Friday, April 1, 2016

Idiocracy is Alive and Well in My State

TL;DR: "But... this plan has electrolytes. It's what kids' providers crave."

I received an alarming call today from our speech therapy provider. Apparently, all of Curlytop's and Snugglebug's appointments (four per week, total) have been "suspended until further notice."

The reason? Because the insurance they receive through our state Adoption Support is being slammed into a Coordinated Care program, and our therapy provider isn't contracted with Coordinated Care. Supposedly, this change takes effect TODAY, April 1st.

But it wasn't an April Fool's joke.

"Oh, I'm sure that's not correct," I said. "If there were being changes made to the contract and plan we negotiated with the state, I'm sure we would have been notified, and had a chance to appeal."

Just to be sure, I called the Adoption Support line. I got a voicemail directing me to contact the insurance division, so I did.

I was presented with a tele-menu: Press 1 for... Press 2 for... Press 3 for... None of the options were for "freaking the fuck out," so I took my chances with option 3, which indicated it was connected to services for adopted children.


Marcia* answered and told me that their systems were down, so she wouldn't be able to give me any specific information -- only general information.

"Okay, can you generally tell me about this change to Coordinated Care, and how I can opt out of it? Because, see, my kids' service provider doesn't accept it, and that's a problem. My kids need their therapy."

"Well," said Marcia, "you will probably have to find another provider for your services, because all foster kids and adopted kids are being changed to Coordinated Care."

"Yeah, okay, except that I can't do that, because these therapists have been working with my kids for literally years, and both of my kids have anxiety disorders, and one is Autistic, and the other has severe Sensory Processing Dysfunction, and we can't just change providers without it being a massive upheaval of everything safe in their world, and why didn't I get any notice?" (Yeah, it was all one big, run-on sentence, and I didn't even breathe until it was out.)

"You should have received a letter."

"I didn't."

"You should have."

"I agree. I should have, but I didn't. So, let's fix it, okay? How do I get my kids off this Coordinated Care plan?"

"Let me transfer you..."

Press 1 for Foster Care. For all other questions, press 3... Apparently, 2 was no longer even offered. Whatever 2 connected to, in the first place.

I pressed 3.

Mary* picked up. I told her the whole story of how we adopted in 2009 and are having problems with the insurance change, and after a big long time of her trying to look up my kids (I thought the system was down?), she told me that there was a glimmer of hope, because, "Oh, my gosh... your kids are ADOPTED!"

"Yeah... I started the conversation by telling you we adopted in 2009. I know they're adopted. That's why I called Adoption Support."

"Well, they're in a our system as FOSTER KIDS, so we just have to get them switched over to reflect that they're adopted," said Mary.

"Great! So, how does the state not know they're adopted? And, that's it? We just switch them over to 'adopted' status, and they won't be affected by this Coordinated Care fiasco?"

"Well, no... It's for all foster and adopted kids."

"Then how will switching their status matter?"

"Let me transfer you..."

"WAIT! Mary, wait! When you transfer me, will there be a tele-menu? What do I push?"

"No," she said, "a person should just answer the phone. No prompts. I'll transfer you, now."

Press 1 for Foster Care. For all other questions, press 3...

(I'm telling you, it took everything I had not to throw the phone through the wall before pressing 3.)

"Foster Care. This is Darcy*." I thought 1 was for Foster Care? Who answers at 3? I wanted 3, damn it!

"Darcy, for the love of all that is good... Please tell me you will be the last person I have to speak with today," I cried. "I don't even know if you're who I'm supposed to talk to, because there wasn't supposed to be a tele-menu, but there was.

Here's the deal: My husband and I adopted our kids in 2009. Our Adoption Support covers them with open medical, but I was just informed by our therapy provider that our plan may have been changed without our knowledge to Coordinated Care, and now our therapy center can't see them, and has suspended all of their appointments. I need this change to not happen."

"Really? You should have got a letter."

"You know, Darcy, I agree. I should have got a letter, but I didn't. Anyway, can you help? Also, the last lady I talked to said the state doesn't know they're adopted, and that you can switch their status or something?" I was getting a little impatient. Not right then, but like fifteen minutes before that, so you can imagine the non-existent level of my patience by this exchange, right?

"Have you talked to Adoption Support?"

"That was the first call I made, and it directed me to talk to the insurance division, who transferred me somewhere else, where I was told that my kids were coded wrong or something, and they sent me to you. Well, to the tele-menu that got me to you."

"Well, for adopted kids, we can just take the change off."

"Really? You can really do that? Like, you can just make the change to Coordinated Care disappear? That would be great! Let's do that, please!" I was truly, remarkably relieved.

"Okay, well, our system is down today, so it will have to wait until Monday, but I can do it then. Why do you not want Coordinated Care?"

"Ummm... because my kids' service provider doesn't take it, and we need them to stay on open medical. What is the difference between the open medical they are receiving now, and Coordinated Care?" I asked out of curiosity.

"Coordinated Care is a managed care plan, so it's better."

"It's better because...?"

"It's better," Darcy sighed, "because it's MANAGED CARE."

(Apparently, my children's medical care is currently unmanageable? I really didn't understand, but, if you read on, you'll see that Darcy did everything in her power to enlighten me.)

"Ah... okay. So, the managed care plan doesn't contract with my kids' provider, so I don't think that is going to work for us. Please take them off Coordinated Care."

"But... Don't you want to talk to your provider, first? I mean, this is MANAGED CARE, so it's better," Darcy insisted.

"Right. But I've already talked to my provider, and they don't accept the managed care plan, so if we are on it, we won't get services from them. And we get several different therapies, from several different providers, so it might also affect any number of our current nine therapy appointments per week. Please take my kids off Coordinated Care."

"Okay, but do you want to talk to your other providers? Because this plan is better. It's MANAGED CARE." Gotta give Darcy credit for trying!

"Well, all of the services we currently receive from our current providers are provided through open medical, so I think we'll just keep that, and continue to get coverage that will allow my kids to maintain their current therapies. Thank you."

"Maybe I could email you a booklet about the managed care? I mean, it's a better plan." Darcy doesn't give up. I mean, I know she works for the state, but I began to wonder if she could also possibly be moonlighting as a Coordinated Care rep.

"Darcy," I said, "I don't see how it could be a better plan for US if it means we will no longer be able to access the services we NEED at the present time. How does that make sense?"

"Well, I understand, but it's MANAGED CARE, so..." I could hear her shrugging.

*awkward pause*

"Darcy, is there a little box or something you have to check to indicate that you've counseled me on managed care? Because, if there is, you can go ahead and check it. I'll make sure we get you off the hook. I'll tell them you really, truly tried to tell me I'm a fool for not wanting my kids on Coordinated Care. I've got your back, Girl... Go 'head and check the box."

*another awkward pause, during which Mr. Wright mouthed, "But it has ELECTROLYTES!" at least three times*

"No," she said, finally. "There's no box."

"Okay. Great. So, you'll call me on Monday and let me know that my kids' insurance has been unfucked? I really appreciate it. Have a great weekend!"

You can't make this shit up!


*Names have been changed to protect members of the Idiocracy

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2 comments:

  1. Love this! Unfortunately I have also experienced this. No one ever should. Frustrating as hell!Besides this CC business I have spent untold hours being routed around and on hold trying to get through to Molina, DSHS and Social Security when my 13 yr old disabled daughter suddenly lost her coverage for no apparent reason. Right before major surgery! Insanity.

    ReplyDelete
  2. Love this! Unfortunately I have also experienced this. No one ever should. Frustrating as hell!Besides this CC business I have spent untold hours being routed around and on hold trying to get through to Molina, DSHS and Social Security when my 13 yr old disabled daughter suddenly lost her coverage for no apparent reason. Right before major surgery! Insanity.

    ReplyDelete

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