Back in post #123 I mentioned that my mother’s Medicaid re-certification papers were lost by the Managed Long Term Care. The “entitlement specialist” promised that she would “walk the papers through personally.” (It was her goof). I was relieved. I had a quiet two weeks without major technical issues and, in addition, my mother was very quiet, if not “normal” for her.  There were few issues to which she would have a manic reaction; not sure that manic is the correct word, maybe over-reaction would be a better word choice, but her behavior reminded me about how she was some years back. Her doctor had once told me that her issues, common to the elderly, are reactive to a stimulus and for months we were living in “Stimulus-City;” day after day she was in a state of fury over noise and intrusion in her environment.

But I should have realized that a “late” (through no fault of MY own) re-certification of her enrollment for benefits would have an efficacy that would be a throwback to previous weeks where I spent hours on the phone.

Yesterday, a call from my mother: “I just wanted to tell you that my this and that didn’t arrive.”

By evening the this had arrived but the that hadn’t. The that being her Ensure which is a crucial supplement. So there I went again. Several calls to the usual provider alerted me that my mother’s benefit for the nutritional supplement would not go through. I realized that the flummoxed paperwork was the culprit; my mother was no longer known to the system during this period of bureaucracy. So… late yesterday afternoon I called her case manager, and then the entitlement department. The case manager was not in and I left two messages between my calls to Entitlement (3 times) Medicaid (4 different numbers) the Ensure provider, (3 times). Entitlement said to call the provider back and “tell them we will pay.” Well, that didn’t fly. No tickee in the computer, no washee. The offered solution: “get new prescriptions and we get new providers.” But I don’t want a new provider, this one was great and took me days to find them in this do-it-yourself-system.

I created a fax for the doctor and held onto it until this morning.

This is what happens when you are a navigator of a system: nothing, I repeat NOTHING goes smoothly because every step requires another step. It took 4 calls to Medicaid to verify that I was INDEED the legal representative, after all the calls yesterday where my name never came up in the system. Without filing as a representative you cannot ask any questions on behalf of the insured. And then I found out that I could. People in the system understood, the social worker was apologetic but the bottom line after three hours on the phone this morning to various people in different capacities is that you can’t bust through the 30-45 day waiting period for certification. Certification that WAS sent in on time but that got lost (again) in the shuffle.

So the way to get around this was likely what the Entitlement person told me: new prescriptions. Meaning I make the request and bug the hell out of the doctor’s staff for a month, and we end up paying out-of-pocket and submitting bills for reimbursement (which will be for less than what is submitted, at the government negotiated rate).

And then I called my mother. I asked the aide: “Is there any Ensure left?”

She crawled under the day-bed, our storage space, and reported back. “three cases. That’s twenty-four times three.”

At two to three per day that might just cover this waiting period. I put the stacks of papers back in folders, back in files, away and decided:

“What, me worry?”

I’m learning which battles to fight.

This series starts here:
Part 1: And The Band Played On … a mother’s life, a daughter’s journey

The previous post is here

The next post is here