My wife came home sick from work today. That, of course, sets off another battle with the damn state.
As per the request of those cowards at the USCP, I have agreed to no longer contact anyone I’d been contacting before. I have allowed one exception, an ACA Specialist at the HHS which called me back a few times afterwards. While she is thick as a brick, we only speak on the phone, and it is a recorded conversation, we keep it civil even though she, in now over a month of effort, can not find anyone in the HHS who understands the law. The best she’s been able to do is that, since the situation is complex, I should know by late 2015 or 2016, if I managed to be in compliance with the law in 2014. That lag time makes planning impossible, and this is something that HHS and the IRS just couldn’t give a damn about.
Calling “OHA Client Services” leads, on average, to wait times of 59 minutes – that’s 59 minutes with your phone on hold – waiting to get through to someone, just to figure out the pathway to seeing a doctor.
There is no intermediary agency governing CAWEM – this program does not appear to have been outsourced to a suite of implementing coordinated care management agencies.
Anyhow – I am now pissed as shit, and just wrote some letter off to email@example.com – then I realized that it was the start of another healthcare battle, so I took a bunch of tranquilizers and am going to try to sedate myself while we overcome the health-care-access obstacle described below. Again, since I will no longer initiate non-followup contact with administrators, I will confine myself to the physical 1-800-* client service pathway, or the publicly available general purpose info emails. Futhermore, I will only contact the agencies involved with the administration of the programs to which we have been assigned, and whose obtuse and incomprehensible rule, and poor implementations lead directly to these problems – all problems which could be solved by ensuring and simplifying access to health care – something our government just screwed up. But I feel it is prudent to keep you in the loop when the DHS picks another fight with me, which they do each time someone in my family gets ill and forces us to face some obtuse legal obstacle between us and our doctor.
Here is the situation and the question I am asking them (and I’m damn tired of repeating this to them – since this is the situation *they* created): does CAWEM require treatment waivers for non-critical care due to OAR 410 120-1280?
Here’s why it applies….
The DHS assigned my wife to CAWEM in our attempt to replace our existing insurance with MEC-compliant health care solutions using the expanded medicaid and the health care exchange system. CAWEM (This is not, we think, CAWEM-Plus, which we know nothing about) is a non MEC-compliant health care program administered via the expanded medicaid program which is run the DHS/OHA. CAWEM does not cover non-emergency services – it is less than, but similar to, the policy we carried previously – a catastrophic only, afforable, fixed-cap policy with a high deductible.
CAWEM is an OHP program and thus activates OAR 410 120-1280, which limits the abilities of providers to receive payment in exchange for services, because it embodies a bunch of protections that I do not want, but which I must receive by virtue of the fact that I am judged unreasonable by the state unless I value and want said level of intrusive over-protection. OAR 410 120-1280 protects me from an unscrupulous provider by assuming that I (a) can not so protect myself, and (b) even if I could, I desire to be so protected by the state in a known, uniform level of protection. There is an escape clause utilizing a waiver and re-establishment of limited rights process.
I ran into OAR 410 120-1280 and discovered the waiver process when I tried to book an appointment for my daughter to talk with a skin care specialist about some zits and pitting on her back. This is what I consider a $20 walk-in appointment at the hospital in my health care home. In Oregon it is a nightmare of bureaucratic obstacles. CAWEM specifically does not cover someone who is basically home with bhronchitis, but has a developed an odd, chronic muscle pain in her legs because she works a full 7 days a week, on her feet, walking, and has pre-existing joint problems because she has so worked for over 30 years. Treatment for such a condition, or even a consultation, wherein I pay money to see a provider, is not immediately legal due to OAR 410 120-1280, which, we think, requires the location of a provider willing to spontaneously re-negotiate our treatment and payment terms and who is suitable to the sort of injury and issues we’re seeking to cope with.
Since this is a legal question, it is not appropriate for me to bother my primary care physician about this – my PCP is for medical, not legal advice, and it is incorrect for the state to require our physicians to be legal experts – doing so directly damages the integrity of the doctor-patient relationship, wherein I want to make sure that my doctor is not distracted by obtuse bureaucracy, byzantine billing process, and intrusive, yet irrelevant, rules.
In addition, I know for a fact that my preferred provider is migrating away from insurance driven practice, following one of the new developments in provider remuneration – one that is based on a monthly subscription fee paid as a sort of health-care retainer. That being the case, distracting her and the clinic support staff with an obtuse question about a situation created by the failed bureaucracy of Oregon Health Care, well….. I just don’t see that my physician should be the first point of contact. I want the legal department who is responsible for Oregon Health Care to document the process by which I correctly obtain medical services for non-critical care for a legal permanent resident covered by CAWEM. Since we were assigned to CAWEM because of the mess of CoverOregon and Obamacare, I feel it is the government’s responsibility to answer this question.
So here I am – my wife comes home sick from work, losing a day of work, and I wonder what to do. At our other domicile we have access to high quality, affordable, accessible, patient driven health care at around 1/30th-1/50th the cost. We would walk into a doctor’s office and take care of it. Here, thanks to Obamacare, and thanks to the obtuseness of our laws, it is actually illegal for my wife to seek health care for non-critical conditions, – after she has been lawfully present in Oregon for 3.5 more years, however, she will graduate from CAWEM to MEC-compliant medicaid.
I would like to state one more thing – before my email, I tried calling the DHS directly. The receptionist who answered the phone had never heard of the OAR – she referred to it as “whatever it is you’re reading from” and indicated that she didn’t know what this OAR was. Imagine that – the person you talk to at the DHS is so competent, so brilliant, so wonderful, that they are *above* knowing what the OAR is. Wow…. i think i kinda lost it at that point.
sigh – i’m so sick of this shit, i just want to be able to see a physician that I trust, using my insurance with a $5000 deductible.
I’m also DAMN SICK AND TIRED of having to repeat this situation over and over and over – I have been working for months trying to get answers, and we have yet to find a single god damn person in the fucking federal fucking government, or the god damn state bureaucracy, who understands jack shit about this law. I am SICK and TIRED and I want the damn government to get the fuck out of my health care. Merkely’s office didn’t know jack shit about the law, wyden is a useless suck-up to money, and some ass from USCP told me that it was unreasonable to expect legislators to understand the law’s they work on. Really? So here the government walks into my life, tells me about some new health care laws, made me change a bunch of shit, changes the laws, changes them again, drops us in some government program, then shuts down operations and cuts town. What has changed? I can’t go to see a doctor – 100% unacceptable, and those useless motherfuckers in Salem owe me a direct apology – hell, they should pay for a platinum policy for my family for the next 10 years just because of their screwup. Treat them with respect starting with 59 minutes on hold – fuck them and everyone in the fucking OHA.
anyhow – you’re now in the loop – new fight – question: does CAWEM require the negotiation of treatment waivers for non-critical consultations?
BTW – i’m likely going overseas in a few weeks – I found a $585 flight to Chiangmai on a new promotional China Eastern route, and one that takes me through Kunming, the northern edge of Tai culture – at $585 I can’t miss the chance to fly over to visit family, oversee the planting, and meet the horses – just got two new colts – bringing the total to 6. Once over there, I’ll be able to walk into a doctor’s office, get a consultation, pay cash or arrange to use insurance if the bill is over, say $100. I will likely get my teeth cleaned by a competent dentist for $40 too – happy with my catastrophic-only dental insurance. The country is in the middle of the third coup in a dozen years, and it still has better health care than the u.s.
hope all is well and healthy with you and yours,