Tags: medicaid

Stargazing Lhunie - SyMara

On Life And Dental Emergency Stuff

Checking in again. Trying to be better about doing it and write more regularly. But don't want to burden anyone with any more negativity than already exists in the world, so I don't talk about half the stuff that does happen.

Still pretty raw and numb over losing both my Aunt and Ember. It has been rough, for the lose itself, and the millions of complications each loss created. Finally managed to get a box of tissues from the store and had a good long and hard cry. Trying to cry a less and not feel sad when I remember.  Trying to celebrate them and remember all the happy times. Tried not to cry while writing this - didn't succeed.

Otherwise not much has changed for us, despite the world gone crazy. Mike working from home and me disabled and staying home majority of the time, we already tried to avoid going out in public much before the outbreak.  Only problem was the increased difficulty of getting anything we ordered online or for store pickups, which we regularly used before everyone started doing it. At first everything was out of stock everywhere. I think the stores are starting to catch up to some degree. but it still sometimes takes multiple orders to snag everything we need, especially the most in demand products.

Been having trouble with my broken teeth and jaws again. It has gotten pretty bad, and I discovered that no one around here accepts the adult Medicaid I have. Not even regular dentists. So I literally would have to go 3hrs+ for any dental treatments of any sort, for it to be covered and not have to pay out of pocket. That is absolutely insane and unacceptable.  Why is dental care not considered as important and part of medical?  Sorry you don't have any teeth or can't eat anything, sucks to be you!  Being able to eat and have healthy jaw structure to easily speak and perform other daily activities, nope, not an important quality of life factor at all.  That seriously needs to change.

I have been miserable for 5yrs + trying to get my dental and jaw issues fixed, just getting worse over time. The pain has been so unbearable at times, I have been suicidal. So many times I literally thought about taking a pair of my jewelry pliers and scalpel to pull them myself. Just to make the pain stop. The amount of pain and related side effects I endure from the numerous exposed nerves and broken teeth, amplified by my neurological and pain sensory disorders, has left me unable to function a majority of the time, even with nerve blockers and pain meds.

I am not sharing this to upset anyone or make anyone feel bad. Just that I think people should be aware things like this happen to others and are not widely recognized like they should be. Until they are, the system will not be forced to change. No one should be forced to live this way, for years, just because they can't afford proper treatment.

These providers shouldn't be able to get away with denying someone care just because they don't want to accept Medicaid. Especially in an emergency situation like mine, with abscessing, infected teeth. People on Medicaid are normally the most vulnerable and at risk, many with little or no income, who desperately need help and like with my own situation, try as they might to improve their life situations, constantly get screwed by the system. It is disgusting and makes my blood boil in a rage I cannot properly express in words.

Anyway, enough of that. I hope that all of my friends out there are safe and well during these strange times.  Please continue to stay safe in the "better safe than sorry" sense.  Wash hands, wear gloves and masks, and treat it seriously. You might not be effected by it. But people like myself, my mother who is having cancer treatment, and my grandmother who is in her 90s are at a higher risk.  People like us could get it because someone else was selfish and careless thinking everything is "back to normal".  So just be smart and cautious and considerate of other people, and encourage everyone you know to do the same, so we can all get through this as safely as possible.
My Mind Escapes Me

Am I back yet?

Just when I thought I'd be back and be able to catch up with online interactions, something else comes up.  Dealing with things as best as I can. Most of it doesn't warrant expending the energy to mention.  Some of it meh.  Some of it sad.  Most recent being the loss of one of my aunts to medical complications.  It was sudden and unexpected, and still hard to accept.  The circumstances around it have made me reflect on my own health issues. I have been in some bad mindspace, so I chose not to burden others with it. Not any different than any negativity I have shared in the past, so why sound like a broken record.

In better news, the Medicaid expansion finally hit.  I got everything with it straightened out, I think.  I went and saw my eye specialist and my rheumatologist. It was finally decided since we'd tried everything else with limited results, it was time to try adding  immunosuppressants. I have been taking Plaquenil and Restasis since then. I wasn't able to until now without insurance, because the Restasis alone would have been over $500 per monthly supply out of pocket, similar to the problems I had with getting my Cymbalta before it went generic.

There is no generic for Restasis, so I am having to fight for a prior authorization for it. The insurance allowed the first month purchase to go through so I would have it, so kudos to them for thinking of the patient in these situations. Now I just hope they are reasonable to approve the prior auth since it is literally the only medication of its class and kind so there are no alternative treatments available to substitute.  I also saw my new primary and she seems pretty awesome. A lot like my awesome Mayo doctor was the first time we met.  Getting referrals for lab work and to see an orthopedic specialist, neurologist, and endocrinologist finally, after waiting an eternity.  Here is to hoping I can get approvals for a bone density scan and MRI real soon.

Finished gathering, compiling, and submitting all the information for my Disability appeal.  My rheumatologist and I sat down and compiled a whole slew of things to throw at them, based on their own listing criteria, and directly quoted those criteria and offered detailed information for a functionality report based on models they use, which should be more than enough medical evidence to support my claim and get approval.  Now it is just a matter of waiting again. It could take a year or more before the case is even issued to a judge.  Unless someone in the processing department reviews it and sees how blatantly it is that I meet listing level criteria and should have been approved the first time around.  Jump. Through. Hoops. Makes my fur bristle the more I have to conform to their inadequate process.

The benefit of waiting is that it gives me that much more time to research and be thoroughly prepared for the hearing when the time comes. I did speak with a helpful woman in their support department who sent me some information for legal assistance for low/no income individuals. I plan to utilize it if I am able to. It's not the same as retaining a private attorney, but I'm sure I can learn something either way if I qualify to use it.
Back to catching up on things I missed.
lwdoodle

Disability Update

Stage one of Disability determinations completed. I called SSA today and apparently I have a new worker, which explains part of the run around. She confirmed everything with me and told me she'd be submitting my case to their doctors for review tomorrow.

Now waiting to hear back on the medical determination stage. This is the big one, where the longest wait normally is. Cross your fingers, and send tons of positive thoughts and prayers for a positive outcome.  Hoping for the best, expecting the worst.
lwdoodle

Preparing For Battle

I have been a little scarce recently. Taking care of medical related stuff.  I am finalizing my Disability/Medicaid application process next week.  I will be going in person with faithful Ember at my side to present my 3inch+ thick folder of medical records and documents, letters of support ( thanks again to those who wrote them ), and fully detailed write-up of my conditions and their effects on activities of daily living and how they adversely effect my ability to work for gainful employment ( lack thereof ) or enjoy activities the way I could before my body decided to try and self destruct.  I am going in fully expecting I will be denied the first time and will have to appeal. They normally almost always deny you the first time, even if you have a metric ton of supporting evidence like I do.  If by some miracle I get approved on the first try, it will be so totally unexpected I will implode from sheer relief and happiness.  I won't hold my breath though.  Thoughts, prayers, luck, and well wishes are greatly appreciated!
lwdoodle

Disability App Preparations

Apologies for the lapse in presence on and off recently. I have been busy for a little while working on putting together all of this information for my disability application process. Digging through old paperwork to find things to use ( thank goodness I kept it ), collecting and sorting documents from providers.  Just waiting on responses from two doctors and that should do it.  I wrote a ton of things with medical jargon and ICD-10 codes to throw at them. 10+ pages to tell them how all this affects my daily life and ability to function. Hoping "doing the work for them" will strengthen my case some, but not holding my breathe.  I expect I will be denied the first go-round, as that seems like the popular thing for them to do. Will probably be submitting everything before the end of the month.  Anyone interested in reading any of it and giving their input?   Also on that note, would anyone like to write anything on my behalf for me to submit to them?  On why you feel I should be able to finally get this help I needed ( and probably should have asked for ) years ago and why it is more important I have it going forward?  I mean, lets face it. My body is self destructing itself one collagen molecule at a time.  That isn't going to change anytime soon!
lwdoodle

LA Medicaid / LaCHIP Aggravations

I am ready to kill someone. I have been fighting with this Medicaid determination nonsense and jumping through their hoops and sending them everything they have asked for, for months. I applied back in November.  I had to call repeatedly and ask them for updates on the status because they never sent me additional information in the mail or called me. They kept telling me "It was under process and review in Baton Rouge". This run around happened for almost 2 months, with me leaving messages and not having my calls returned. Then I *finally* managed to catch the woman supposedly helping handle my case on the phone, and she tells me the same thing again.. and at that point I blew up, telling her the "coverage" they stuck me with "in the meantime" does NOT have prescription coverage for medications I need to function like a normal person. And there was a pause on her side, and then she says "Well we're still waiting to receive your medical records from Mayo Clinic. We sent 3 requests."

Excuse me?!  So you have been waiting for records over a month, never got anything from them, and *never* bother to contact me about it?  I was livid, and I expressed such.

Thus I had to go and call Mayo myself, and get bounced around between their departments, but not a single one that was relevant for medical records requests typical of the kind Medicaid offices send, had any requests of that nature on file.

In other words, they had never been contacted by Louisiana Medicaid asking for my records. So either they never did it, or they sent the request to the wrong place somehow, repeatedly.

So I kindly requested the correct info direct from Mayo, and then called the woman back and gave it to her so she could request it again.  So once again I give it a week, because it was the weekend by then. Nothing heard back, I call and leave a message, no response. I wait, and I call and leave another message clearly asking if they had gotten my medical records from Mayo, and requesting a callback and offering my number.

I finally got an issue with my Mayo online patient portal cleared up, and I can access certain condensed versions of my medical files. So I call the woman back again, and get her voicemail again. I leave another message asking again to be contacted so I know they got my Mayo files, and I asked if they had not, could I try and get some of the relevant files from my patient portal and send those instead as proof of my medical conditions.

They still haven't called me back as of Friday. Then Saturday I get another letter in the mail dated for the 19th stating they needed me to resend my bank statement info because what I sent before wasn't adequate enough ( it's an online only e-check account, so yeah ).  No mention of *anything* else, not telling me they got my message or medical info, just requesting I resend the bank statements.

Now today I get something dated the 20th, literally the day after they mailed the other thing, telling me they have determination I am not eligible. *Before* I have even sent them the remaining info they requested.

My blood is boiling over the aggravation and stress this has put me through, on top of the burden of trying to come up with $500 per month *before* the Cymbalta generic came out, and now still having to pay $300 a month for the generic of Cymbalta. I had to cut my dose in half so I could safely taper off of it, because my family can't keep struggling to scrape out that much money that none of them have for something that used to be almost fully covered by my damned Minnesota state aid healthcare.

It is clearly obvious these people are either complete idiots and the left hand doesn't know what the right hand is doing, they are intentionally doing this to screw me ( and who knows how many other people ) over, or all of the above.