Multitasking to prevent madness

Multitasking is essential.

 I have learned to entertain myself while waiting on hold for supply companies, pharmacies, doctors offices, state agencies and, everyone else I have to deal with in Maggie's' World. To that end, I am writing this as I wait for Anthem Blue Cross to answer the phone.

Dealing with the insurance company is best handled early in the morning before the operators have had 100 irritated  customers swear at them and before other aggravations of the day take their toll on me. Everyone is fresh and eager in the morning. Right?

Maybe not.

Something preventing me from being fresh and eager this morning: this call is completely unnecessary and aggravating. One of Maggie's (several) supply companies, Byram Healthcare, refuses to send her supplies, diapers, catheters, under pads, etc, until they get a letter from the insurance company verifying these items are not covered by Anthem Blue Cross. Theses supplies were supposed to be shipped on Friday November 1 and I parsed out our dwindling stock carefully over the weekend anticipating a delivery on Monday. No delivery received. Instead at 5:30 PM I receive a call saying they need this letter before they will ship the supplies.

The supplies are paid through Medi-cal, and I understand Medi-cal only pays for things insurance doesn't. What I don't understand is why I have to run this down. Every other provider simply submits the bill and the insurance either pays it or denies it. That is efficient. Making me call is not. Also, holding Maggie's supplies which we desperately need,and informing me they need this after they were supposed to be shipped is just cruel.

Ranting aside, it has to be done. I called Anthem just after 8:00AM and went through the entire matrix of the automated phone system. It took at least 5 minutes Press 1 for member. Done. Say or enter the membership number or the social security number. Done.  Say or enter the subscriber's date of birth. Done. Sorry we don't have anyone with that birth date. I find that incredibly hard to believe but I don't argue with machines. I just enter same thing again. Done. If you want information on a claim press 1, information on pharmacy 2, etc etc etc. For more options say "More" MORE. another menu of choices before I can finally press zero only to hear:

You have reached us outside of normal business hours. We open at 8:30.

Deep breath. Serenity now.

8:31, I go through the same thing and eventually reach a kind, well rested eager human. Ahhh. He tells me. Oh, you've reached the wrong department, let me connect you to blah blah blah department.I hold my breath hoping I won't get another automated answering system while I wait and wait praying I won't be cut off. I'm not. I reach another well rested eager human. I repeat all of the information I already told the computer, but I do it without snarkiness and without complaint.  He is perplexed by my request because it is so out of the ordinary, even though I make this request every year. I tell him they sent one about this time last year, and I believe he found it because suddenly he understood and agreed they could fax the letter to me.

I started to hear a small choir of angels until he said "It takes up to seven business days to get the letter done." The music stopped.

Seven business days is two weeks in real time. That is a long time to go without diapers.

It's not the end of the world. I will take my credit card and head to the medical supply company to buy what she needs for the next two weeks. Of course there won't be any reimbursement for that, but I am going to take care of my daughter. I just wonder what happens to the Maggie's of the world who don't have families to step up to the plate when the system hits these ridiculous and unnecessary bumps.

Call completed Blog entry written.

What's next on the hit parade?

Addendum: Fax received from Blue Cross less than 90 minutes after my call. Huzzah.

The Notebook

I love The Notebook.  No, not the movie. It's an actual notebook. I think I bought it at Christmastime when I was shopping for others. That's the only time I really "shop" and find all sorts of little trinkets to buy for myself. It was pale blue and pretty and on sale and that's pretty much all I needed to know.

I started using it immediately and amazingly, I have continued lo these 4 months. Whenever I talk to someone on the phone I write down the date and any other pertinent information in this notebook.

This is a huge improvement over my former "system" which involved the backs of used envelopes or other scraps of paper near whatever phone I was using. Inevitably they would be discarded as trash when in fact they had the key to cutting through hours of bureaucracy.  No one throws away The Notebook. I have names and dates and flight numbers and all sorts of things in The Notebook.  I can easily go back and find that confirmation number, or phone number or extension or whatever I need.  It's all in one place.

Yesterday I was trying to do 50 things at once and continued an important phone call as I drove to the bank (and YES I was hands free, thank you for asking.) I brought The Notebook with me so as not to miss jotting down that number or whatever crucial information I might need. I was very pleased with myself.

Sadly, when I returned home I accidentally left The Notebook in the car. Sadder still, I did not realize this until I was on hold with the Social Security Office this morning. The Notebook is especially helpful for things like conversations with Social Security. In fact that may be its greatest strength.

I was on the house phone, not the cell, and The Notebook was in the car around the corner.  I had to make a choice. Hang up or improvise. I could not hang up, I had too much invested. It takes so long to get through the phone system there and I was getting close to a REAL PERSON!!  I had to improvise. I knew an old envelope was dangerous and I anticipated a very long call, so I needed something bigger. I spied this oversized piece of cardboard and figured it was perfect. I could transfer it to The Notebook when I was done.

I tried to position the cardboard on the overcrowded table (mail, folded laundry and all matter of other things placed there during our brief  foray out of town). It was hard to find enough room. I placed it over the top of the computer, (pictured) tried to push the computer out of the way and then closed the computer putting the precious cardboard on top so I could take notes. As I wrote the date and who I was calling at the top of the cardboard, it suddenly dawned on me ---

Rather than use the computer as a backing for my cardboard, perhaps I could just open the top and type the information right into the computer. What a concept!

I hate it when technology makes me look like a dinosaur. I dutifully took notes typing everything pertinent into my computer. It is neat and orderly and I understand I may even be able to save it in some sort of file. Wow!

Of course that won't be necessary, because as soon As I was done I ran down to the car and transcribed my notes directly into The Notebook. All is "write" with my world again.

 The pen is mightier than a lot of things.

Basking in bureaucracasy

After a brief break to deal with garbage cops and misbehaving home appliances I am back where I belong --. in bureaucratic hell.

I am still trying to work out  Maggie's medications with Anthem Blue Cross. This has been going on for weeks. They now require certain medications to go through their "specialty pharmacy" but that pharmacy will not work with medi-cal and the cost to Maggie is $150/month for two different medications. Maggie does not have $300 month and if she is not in this program the cost to her is zero. We like zero better.

I gathered all my patience and made the call to once again try to get this resolved. The woman was reasonable and informative and had me re fax the forms directly to her and confirmed they were received!! I asked her if a written explanation would help as Maggie's situation does not fit into any form every created. She said if I wanted to fax that I could.

Why yes, thank you, I believe I will.

I'm sure you don't want to see the entire letter, so I will just give you some excerpts.

I have been trying for several weeks to get assistance regarding an exemption from the Specialty Pharmacy Program for my daughter Mary Margaret McDonald. I have had several conversations with Blue Cross, who would refer me to Curascript, and countless conversations with Curascript all without resolution.  (In addition, I was receiving at least 6 or 7 Curascript robo calls every day asking for more information but receiving no assistance.)  Finally, I was advised by “Mr. X” at Anthem that there is a method of seeking exemption.   I followed instructions, obtained the proper forms, went to the doctor to have them completed , forward (faxed) the completed forms signed by Mary Margaret's doctor to exempt her from the program, but never received any response. I followed up this morning. I was instructed to fax the forms to a different number than is printed on the form (!), and did so. This morning’s conversation with Ms. X seemed to (finally) break some ground. She confirmed receipt of the form

.........

Mary Margaret receives medi-cal, California State program for the disabled or indigent, to help defray her extraordinary medical costs.  Medi-cal picks up the co-pays and provides coverage for some things that are not covered by private insurance. This includes the co pays on medications, which in Mary Margaret’s case can total thousands of dollars each month.  I have explained this to Curascript and to Anthem in the past, but I cannot make anyone understand the complexity of the situation. They have suggested that Mary Margaret  pay the out of pocket co pay of $150 per medication and seek reimbursement from medi-cal. First of all, Mary Margaret does not have $150 a month to pay and, in any event, Medi-cal does not work like that. There will never be a reimbursement.

I recognize her situation is very different from the typical insured. Most people on medi-cal do not have private insurance,  but she does.  However, the existence of private insurance should be a help, not a hindrance, to getting her the medication and services she needs.   

I think that last line is my favorite. I should receive a decision in two to three weeks, which is great, since I've been trying to get one for seven weeks already. 

Stay tuned.  

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.

 OMG

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.