As you all know, we’ve had a dangerously cold couple weeks. I hope everyone stayed safe and had no unforeseen incidents. Most of us who have lived here for some time know the serious risks of being caught off-guard in extreme frigid weather. Getting stuck on a snow-blocked curb cut, an un-shoveled sidewalk or slippery icy spots can create a situation with potential for hypothermia, pneumonia or even death. Even as the weather turns milder, it’s important never to take winter weather lightly. Sure, we’re tough, but let’s be tough and alive.
The new year will bring me a new wheelchair, which I was granted by Medica after more than a year of jumping through hoops to replace a nine-year-old chair that required frequent repairs. The price that Medicaid paid was outrageous, but I had no control over that, and wish someone did. I went through several appeals of insurance denials as well as what’s called a Medicaid Fair Hearing at the state level, just to get the same specifications as my current chair. I’m grateful for the help from my durable goods provider’s rehab documentation specialist, although it caused the company (Handi Medical) extra time, and reduced their profit. The Disability Law Center also got involved and discovered significant mistakes made during the Fair Hearing process. In the end, the 20-month process required many hours of effort by me and many advocates, as well as a second visit by the Gillette occupational therapist to re-evaluate my needs. It was all much costlier in time and work and dollars than it had to be, and I’ll be glad to be using my new chair soon. I suspect most of you have similar stories you could tell about the frustration and expensive process of getting services that too often waste the state’s, and our own, and providers’, resources.
There are so many ways we could reduce the costs of health insurance by respecting the decisions of trained professionals. The state already requires extensive, specific curricula to educate and licensure to certify medical professionals. They know their jobs and responsibilities and the approval and reimbursement process should respect that. Yes, there need to be audits and compliance checking, but too often, healthcare clients have to wait weeks or months for appointments or care to take care of a problem that would be far less costly if taken care of quickly.
Of course, companies and bureaucracies recognize that many people will not fight a decision, and so it may be that cost savings are achieved through broad-scale denials of initial requests and claims. If that’s how things are designed to work, it’s a damned shame. In the disability community, it’s long been said that the Social Security Administration has such a policy for first-time disability status requests. SSA says that’s not true, but it is a fact that overall, about two-thirds of all new disability claims are denied, and only some are approved after appeal.
If money was used to provide early and efficient services instead of presenting obstacles, isn’t it just possible that we would be healthier and our provider organizations would be better off?
The legislative session is just around the corner, starting on February 20. As I’ve said before, many organizations are already planning their legislative priorities for 2018. Be sure to join in the community’s efforts to make sure your priorities are well-represented in a session where there are many demands for state funds.
Finally, I want to apologize for the many spelling and grammatical errors in last month’s issue. I can give you my word that I will watch much closer. Thanks to those folks who pointed it out to me; we really don’t want mistakes and I appreciate your responses.