Tuesday, March 11, 2014

I Should Win A Ribbon Too! This Race Is Brutal!!!

 


**DISCLAIMER: Long Venting Rant ahead!  So if you're not in the Mood for a Difficult Read, just Enjoy the Pretty Uplifting Pictures!  Smiles***
 

I Miss our Old Insurance for the G-Kid Force... in over 13 Years I never had not one problem with them Approving or Covering anything the Children needed and was prescribed by a Physician or Specialist Caring for them.   Thank You Mercy Care for all you have done over the Years, it was Appreciated more than you'll ever know and we long to have you back!  So... I wasn't on Board at all when CPS forced the Old Insurance to be dropped and the G-Force to be covered by their Insurance.  One they Alleged to be Superior... but which, in Reality and Practice, has already shown itself to be Inferior by not looking out for the Welfare and Well Being of the Client, and which I'm currently in an ongoing battle with to Approve and Cover the other half of Princess T's Pain Management meds!  I should Win a Ribbon for the Endurance necessary to run this Race of Raging against The System so that we can cross the Finish Line intact and Healthy!
 
 
 
 
I don't Enjoy doing the Dance with Insurance Companies that aren't up to the job of adequately providing for their Clients, IMO they shouldn't be in the Business.  This was the first time I'd had to utilize the New Medical Insurance and First Impressions are Lasting ones, they haven't instilled confidence and have aroused only contempt and anger at this point already.  After release from the Hospital with Rx for her Pain Management med in hand, a med that she needs to take every four hours so that swelling and pain is controlled... so that she doesn't have a rupture or be unable to swallow and can be properly hydrated and nourished, I didn't anticipate any looming battle on the Horizon.  So I wasn't doing the Dance... just yet... boy was I in for a Surprise... and not in a good way!
 
 
 
 
My usual Pharmacist tells me he doesn't carry this particular Pediatric Painkiller anymore because it's now become Expensive and so some Insurances are balking at paying for it after the increase.  But being the great Guy that he is { I 'Heart' our usual Pharmacist}, he finds a Pharmacy for me that carries it and over I go.  Trying not to consider the Expensive part as a Bad Omen, even though in the back of my mind and not knowing what to expect from this New Insurance, I certainly had Red Flags going up already.   Sure enough, the other Pharmacist tells me that the Insurance won't Approve or Cover all of the prescription... only HALF OF IT!!!   WTF?  Is she only supposed to get halfway Recovered?  What about the serious risk factors involved if her pain isn't properly Managed?!   The Specialist's Office insists this is what they want her to be on, they don't want a substitution... I Trust their Judgment, they've been doing these kinds of Procedures a long time and I'm not Rationing Meds to make them try to last twice the time because I only have half as much as we should have!!!
 
 
 
 
So... I leave Voice Mail for the CPS Caseworker... several times over the course of three days, they don't return my calls and are "Out" when I go in to the Office to try to see them in person.  In fact the surly CPS Receptionist tries to slough me off and put me in a long DES line "Over there", pointing to a long line snaking out the door, so she won't even have to deal with me.  Not a chance Sista... I tell her that this isn't one of these "Long line over there kinda Problems", I'm right in front of who I need to be because of the Problem with a Bum Insurance they forced upon us and I WILL get resolved because my Grandbaby's Welfare is at stake!   And under my breath... Lord Jesus, Help me to not blow my whole Christian Witness with this confrontational Woman who doesn't want to do her Job and is intent on doing the least amount possible for Clients!!!    Of coarse, being its CPS maybe that IS her Job, I dunno, that's probably part of the reason why they're in the midst of a Huge Investigation and have two separate subcontracted Agencies scrutinizing all their Work now!?!  In fact, both subcontracted Agency Caseworkers involved with our Case will be hearing from me too when I can finally get hold of them. *Winks*  
 
 
 
 
 You see, at this juncture I cannot contact the Insurance directly because the Insurance Cards with Point of Contact Info that were supposed to arrive in a Week... well, a Month later we still don't have 'em... another Bad Omen?  Perhaps.  So back to the Pharmacy I go to check the Status, Hoping that something might have changed with the Doctor's Office trying to do an Override?  Nope.  Dear Pharmacist knows my plight and looks up the 'Top Secret' Point of Contact Info for the Foster Care System Insurance in her System so that I can call directly and address this before we run out of meds and reach Critical Mass.  This Recovery Period is Difficult and Painful enough for this Poor Child without un-necessary Drama and even more Obstacles pushing back a Healthy Outcome AGAIN!!!   Lord have Mercy, wasn't waiting over a YEAR to get the Surgery Approved and DONE enough already?!?
 

 
 
Direct Call is received with mild shock... we never hear from actual Clients he says... you're not even supposed to have this Number, we usually deal with Doctor's Offices, Pharmacies and Agencies directly... oh, yeah, well not Today, 'cause we got a Big Problem here and I'm this Kid's Custodial Gramma and she's being Denied sufficient Post-Op Medications and that's not gonna Fly.  So... this needs to be Explained to me in great Detail so that when the Kiddos Attorney Ad litem shows up Tomorrow to meet with us, I'll have all the Pertinents to address with her since nobody else is Helping me to Resolve this here 'Issue'... and I don't want to wait til' my Grandbaby ends up back in the Hospital in an Emergency Status because meds have been with-held.  Hopefully the Kiddos Attorney can Intervene and rattle some cages or roll some heads... at this point I don't care what Casualties of War are on the other side, so long as there's none on ours!!!  If you're not part of the Solution then you're part of the Problem... and I am Tenacious and Relentless at getting rid of Problems that affect my Loved Ones Well-Being.  I don't fight fair, I fight to have Victory.
 
 
 
 
The Insurance Company's Answer... after Consultation with a Supervisor and that whole rigamarole over the phone... we'll Approve and Cover the OTHER HALF NEXT MONTH!!!  WTF!?!??  She Hopefully won't need the Meds NEXT MONTH, well, unless her Recovery is hindered by this gross negligence and she ends up rushed back to Hospital if she cries too hard and ruptures something or can't swallow liquids or nourishment you Idiots... she NEEDS the Medication and Pain Management RIGHT NOW!!!   Okay, so now I'm clearly Raging and so the Guy says he can't talk to me anymore... to have the Pharmacist, her Surgeon, CPS... or anybody BUT ME Call them... they're standing firm and not budging on their decision!!!  Yeah, obviously you don't want to talk to me anymore because I'm asking all the difficult Questions you can't give anything but lame answers to.  This is all so Archaic to me, this Insurance System and it's Claims, like someone peddling Snake Oil, it's all so disingenuous.  Because the Guy ends the Call with the Claim that their only Objective is the Health, Wellness and Well-Being of their Clients!!   No you didn't!!!!!!!!!  REALLY, after the Conversation we just had, are you SERIOUS or just being facetious or reading off your Call Card buddy... or were you really even Present in your Head Space when we discussed ANY of it or merely Checked Out and thinking about something else the entire time, because I can't even Believe you just said that?!?!?  Clearly Customer Service is not their forte, which is why their Point of Contact Info is probably with-held from us Clients and such a closely Guarded Secret?!?
 
 
 
 
So... my Plan is to go back to the Pharmacy again this Morning... and see if they will just allow me to absorb the Cost of the other half of her necessary Medications the Insurance won't Approve or pay for... whatever it costs... I don't even care anymore, she NEEDS it and that's all that anybody should be considering and NOT their bottom line.  I'm fairly certain the CPS Insurance Company has deeper pockets than we do and the Cost of the other half wouldn't break them... and that another Emergency Hospital Stay and Medical Intervention if things go Left because she's been Denied something she NEEDS for Recovery would Cost a whole lot more.  Not to mention any subsequent Lawsuits Heaven Forbid if things went really Left.  But... that would just make Sense... and lately nothing about The System and it's logic, or lack thereof, makes any Sense to me whatsoever. 
 
 
 
 
I really Feel like I've fallen very far down the Rabbit Hole this time and have a Red Queen Situation at hand!!!   Where IS Johnny Depp when I need him?  *Winks*  And so, when I get a Letter stating that at the end of this Month our Old Mental Health Coverage will be involuntarily dropped and converted to the New 'Superior' Mental Health Coverage CPS will provide for the Children... I called in every refill early that Prince R had pending!  Because if the CPS Mental Health Coverage is anything like their Medical Health Coverage, I better have some Rx backup in stock so that the Young Prince doesn't go off the rails if they start denying him his Psychotropic Meds and another battle ensues!?!???!
 

 
 
Blessings from the Arizona Desert... where Battles are Raging and I bought myself those Ribbons because I Deserve and Earned them dammit... and my Saintly Status and Halo are seriously slipping with this Test and I'm ready to go Straight Up Apache now! {She Winks}... Dawn... The Bohemian

4 comments:

  1. Somewhere it is written -- in bold, Old Englishe Gothic, 18pt font -- that one is permitted to overturn money-changers' tables and certain insurance claims adjusters desks without dislodging one's crown options. One also keeps any ribbons which adhered during one's campaign. [Insert drum roll here: "Onward Christian Soldiers..."]

    Please, do take more care for yourself than usual. The kids need their champion safe in the saddle.

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    1. You crack me up Beth... and yet, it was also an encouragement, Thank You! Now I don't feel quite so wicked in my indignant responses to this frustrating and unjust situation! *winks* Dawn... The Bohemian

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  2. Why Why Why do these things keep happening to you and yours! I am so sorry!!! Yes you deserve those ribbons and many more too!! You and your are still in my prayers!

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    1. Marlynne, I am quite certain we are not the Lone Rangers in enduring such Drama... I have spoken to so many also dealing with an uphill battle once they get sick or need help of any kind. I find some solace in knowing we are not alone and others have survived similar circumstances and can encourage us and commisserate.

      Dawn... The Bohemian

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