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So, since I still had Kaiser coverage through Warner Bros., I called to make an appointment. That was a Thursday, and the earliest they could get me in was Monday, but they gave me the option to call first thing Friday to see if there had been any cancellations. That is what I did.
That Thursday was a 50% day. Friday was, miraculously, a 90-95% day. Of course. Like when you've been listening to your car make a bunch of funny noises, but by the time you get it to the mechanic, it purrs like a kitten. That was me, but I wasn't gonna ditch my chance to be seen before I dropped dead, maybe, over the weekend, waiting for the Monday appointment. I wasn't diagnosed with asthma or bronchitis or anything, but I was prescribed a rescue inhaler to cope with the shortness of breath and wheezing. And the doc indicated that if my condition got "worse" in the next week to month, I should follow-up with him. Okey-dokey!
The rescue inhaler did exactly what it was meant to do: it rescued me on winded days, and on other days, it just patiently waited to rescue me, just in case. My condition did not worsen, so I did not follow-up with the doc.
And then, in November, my health insurance "ran out". I immediately filed through the Covered California website, but apparently I did it wrong, because I never really heard from the state saying "pick a plan" or from Social Services saying "here's your free Medi-Cal coverage, because you're clearly eligible for it".
So from time-to-time, particularly before the ACA renewal deadline hit (January 31st, right?), I would re-visit the CC website. According to them, I should pick a plan, but also, I might be eligible for Medi-Cal, so what was the Department of Social Services telling me?
Finally, I got frustrated enough to call Social Services, because I ain't got the money for a self-insured plan through the website. According to whomever I spoke with on the phone, I needed to provide income evidence AND evidence that I wasn't still covered by Kaiser Permanente (oh! THAT's why I haven't heard back - you think I'm still covered!)... so I did. I took in all the supporting docs I could, and the day I went in, the elevator was out, and there wasn't a public stairwell for the hordes and masses to use, so the whole system was backed up with people waiting for a worker to see them. The worker who came to see me was not my assigned caseworker, so she took what I'd brought, made copies, and sent me on my way with a supervisor's phone number so I could follow up. #BureaucracyAtWork
Then some more time passed, and I still hadn't heard anything, so I called the supervisor a few times, leaving messages a few times, and then finally reaching a person! He told me the name of my caseworker and transferred my call. THAT guy said I was probably definitely eligible, but could I send/fax/bring in supporting docs? Ugh.
We made an "appointment" for me to show up 2 p.m.-ish that day, and things went very well. And now I'm going to tell you why I was beginning to panic about having no coverage:
My "rescue" inhaler had made it through the winter, and now it was Spring (well, for us), and the construction on the Shitology church was reaching its end-phase, and my breathing had gone back to total shit again. As of Monday of this week, I had 2 (TWO) doses left! From whence would I be acquiring a refill? I couldn't see, or even speak with, the original KP doctor, since I was no longer a KP member, nor did I really want to pay for the inhaler, if any insurance would cover it.
So on the 14th of this month (fifteen days ago, around 2 p.m.-ish), I was officially "granted" Medi-Cal coverage, and I was given numerous phone numbers to call to be able to use it to get that inhaler refilled, because even though Medi-Cal is state-sponsored "insurance", it still has to be attached to a "real" insurance plan. And since I had had a Kaiser Permanente doctor before, I have been trying to attach my Medi-Cal plan to KP. So I can see the same doc! And he can prescribe a refill! And I won't die from trying to take a full breath! #WooHoo!
Sooooooo Many Phone Calls have I made in the past two weeks. Interesting mail have I received, from both Social Services and Covered California (the latter is still saying that I should sign up for a plan, but I won't get the tax break, because I don't make enough money, but while we're on that subject, I make too much money for Medi-Cal, so ... I should sign up for a plan. All the while, the former is saying that I've been covered by Medi-Cal since November. What?)
On Monday, when I had two doses left in the old thing, I walked to the local CVS Minute Clinic, which I had been told by a CVS pharmacist would be able to "diagnose" and prescribe for me the same dealio I already had, and Medi-Cal would cover it (in case I couldn't get back to KP in time). It was a 10,000 step walk, but I didn't get winded (thankfully). But the nurse running the clinic couldn't take my Medi-Cal. She told me to Google free/low-cost clinics and call them to see if they do, or to do the same with Urgent Care facilities, as most (but not all) of those will be able to do what the first pharmacist had told me the Minute Clinic could.
But also on Monday, I received my Anthem/Blue Cross card in the mail. That is what the M-C plan is attached to until April 1st, when I'll be officially enrolled in Kaiser. Big deal. I'm not interested in seeing a rando doc I've been assigned to, this close to getting my Kaiser coverage back. So Monday afternoon, I took a new tack. I called the KP pharmacy phone number on the old Rx, told them what my issue was, and while I was talking to them, they sent an internal memo to the doc I'm not allowed to see or talk to, asking him to authorize a refill. If I had known to take that route as soon as I had my Medi-Cal letter, I'd have called them while I was also calling all the other numbers trying to switch plans.
*****See, Medi-Cal has to be "attached" to an insurance plan. In order to "attach" it to Kaiser, you have to have been a member already within the past six months. I was, so no big, right? Wrong. You still have to request "permission to enroll" and you have to get approved, and unless you stress that it's incredibly fucking urgent like I was, it could take up to a month to even happen, and then up to another half-month to your "effective" date. Meanwhile, you die of shortness of breath.*****
Ennyhoo. The KP pharmacy requested a refill from the original doc. He had up to 48 hours to approve it, but did so as of mid-day yesterday. Then I was instructed to have my local CVS pharmacy call to get the Rx transferred out, so M-C would pay for it. By the time my local CVS pharmacy got it done, it was today. Like, mid-day. When I called to see if I could pick it up, they asked me about insurance, and then they said that only Rite-Aid takes the M-C plan I'm currently covered by, but the Rite-Aid pharmacist would have to call the CVS pharmacist so they could transfer the Rx again.
So I found the closest (walking distance) Rite-Aid pharmacy and requested that they make it happen. They assured me, since they close at 9, that it would be done today. I called a few times, because by 6 p.m., I still hadn't heard that it was filled, and I knew I'd be walking, and I really didn't wanna walk both directions after dark. Their pharmacist had been trying, ever since my first request. CVS washolding my damn refill too damn busy to take care of business that they'd lost anyway. So I decided to walk to Rite-Aid, knowing I'd probably have to wait, but being there in person, I couldn't get ignored. (Not that Rite-Aid had been ignoring me, but what did I know?)...
Arrived at Rite-Aid ~7:30 tonight, and once it was my turn (there was a line), the pharmacist immediately tried calling them again, after telling me that the person at CVS had "lost the fax" and then gone to lunch. Whatever. I was sent to wait, so I checked my blood pressure. "At Risk" - wow. That has NEVER happened! I was called back to the counter so the pharmacist could tell me she'd been on hold for an hour, and what did I want to do? I recognized the classical piano on her speakerphone, so I didn't doubt that it was CVS on the line. I decided to call them from my phone, and wouldn't you know it? As soon as someone actually answered my call, and I was telling them that my pharmacist had been on hold for an hour, HER phone picked up with a real person!
She was a delight. A saint. She said she hated the classical piano, but I think that's only because she'd not gotten to choose what she'd be hearing on her speakerphone for a full hour, and frankly, it is one song on repeat, so I completely understood. However. she really did everything she could to help me not die of breathlessness, and she even wished me a safe journey home (walking in the dark)! Now I have My Friggin' Inhaler Refilled and all is right in my world. It only took fifteen days and seven hours to do it, give or take three months.
If you ever need a prescription filled or refilled, I give two big thumbs up for Rite-Aid, or at least the specific one on the southeast corner of Victory and Tujunga. Ask for Olivia. ;)
And then, in November, my health insurance "ran out". I immediately filed through the Covered California website, but apparently I did it wrong, because I never really heard from the state saying "pick a plan" or from Social Services saying "here's your free Medi-Cal coverage, because you're clearly eligible for it".
So from time-to-time, particularly before the ACA renewal deadline hit (January 31st, right?), I would re-visit the CC website. According to them, I should pick a plan, but also, I might be eligible for Medi-Cal, so what was the Department of Social Services telling me?
Finally, I got frustrated enough to call Social Services, because I ain't got the money for a self-insured plan through the website. According to whomever I spoke with on the phone, I needed to provide income evidence AND evidence that I wasn't still covered by Kaiser Permanente (oh! THAT's why I haven't heard back - you think I'm still covered!)... so I did. I took in all the supporting docs I could, and the day I went in, the elevator was out, and there wasn't a public stairwell for the hordes and masses to use, so the whole system was backed up with people waiting for a worker to see them. The worker who came to see me was not my assigned caseworker, so she took what I'd brought, made copies, and sent me on my way with a supervisor's phone number so I could follow up. #BureaucracyAtWork
Then some more time passed, and I still hadn't heard anything, so I called the supervisor a few times, leaving messages a few times, and then finally reaching a person! He told me the name of my caseworker and transferred my call. THAT guy said I was probably definitely eligible, but could I send/fax/bring in supporting docs? Ugh.
We made an "appointment" for me to show up 2 p.m.-ish that day, and things went very well. And now I'm going to tell you why I was beginning to panic about having no coverage:
My "rescue" inhaler had made it through the winter, and now it was Spring (well, for us), and the construction on the Shitology church was reaching its end-phase, and my breathing had gone back to total shit again. As of Monday of this week, I had 2 (TWO) doses left! From whence would I be acquiring a refill? I couldn't see, or even speak with, the original KP doctor, since I was no longer a KP member, nor did I really want to pay for the inhaler, if any insurance would cover it.
So on the 14th of this month (fifteen days ago, around 2 p.m.-ish), I was officially "granted" Medi-Cal coverage, and I was given numerous phone numbers to call to be able to use it to get that inhaler refilled, because even though Medi-Cal is state-sponsored "insurance", it still has to be attached to a "real" insurance plan. And since I had had a Kaiser Permanente doctor before, I have been trying to attach my Medi-Cal plan to KP. So I can see the same doc! And he can prescribe a refill! And I won't die from trying to take a full breath! #WooHoo!
Sooooooo Many Phone Calls have I made in the past two weeks. Interesting mail have I received, from both Social Services and Covered California (the latter is still saying that I should sign up for a plan, but I won't get the tax break, because I don't make enough money, but while we're on that subject, I make too much money for Medi-Cal, so ... I should sign up for a plan. All the while, the former is saying that I've been covered by Medi-Cal since November. What?)
On Monday, when I had two doses left in the old thing, I walked to the local CVS Minute Clinic, which I had been told by a CVS pharmacist would be able to "diagnose" and prescribe for me the same dealio I already had, and Medi-Cal would cover it (in case I couldn't get back to KP in time). It was a 10,000 step walk, but I didn't get winded (thankfully). But the nurse running the clinic couldn't take my Medi-Cal. She told me to Google free/low-cost clinics and call them to see if they do, or to do the same with Urgent Care facilities, as most (but not all) of those will be able to do what the first pharmacist had told me the Minute Clinic could.
But also on Monday, I received my Anthem/Blue Cross card in the mail. That is what the M-C plan is attached to until April 1st, when I'll be officially enrolled in Kaiser. Big deal. I'm not interested in seeing a rando doc I've been assigned to, this close to getting my Kaiser coverage back. So Monday afternoon, I took a new tack. I called the KP pharmacy phone number on the old Rx, told them what my issue was, and while I was talking to them, they sent an internal memo to the doc I'm not allowed to see or talk to, asking him to authorize a refill. If I had known to take that route as soon as I had my Medi-Cal letter, I'd have called them while I was also calling all the other numbers trying to switch plans.
*****See, Medi-Cal has to be "attached" to an insurance plan. In order to "attach" it to Kaiser, you have to have been a member already within the past six months. I was, so no big, right? Wrong. You still have to request "permission to enroll" and you have to get approved, and unless you stress that it's incredibly fucking urgent like I was, it could take up to a month to even happen, and then up to another half-month to your "effective" date. Meanwhile, you die of shortness of breath.*****
Ennyhoo. The KP pharmacy requested a refill from the original doc. He had up to 48 hours to approve it, but did so as of mid-day yesterday. Then I was instructed to have my local CVS pharmacy call to get the Rx transferred out, so M-C would pay for it. By the time my local CVS pharmacy got it done, it was today. Like, mid-day. When I called to see if I could pick it up, they asked me about insurance, and then they said that only Rite-Aid takes the M-C plan I'm currently covered by, but the Rite-Aid pharmacist would have to call the CVS pharmacist so they could transfer the Rx again.
So I found the closest (walking distance) Rite-Aid pharmacy and requested that they make it happen. They assured me, since they close at 9, that it would be done today. I called a few times, because by 6 p.m., I still hadn't heard that it was filled, and I knew I'd be walking, and I really didn't wanna walk both directions after dark. Their pharmacist had been trying, ever since my first request. CVS was
Arrived at Rite-Aid ~7:30 tonight, and once it was my turn (there was a line), the pharmacist immediately tried calling them again, after telling me that the person at CVS had "lost the fax" and then gone to lunch. Whatever. I was sent to wait, so I checked my blood pressure. "At Risk" - wow. That has NEVER happened! I was called back to the counter so the pharmacist could tell me she'd been on hold for an hour, and what did I want to do? I recognized the classical piano on her speakerphone, so I didn't doubt that it was CVS on the line. I decided to call them from my phone, and wouldn't you know it? As soon as someone actually answered my call, and I was telling them that my pharmacist had been on hold for an hour, HER phone picked up with a real person!
She was a delight. A saint. She said she hated the classical piano, but I think that's only because she'd not gotten to choose what she'd be hearing on her speakerphone for a full hour, and frankly, it is one song on repeat, so I completely understood. However. she really did everything she could to help me not die of breathlessness, and she even wished me a safe journey home (walking in the dark)! Now I have My Friggin' Inhaler Refilled and all is right in my world. It only took fifteen days and seven hours to do it, give or take three months.
If you ever need a prescription filled or refilled, I give two big thumbs up for Rite-Aid, or at least the specific one on the southeast corner of Victory and Tujunga. Ask for Olivia. ;)
Damn Emelle! I'm breathless from just reading all the frustration you had to go through. I'm glad you finally got what you needed.
ReplyDeleteThis post was originally titled "bureaucracy and red tape" but this title is more grabby, right?
Delete*I was never in any danger of actual death. :)
I'm currently on my dad's insurance plan because I'm far too poor for my own and he might as well do SOMETHING positive for my life... but when I switch over to my own plan, I'm definitely asking you for advice, since you've done literally everything already.
ReplyDeleteI honestly can't offer any advice regarding insurance. The system is really screwed up. I would love for the Progressives we have working "for" us to finally get us to a Single Payer deal, which is essentially Socialized Medicine, or what folks in this country are calling "Medicare for All". Because EVERY advanced Western society covers the health of its citizens, except for ours.
DeleteIf you have a doctor you like, who knows you, then you have to have insurance that will allow you to continue seeing that same doc. If you have a lot of health issues that require frequent visits, then you want a plan with a lower deductible so you get that outta the way right away and then everything else is covered for the year. If all you ever see a doc for is "wellness" (an annual physical), then you can opt for a higher deductible that you'll never meet but it won't matter, because wellness is usually covered w/o the deductible.
That's pretty much all I know about insurance. There wasn't a plan on Covered California that I could afford the premiums for, regardless of deductible!