Thursday, April 12, 2012

If, Then

I don't know if this is a San Francisco phenomenon or if it happens everywhere, but almost anytime you call the City  or State you end up talking to a person for whom English is their second language. Many people complain bitterly about this, but that doesn't bother me.  People blame the accents but I don't think it's the accents that make it difficult. It's the bureaucracy speak.

After spending three days in a morass of red tape, I can safely say that Bureaucracy has its own language. And that language does not have any words for "please", "thank you" or "maybe."  It is limited to a structure of "if, then."  If you received that paper, then you must complete it. It doesn't matter how ludicrous, it's just IF, THEN.  If you have three heads, then you MUST wear three hats. It is rule based.

Maggie of course, does not fit in an IF, THEN world. Never has. never will. And it is my job as her advocate to break through that to get answers. It is frustrating. But I am persistent and eventually get what I need. This time I may have waited to long to begin the discussion, but hopefully I have prevented an error from occurring. IF that is the case, THEN I will be happy

Maggie receives Medi-cal, the California program for Medcaid. Medi-cal has been a complete lifesaver for us. Even with our private insurance, there is absolutely no way we could have kept Maggie at home and healthy without this program. It pays for things the insurance doesn't cover or only partially covers. It also used to pay for the nursing, though that is now paid through another program.

Medi-cal is now going to a managed care model, but the few beneficiaries like Maggie, who have private insurance, are not supposed to sign up for a managed care plan. Because of that I ignored the packet of material that arrived in January about choosing plans. It was sitting on the table in the hall for weeks unopened. Last week Maggie received a letter saying the State of California would choose a program for her if they didn't get a response by April 14. Hmmm. Maybe there's a problem here. I started to call.

The number in the packet is Health Care Options, only for making the choice or questions about the choices. IF there were other types of questions, THEN I had to call Medi-cal. OK. call medi-cal. IF she received the packet THEN she must choose a plan. Call Health Care Options. Lather rinse repeat until on about the 4th call to medi-cal, the woman tells me Maggie does NOT have private insurance. Yes, I assure her, she does. She always has. IF the computer says she doesn't THEN she doesn't.


But she's right. It doesn't matter what I say, it matters only whats in the system. This woman is actually helpful and tells me I have to fix it with Social Security. Oh joy. Another huge bureaucracy. But I have a secret weapon. I have the direct line of the guy who did Maggie's intake for SSI and I still have to give him other information. I can call someone directly. It takes a day or so to connect, and he confirms that the private insurance is not in the system. (I must have checked some box incorrectly.) That is fixed. I start the other calls again. Three or four calls later, a woman in Sacramento tells me to instruct Social Security to advise medi-cal of the change and then call back on Monday and see if the records have been updated. I wonder why a federal office of Social Security would have to report to a State medi-cal office (things usually flow the other way), but I do as instructed. As anticipated, my contact at Social Security says, we don't really have any direct contact with them.

I decided to walk away from it and hope for the best. First. though I sent a letter explaining what was happening and that I would check back on Monday. Of course, they are FORM people. I'm quite sure they won't know what to do with a letter with complete sentences. Letters are "maybe" things. That does not compute in Bureau-speak.

IF I have to start this all over again, THEN I am going to scream.

1 comment:

  1. IF this is what's in store for me this year, before Sophie turns 18, THEN I might as well run away now.


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