Guest Blogging in bold black lettering on a spiral notebook paper, on a desktop with a cup of coffee, laptop computer, and other accessories.
By Allison Jonergin
Dealing with Medicare, Medicaid, and the Department of Social Services on top of doctors’ offices and pharmacies is a nightmare.
By now we all know that healthcare in America is screwed up. That goes for all Americans, but the disabled are at an even steeper disadvantage.
We’re forced to rely on Medicare and Medicaid, and as such, are at the mercy of the politicians who write laws dictating their terms. Being that Medicaid funding is a partisan issue, Medicaid programs vary widely from state to state.
If I need to see a specialist out-of-state, my NY Medicaid won’t apply, leaving me with significant out-of-pocket costs that Medicare doesn’t cover. I also have to have a separate Medicare Part D insurance plan to cover my prescription medications, meaning I have three separate health insurances to fight with.
I live with multiple chronic illnesses, and thus attend doctors’ appointments quite regularly. I spent two months delaying treatment this summer after being told any future visits taking place prior to the conclusion of my current benefit year wouldn’t be covered.
As that date wasn’t for another five months, I hurriedly contacted every one of my providers to cancel my appointments. Furthermore, I asked that they each file a request to increase my Medicaid Utilization Threshold, which outlines an arbitrary number of appointments Medicaid will pay for in a given year. I faced confusion from virtually all of my doctors’ offices, and was told by many it would take weeks for them to even receive the forms needed to file the request on my behalf. When nearly all of my doctors offices had successfully increased my limit, I was finally told by Medicaid that as long as my coverage is active, I cannot be turned away from an appointment. The doctor’s office, however, will need to battle it out for payment.
It’s no wonder so few providers accept Medicaid. They are paid so little for their services, and face the same hurdles we do when trying to secure payment. These reasons factor into why it’s difficult as a patient to find accessible care.
One mission President Biden has is to expand Medicaid, but it seems the only means by which he hopes to do so is by broadening the eligibility criteria. Unless his plan also includes changes to Medicaid’s administrative procedures that will streamline the billing process, I fear the existing issues will only be compounded as the number of covered individuals rises. Eligibility means nothing if you have to travel to find a provider.
My dentist’s office, for instance, is located 50 miles away, because that was the closest one I could find that accepted Medicaid. For some, that may lead to putting off or foregoing treatment altogether.
Additionally, the amount of time we must spend on the phone to ensure we receive the care we’re entitled to is maddening. It doesn’t help that we often have more doctors treating us than the average able-bodied person, multiplying the legwork it takes to coordinate our care.
In regard to President Biden’s agenda, expanding the eligibility criteria for Medicaid would benefit many Americans and their families. Therefore, it is even more vital we enact changes so that Medicaid functions better for everyone.
Allison Jonergin is a SUNY Plattsburgh alumna and North Country native. She has multiple chronic illnesses including fibromyalgia, CFS/ME, endometriosis, irritable bowel syndrome and degenerative disc disease. She also has post-concussion syndrome, anxiety, depression and PTSD.
We are always looking for writing on disability-related topics by people with disabilities in the North Country. If you are interested in writing a guest post for the NCCI Blog, send an email inquiry or draft article to: apulrang@icloud.com.