I’m on Medicaid. I have no problems admitting this or talking about it in public. In fact, I’ve done it three times now: in a local TV interview, at an Organizing For America-sponsored health care rally and at Rep. Steve Kagen’s recent town hall on health care.
Medicaid is socialized medicine. A short description from the federal Centers for Medicare and Medicaid Services:
Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.
Depending on state law, you might also have a co-pay. I don’t know how it is in other states but Medicaid in Wisconsin is excellent. It is there for people who need it, like me. Within a few weeks of becoming paralyzed in 2005, I applied for Medicaid. I was approved within a month. Medicaid retroactively covered my hospital expenses from the date of my application. It paid for two full weeks of inpatient rehab more than United Health Care had authorized. Those two weeks may be the reason I am walking today.
United Health Care had said I could have 20 outpatient physical therapy sessions and 20 outpatient occupational therapy sessions. Medicaid didn’t set a limit. I went to occupation therapy twice a week for five months and have regained all function in my hands. At one time, they were completely paralyzed. I went to physical therapy for eleven months and am walking normally again. At one time, I was a quadriplegic.
That’s not to say Medicaid just writes a blank check. The first year I was home from the hospital was a difficult one. My mom, who was my primary caregiver at the time, and I ran into a lot of problems related to my care we didn’t know how to handle, often late at night or on the weekends. After I ended up in the ER more than 10 times in less than a year, I received a letter from the state Medicaid agency saying I had reached my limit for ER visits. They gave me the names and numbers of my doctors (internist, neurologist, rehab specialist) that I should see instead of going to the ER.
I was thinking about all of this this past Monday. The regular clinic I go to is usually booked weeks (sometimes months) in advance so they have set up an urgent care clinic adjacent to the ER. This is a walk-in clinic; first-come, first-served. It is staffed by physicians’ assistants and doctors and I believe they charge the same as a regular clinic visit.
So Monday – I had been sick for a few days. I knew I’d never get an appointment with my regular doctor so I went to the walk-in clinic. I registered at the desk, where they confirmed my personal data, including my insurance, the “Forward card.” (Wisconsin had so many names for Medicaid it’s ridiculous – Medicaid, Medical Assistance, EDS, Forward Card, Title XIX).
The clerk told me I could have a seat. A few minutes later, a nurse called me into the triage area to take my vitals. After that was done, I went back to the waiting area. About five minutes later, they called me to go back to the exam room. Long story short: the entire exercise in socialized medicine, including the PA pulling up my records online, waiting for the lab work to come and having my prescription filled at the pharmacy (co-pay $1) took about an hour and a half.
Medicaid is socialized medicine. It is not evil. There is a place for it in our society. As for “government takeover of health care”, that’s ridiculous. The government had no role in my health care on Monday, except to pay the bill. They didn’t choose the clinic or physician’s assistant I saw. I could have gone to the other clinic in town. They didn’t tell her which drug to prescribe. She chose the one that was most appropriate for me, although the pharmacy did substitute a generic.
Prior to my enrolling in Medicaid, I had been on Blue Cross/Blue Shield or United Health Care plans for most of my life. The insurance chose which networks of doctors I could see. Medicaid does not do that. Doctors may choose not to participate in Medicaid but there aren’t many who do so. The insurance companies also had lists of drugs they would cover or not cover.
Rationing and government takeover on health care? Please. It’s far more likely to happen with private insurance and we all know it. Is this really about health care or is it about a few hundred Republicans’ job security?
When 14,000 people lose their health insurance every day, that seems incredibly selfish.
Amen. Thank you for writing this.
I am a dental hygienist for one of the few or last of the dentist’s who are SIGNED up as accepting medical assistance insurance. You are very correct that you get great health care at very little cost to you. But unfortunately, the reason I work for one of the last dentists in the Waupaca County to accept M.A. (Forward, Badgercare) is because the reimbursement rate for M.A. is less than 25% to 40% for services. 40% is for preventative care such as exam, cleanings and x-rays, which are only covered one time a year-per M.A. If a patient wants another cleaning in 6 months, they can but they have to pay out of pocket. We can charge and accept cash for the second cleaning because it is NOT covered by M.A. Any other services covered under M.A. we can not accept cash for. The ADA, by the way, recommends exam and cleanings 2x’s a year, which private insurances do cover. (MA covers one cleaning per year on adults, 2x’s a year for kids). So, when we see a patient on M.A., that means we make ZERO profit and in some cases lose money (if we have to send anything to a lab, the reimbursement dose not even cover the fee we are charged from the lab). So what it means for private physicians, optometrists, chiropractors, dentists is that it really is not profitable for business–zero profit. Private insurance reimbursements rates are around 70-100% for services, some go as low as 50% for crowns and bridges.
What bothers me, is that Senator Steve Kagen has not been completely honest on when he was a practicing physician and accepting M.A. insurance. There is a huge difference between accepting M.A. patients to your office and being signed up as a provider with M.A. A Dr who is NOT signed up as accepting M.A. insurance at their office gets to charge for services provided which would normally be covered by M.A. because obviously they do not have to submit anything to M.A. So, having MA pt’s come to your office is like accepting patients with no medical insurance, so the pt has to pay out of pocket—this person should not have to pay out-of -pocket, that’s why they were on MA to begin with. That is why, those physicians from Green Bay asked for money from John Gard to make their now controversial commercial, Steve Kagen was part of the problem by not being SIGNED up as a provider himself. Now he supports a new public health care option and some funding coming from further reducing the Medicare reimbursement rate. Physicians and other private doctors would get even less than hardly anything for services provided (what’s less than zero profit or reimbursement that doesn’t even cover the private doctors fees, such as lab fees). I just don’t think that is right. Instead of adding yet another public health care plan— spend money on raising current reimbursement rates on the public plans already out there. Big difference between accepting M.A. and being signed up as a M.A. or medicaid/medicare provider. Granted, I work in a dental office, so unless reimbursement rates were further lowered to M.A. it won’t affect dentists.
M.A. does have their own website which show what their reimbursement rates are for services. Also, just so people reading this know, as far as dental care goes, MA only covers resin crowns not metal crowns. Those of us in the dental field call resin crowns temporary crowns because they are plastic, we make them to put on your tooth temporarily, 2-3 weeks, until your metal crown is made and returned to us by the lab. Resin crowns are not permanent, yet MA says otherwise. Also, as a hygienist, when I see a pt on MA who needs a deeper cleaning, rather than a regular cleaning, I have to answer a short list of questions and answer thoroughly. One question is basically asking me if I think this pt will come back to receive the follow up maintenance cleanings (occurs every 3 months). Why do I have to explain to MA if I think the patient will follow through on maintenance cleanings? I find this question in particular very irritating! (Government has no role in health care??? Someone there does). I wonder if I ever wrote down what I really think, which is “No, this patient will probably show up for the deep cleaning but will not show up for follow up appts.”–If I gave my honest opinion would they deny this person coverage? I don’t know, I can only speculate because I don’t want to have to tell a patient that MA denied your deeper cleaning. Patients (on MA or private insurance) not showing up for maintenance appts happens a lot. With private insurance, they follow the coding laws, for example if I find a 5mm pocket on a tooth that means a deeper cleaning because it is most likely perio disease, bone loss on x-rays confirms it. All I have to do for some private insurances is submit my perio charting on that patient and in a few cases some x-rays to show bone loss. Not one private insurance company asks me if I think the patient will come back for maintenance appts. Private insurance does have it’s problems, missing tooth clause, amongst other things but far less of a headache than working with MA. There are many more procedures that MA covers that we as providers would not consider acceptable, such as resin crowns acting as permanent crowns.
I do not want to see Medicare/Medicaid go away, it is wonderful, especially if you can’t afford anything else. But for myself, my choice would be private insurance and I would also be extremely grateful for MA if my husband lost his private insurance. I am all for health care reform, but not all new plans, I would like to see more government oversight into private insurance (despite people against government getting into too many things, I think they need to stop private insurance greed)….denying claims is how ALL insurance companies make money or save money, even public insurance. No stupid missing tooth clause, a person should not be penalized for having a tooth extracted because it is cheaper than RCT and crown, then they get private insurance and now they say well you were missing a tooth before this insurance, so we won’t cover your bridge.
Last time I checked, The American Medical Association said they would be on board for a new public insurance plan if the reimbursement rate was more equal to that of private insurance. You shouldn’t expect your private physician/business owner to have to pay out of pocket to see you as a patient. That’s not even so much as government run health care as it to say, Here doctors, you can see these patients for free, and depending on what procedures you do, you can pay for the cost.
World News Tonight with Charles Gibson, back in Aug I think, ran a segment about how these different doctors…dentists, physicians, optometrists, ect ran a program/clinic that they usually do in 3rd world countries, but are doing it right here in the US. It seemed to me, they wanted to say, “See, this is why we need health care reform.” But, I’m sitting at home screaming inside, wondering how many of these doctors own private businesses where they themselves are not signed up as MA or medicare providers. Which would mean that some of these people they are treating cannot make use of their free insurance at these doctors’ offices. Again, public insurance reimbursements rates does not make good business sense, so instead these doctors do these clinics outside their usual business.
We should also not let our congressmen pass a health care reform bill through ASAP. If you agree with the current plan or not… any health care reform should take a long time to be worked out properly, or as close to it as we can get. It should be scary to those of us, for or against the new plan, that it was going to get pushed through as quickly as it was, without a lot of congressmen not even reading it first! But with another public option, I’m afraid, I’ll see more problems with people finding a providers, especially if reimbursements continue to be as low as they are. We tell patients all the time who are frustrated that they can not find a DDS to call their congressman and tell them to increase reimbursement rates… I have had patients tell me, it is up to me/our office to contact our congressmen. No, sorry, we’ve tried that, they do not want to hear from the private business complaining about not getting proper reimbursement for services provided, they want us to basically foot the bill for pts, so to speak.
I am so glad that you have not all been affected by the frustration I have seen with public insurance.
Did not mean to leave such a long post, but I wanted to make sure some of you got an insight from a health care provider and my frustrations from what I am seeing. MA should cover the same type of crowns, 2x’s a year cleanings on adults, amongst other things, as private insurance does, and the reimbursement needs to go up, rather than down. I wonder what Senator Kagen thinks, or if he’ll spin what I’ve wrote as an argument to keep a public option in the bill.
I really appreciate that you took the time to share your thoughts about the unbelievably complicated issue of Medicare/Medicaid reimbursement rates.
Until I went on Medicaid, I have never had dental insurance. Since I’ve been on Medicaid, I haven’t found a provider within reasonable driving range. So I’ve always paid cash for my dental services.
However, I suspect your concerns apply to the medical profession as a whole, which is what makes the debate so complicated. Thanks for sharing your thoughts.
Just need to clarify a few more things…..
Title 19 (XIX) is also called Medicaid, Medical Assistance (Forward, Badgercare in WI)-this covers dental
Title 18 (XVIII) is also called Medicare–this is for those 65+ and does not cover dental
You also stated that, “The insurance chose which networks of doctors I could see. Medicaid does not do that. Doctors may choose not to participate in Medicaid but there aren’t many who do so. ”
This isn’t completely true either. Again, I work for a private business owner a DDS who tried to hold out as long as possible and not be signed up as a Preferred Provider with a private insurance. However, we had many pts with private insurance who were asking us to become Preferred Providers because they, for example had Delta Dental. If we were signed up as a Preferred Provider with Delta Dental those pt w/that insurance could come to our office and receive the full benefits of their private insurance.
MA is the same. You said you received a list of doctors, internist, neurologists, ect from Medicaid to see rather than continuing to go to the ER. I’m assuming this was a list of doctors who were signed up as Medicaid providers.
This really isn’t any different than receiving a list of preferred providers from a private insurance.
And again, my problem with Sen. Kagen, is that if, for example if you needed to see and allergist/dermatologist…you would NOT have found DR. Kagen’s name on your list from MA, as he was not signed up as a Medicaid provider. Remember the difference between accepting MA patients and being signed up as a provider.
If your experience has been that not many doctors chose not be signed up as providers with Medicaid, then Sen. Kagen would have been in the minority of those doctors who chose not to do so. And yet, he is alright with reducing the already low reimbursement rate to doctors, to help fund a new plan.
It has been my experience, working in one of the last dental offices in Waupaca Co., WI to be signed up as Medicaid provider, that many patients are frustrated in the inability to find a dentist, orthodontist, chiropractor, ect. This is mainly due to the poor reimbursement rate, amongst other things. Those “other things” I’ve heard dentists say they can get over, if only the reimbursement rate were more comparable to private insurance.
The DDS I work for, would be found on both several private insurance lists as a Preferred Provider, as well as on the list from MA as a provider accepting MA insurance.
Also, not being able to get into an appt with your regular doctor….is your regular doctor signed up as Medicaid provider? If so, that may be why you can not get an appt with regular doctor sooner. We also have certain times and days where we see MA pt’s, as many do. Those spots are limited and therefore fill up sooner and further out. In our case, it had a lot to do with other dentists no longer, or not all, being signed up as providers with Medicaid—so we see a lot more of those pts.
Some doctors who are not signed up as Medicaid providers still see MA pt’s but do not have to submit to any insurance and therefore are accepting cash (for services normally covered under MA) from those who needed to have the free health care in the first place. Please be able to recognize the difference between the two providers.
All I ask, is that those of you who do not understand how Private insurance and Medicaid & Medicare work is to really do your research. Ask your dentist if he/she is signed up as Medicaid provider, if not, ask why. I’m sure they will enlighten you much more than I have. Ask those who are providing MA coverage what their big concern with it is.
For me, it’s a blessing when a patient on MA verbalizes they understand that the services we provide to them are done by us without making a profit and yet they are paying very little to nothing themselves. (We write off a huge chunk of change from public ins. compared to private ins.). After 7 yrs, it’s only been about a handful of patients that understand this. And I feel helpless for these patients who are struggling with money, lost their jobs and private insurance, and are now on MA, and would like 2 cleanings per year, metal crowns, and other services they were used to receiving on private ins, but still have to pay out of pocket if they want an extra cleaning or would prefer the metal crown. Public insurance and private insurance both have their own restrictions/coverages and headaches. One is actually run by the government and the other by private companies.
Government take-over on private insurance…”far more likely to happen and we all know it”……I don’t think so. Not those of us who understand how both systems work, see first post. Although, government should step in with oversight on private insurance, in my opinion, set up some rules and regulations….AND fix their own public system as well.
I hope that whatever happens with health care reform, that you continue to not be effected as many others I have seen. It truly sounds like MA has been a blessing for you.
Holy cow, you’re there! I posted so late, I didn’t expect to hear from anyone. I posted another long speech before I saw your post. You are correct, I do have issues with public ins as a whole (as well as some issue w/priv ins) and not just in the dental field—but for private dr’s it all works the same.
I sometimes wonder which would have been worse. John Gard as senator who didn’t understand how the MA provider reimbursement issue works and therefore wouldn’t know how to fix it–Or Sen Kagen, who does understand the system and supporting less reimbursement for his former colleagues.
Sorry for the 2nd long posting…would’ve stopped after the first, if I’d noticed your post first.
OK, it looks like I need to clarify a couple of things.
1) Steve Kagen is a member of the U.S. House of Representatives. His title is Congressman or Representative Kagen.
2) The list of providers I received after going to the ER ten times in less than a year was a “suggestion” to see one of my regular doctors rather than going to the ER. The issue was not “preferred providers” but rather that I had gone to the ER too many times, which is expensive. BadgerCare was “suggesting” I go to a regular physician next time instead of the ER.
The only medical doctor I’ve had trouble finding access to is a dermatologist. The local dermatologist at Ministry in Rhinelander left to go to Appleton or Neenah. The guy in private practice who runs his own shop here no longer accepts BadgerCare so now I go to someone in Wausau, an hour away.
3) As far as not getting into see my regular doctor, I wait the EXACT same amount of time as my mother, who sees the SAME doctor and is on a private insurance plan.
The doctors are just backed up here so they have set up a walk-in clinic for colds, sinus infections, etc. You go to the regular doctors for checkup and the serious stuff.
4) I had to have braces for the second time this last year. The provider didn’t accept BadgerCare so I had to put it on a payment plan and paid it off a little every month. I also just had gum surgery and had to pay cash because BadgerCare wouldn’t pay for that, either. I get my teeth cleaned twice a year and pay cash. I have to budget for that.
I have ALWAYS had to pay cash (check, credit, etc) for my dental/orthodontic work. Before I was on my own, my parents never had dental insurance either. They paid for my original braces in cash, too. I understand that this is an economic hardship for some people but I’ve always expected that I will have to pay for it myself. So some of your complaints don’t go very far with me. If it’s that big of a deal, stop accepting Medicare/Medicaid. I don’t mean to be rude, but you have posted very long diatribes on my blog.
That said, there is something to said about the burden of low Medicare/Medicaid reimbursement rates on small businesses. However, health care is Big Business and it is extremely hard to feel sorry for these giant corporations. This is not a reason to slow down or derail health care reform.
Also, it appears you have some grievances with Congressman Kagen, which may be very legitimate, but I desperately need health care reform. I don’t want to be on Medicaid forever. I want a public option or some other way to help me buy low-cost, high-quality health insurance so that I can become self-employed and get off disability.
Here’s a little bit more about my story:
http://danine.net/blog2/portfolio/why-i-need-a-public-option-for-health-care-reform9/
Regards,
Danine
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