spoke to four different persons in nearly two hours -- let's say their names were Rhonda, Wanda, Larry and Jill. Rhonda was the quickest to bump me off to Wanda who was the type of service professional you can imagine staring at a Service Manual and reading the script best suited for Disruptive Women. Whenever I said "thank you, Wanda," or "Ok, Wanda," she said, "No! Thank YOU!" and we might have gone back and forth for hours with pleasantries if I weren't so disruptive. I won't even tell you how apologetic she was every time she put me on hold and popping back in periodically to make sure that I was all right. In the end, Wanda sent me to Larry who -- quite literally -- FREAKED OUT. When I explained my "problem" to him for the second time (the first time, he kept insisting that he was trying to help me but kept asking me really stupid questions, so I admit to being impatient), in my most disruptive voice, he said, "Whoa, whoa, whoa. That sounds like something really big. Really big." Larry was undone and advised me to call the Ombudsman. He said Ombudsman in a tone of voice that conveyed the mystery of The Wizard of Oz and then, very, very solicitously spelled it out for me. Because I'm disruptive (and perhaps a teensy tinesy bit stressed), I actually interrupted him at that point and said, Larry, I KNOW what an Ombudsman is and how to spell it thank you very much. Larry and I said our good-byes, and at  approximately 4:54 pm, I called the number Larry gave to me and spoke to Jill who got a gold star for even picking up the phone so close to closing time and then after the first explanation sighed and said that I would have to call the fraud department of MediCal on Monday morning.

Are you still reading?

I put my finger to my temple and did a Rodin pose and then recalled a similar stack of papers that I received earlier in the year or maybe last year with a whole lot of weird amounts of money paid out. There was one in there from 1999, when Sophie wasn't even a recipient of MediCal, so I called then and reported "fraud" and maybe even wrote a post on the old blog about it. Because I'm a disruptive woman in healthcare and mighty efficient, I pulled out that stack of papers and found my notes. Needless to say there has been no follow-up, and now I'm facing a Monday morning call to the Fraud Department.

The most disruptive thing I'm thinking at this point is who would want Sophie's medical identity, anyway? What would be great is if we could just switch with someone healthy milking the system and really go to town on the amazing benefits.

Clusterf*$%kery, part 4,345,678

Despite all the recent excitement with the press beating on my door as I attempt to muddle through the clusterfuckery that is The Cannabis System, we need to get back to our regular programming. I just spent the last 15 minutes on hold with Medi-Cal and then 45 minutes in conversation with a very helpful, very clueless gentleman at Medi-Cal. You might wonder how someone can be both very helpful and very clueless? The ability to hold opposing thoughts and ideas in unison -- equanimity, if you will -- is a skill I've perfected over the last couple of decades (ok, to be honest, it's only happened in the last five years or so), as is the very careful walking of the tightrope, swinging from the trapeze and other grand carnival acts.

So, you can take my word that the gentleman I spoke with on the telephone was very helpful and very clueless.

I called because as of February 1st, Sophie was added to our health insurance policy (Healthnet), and we dropped her Anthem policy. Sophie also has Medi-Cal, which is secondary to her private insurance, but at present, Medi-Cal is LINKED TO ANTHEM. I called Medi-Cal (my fifteenth attempt, I should add) to ask them to:

1. Drop Anthem Blue Cross 
2. Add HealthNet
3. Link Medi-Cal to HealthNet

My aim is to ensure that when medical claims are filed with HealthNet, Medi-Cal picks up the uncovered stuff, LIKE IT'S SUPPOSED TO.

Well, the helpful but clueless gentleman informed me that I needed to fill out form -- let's call it AGNES because I don't want to stress you out further with the amount of numbers I'd have to type out to indicate which form -- proving that I was indeed authorized to act as Sophie's conservator. In other words, since Sophie is over 18, her privacy is protected and Medi-Cal can't authorize the release of information. If you remember the other, now distant clusterfuckery that was gaining Conservatorship, I am officially Sophie's conservator (in addition to being her mother). God forbid this sort of snafu should have been taken care of back then with the Social Security office. He very helpfully directed me to Form AGNES but upon perusal of it, he decided that it was maybe Form GLADYS that I needed. He then directed me to Form GLADYS, and we both realized that Form GLADYS was actually the wrong form, so we moved on to FORM MILDRED after he checked with someone.  

Form MILDRED it is, and I was instructed to fill it out and send to the address at the bottom of the form. I said, There is no address at the bottom of MILDRED, and he said, Oh. Let me go and see where you send her. 

And I said OK and then I did a little pirouette on the high wire and smiled down at the admiring crowd. When the helpful but clueless man came back on, he gave me an address and thanked me for my patience. I now must fill out MILDRED, send her to Sacramento, hope that she is received and processed, upon which I will call back Medi-Cal to request that they do Numbers 1 and 2 above.

Did you get that?

I'd really, really appreciate if you, dear Reader, moved that net right under me as I do believe I might be plunging to my death at any moment.

How I look when I'm on hold with Anthem Blue Cross

I'll blame the jowls on them, too

and the dark circles.

Yesterday's joust with the most loathed company in America came about because I wasn't properly reimbursed for Oliver's recent twelve year old check-up. Evidently, the doctor had checked off the Age Range 12-17 box on the diagnostic code list, and the Date of Service was May 9, 2013 which made Oliver 14 hours younger than Age 12 (he turned twelve on May 10th) and therefore not reimbursable because he was STILL ELEVEN AND NOT YET TWELVE. Got that?

I'm not kidding you, folks.

After that phone call, my jowls hit my cleavage, and there they swing.

Drug Mule, Part 5,467,890, Oliver's Music Concert and Elementary School Shootings

So that's Oliver in the middle there, looking all sweet and ready to sing at his school's Winter Holiday Concert. The concert last night was the highlight of my day and a balm to the soul, as I spent most of the morning and some of the afternoon on the telephone with Anthem Blue Cross and then with My Canadian Boyfriend, the pharmacist in Vancouver, and then my Jane Austen Lover Friend in Vancouver who will be performing drug mule duties today and bringing Sophie's medication to Los Angeles this weekend. Who knew there was such excitement to be had in the world of Big Pharm/Big Insurance? If you're really into this stuff, you can go back and read my drug mule posts, here and here and here. Actually, there are about ten posts that refer to drug mules, and I can't vouch for their being interesting or exciting, but yesterday, as I tried to figure out what was going on with my grievance against Anthem, I thought of this photo that I posted years ago on this blog as an example of where I believed the Anthem Blue Cross Review Panel did their diabolical work:

In one of the inane conversations I had with one of the pathetic clerks that work in this office, I asked whether Sophie's drug had been added to the formulary, yet. The Pathetic Clerk typed away and told me that the Drug Review Panel met quarterly to decide what drugs to add to the formulary, and that the decision had already been made for January 2013 and that no, Onfi was not on that list. I asked The Pathetic Clerk  how I might reach the Drug Review Panel or how my doctor might reach the review panel, and she said, I have no idea where they are and how to reach them. We are not given authorization for that sort of information.

I began to weep profusely, then, and curse the heavens.

Just kidding. I felt my heart beat quickly and let off steam by sympathizing with The Pathetic Clerk, telling her that I couldn't imagine working for such a diabolical company. She laughed and when I hung up, I actually did shed some tears before I went into action, called The Neurologist and My Canadian Boyfriend Pharmacist, arranged to purchase the drug again and then called My Friend J who referred me to our mutual friend, The Jane Austen Lover who lives in Vancouver but who is traveling to Los Angeles this Saturday and who will be picking up the medicine from said pharmacy and bringing it to us. I made a copy of Sophie's birth certificate and typed a letter authorizing this drug transaction should customs officials question The Jane Austen Lover and emailed the appropriate documents.

Then I went to Oliver's concert.

This morning, I woke up to read the news of another elementary school shooting, this one hitting very close to home as a good friend and former blogger who is now blogging again, has two children at the school. Thank the good heavens that her kids are now safe at home, albeit traumatized, but I can't help but wonder why in the hell one is able to go online and order hundreds of rounds of ammunition in this country yet have to go to ridiculous lengths to get a 60-day supply of medication for one's epileptic daughter.

Another sight for sore eyes

This is Sophie and me, looking at each other in The Neurologist's office. We had a good visit with the doctor, not much was said or done, but it was pleasant, Sophie's health is good, and I enlisted The Doctor to really help me with the drug and insurance situation. I'm grateful for Sophie's relative stability (if you call having one to three giant tonic-clonic seizures a day stable, but that's where we are!) and for her sweet attention to me in the office yesterday. We've been doing these doctor visits for nearly eighteen years and have them down.

How women like me get excited

I'm going out tonight to hear the U.S. Poet Laureate, Natasha Trethewey, read from her poetry and speak a bit at our downtown library. And you thought this post was going to be inappropriate, didn't you? HA! I just thought I'd throw a wrench in, seeing that I've spent the last day or so ranting and raving about health insurance. I haven't been out at night for weeks and will be meeting a friend and having drinks beforehand. I know nothing of Trethewey or her poetry, so I'm excited. I found this poem online and liked it.

Vespertina Cognito

Overhead, pelicans glide in threes— their shadows across the sand dark thoughts crossing the mind. Beyond the fringe of coast, shrimpers hoist their nets, weighing the harvest against the day's losses. Light waning, concentration is a lone gull circling what's thrown back. Debris weights the trawl like stones. All day, this dredging—beneath the tug of waves—rhythm of what goes out, comes back, comes back, comes back.

Natasha Trethewey, via Poets.org