Wednesday, November 11, 2009

Slog, Slog, Slog: Adventures in Getting Medi-Cal State Insurance

I promise that tomorrow I will be more optimistic... However right now, I'm struggling with optimism simply because I spent part of my afternoon at Health and Human Services and that offices is most definitely not a nice place to be.... so here's the newest update (and it is definitely Sadie frown worthy!):

I didn’t really think that the letter I wrote to our “Social Worker’s” supervisor would do anything. I say “social worker” in quotes because he’s never actually done any sort of social working in our case and from what we hear around town, that seems to be his modus operandi with all of his clients. I did get a voicemail message from the supervisor that said that we would receive a letter “explaining the outcome of our application” today (for anyone who's curious, it's still not here).

Despite the fact that it hasn't been delivered I know what it says because the social worker who wrote it (who is not our social worker, he is apparently too lazy to type a letter and sign it) felt so bad about it she told my husband what it says (she shops at the store he works at, so he talks to her a lot, and he stopped by the office last night to tell them that we REALLY need coverage now that I'm pregnant). She said she felt horrible and didn’t want to be the one to write it, but that she didn’t have a choice.

It says that we were rejected because Paul works over a hundred hours a month. I paused when I heard this because he doesn’t. We wish he did, but with unemployment hovering around 20% in our county, we’re thankful for the 20 hours he’s been cut back to, each week (thankfully there is a light at the end of the tunnel when he finishes grad school). The problem was, when our old social worker did the paper work, she asked us how many hours a week he worked. The store was just changing over, having been bought out by a large corporation and he’d been getting between 25 hours a week. That, averaged in with the 16-20 hour a weeks made it pretty close. When she asked the question I said between 80-100 hours and finally wrote down 100 (I had no idea that that was the limit, although I’m sure the worker, who heard the entire conversation, did). So between 80-100 hours a month became over 100 hours a month and just like that, we were disqualified, yet again because of a technicality.

But the pregnancy, theoretically, changed everything. There’s “presumptive eligibility” although, my doctor doesn’t accept it (I was giddy when I found out that she does accept medi-cal, however). And the women at Health Services were very reassuring that this would, in fact, change everything. I should, easily, qualify now.

However, I’m not giving up on getting Paul coverage. I’ve read all the paperwork. I’ve done all the research. We do qualify. Twice they have twisted our own answers to come up with an inaccurate reason to deny coverage. Now it’s become a matter of principle (added to by the fact that it looks like he broke his foot months ago, has been walking around in pain and would really like to see a doctor, although at this point I doubt there’s much they could do).

We are reapplying (we have an appointment with the nice social worker, who is not our social worker, to help with our paperwork on Thursday). It drives me crazy to fill out the immense amount of paper work, yet again (third times a charm!) but that is how I will be spending tomorrow.

Welcome to State Run Medical Coverage. The clock is ticking. It’s been 16 months and we are still filling out paperwork. Sadie was approved last spring and they’re still refusing to pay her bills for well baby check-ups. They say that we have the wrong birth day and sex for our sweet 16 month old girl. Apparently they have decided that Sadie is a 5 year old boy…. Yup…. State run coverage is going to be great….

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