Friday, April 30, 2010

On Medi-Cal - or not

It’s the waiting game, and I know a lot about playing it. I’m playing it now.

I went back to Casa Colina Hospital a couple weeks ago as part of an evaluation for a getting speech device - the Vmax by Dynavox. (See April 7 post.) This was the last appointment in the process, and now comes the hardest part.

Yep - waiting for Medi-Cal to approve - or not approve - my getting a Vmax (a reader has told me that "the device" sounds like a disease).

The three therapists who have now seen me - I have a team! - have (hopefully) written a report, endorsed by my physician, arguing why I should have the Vmax and submitted it to Medi-Cal. (The report was still being written as of last week, when I was called with a question.) I have been assured that my case is strong (gee, why do I feel like I’m on trial?). I’ve also been told that it will take only about a month for Medi-Cal to process the request, which, based on past experience, I find hard to believe.

Actually, the appointment two weeks ago wasn’t about the Vmax. It was about my wheelchair. The two therapists who had seen me were not happy with my chair, and so I had this appointment with a physical therapist and a wheelchair vendor. I went with some trepidation, fearing that they would want to get a chair in which my movement would be severely restricted, and I took a note explaining in detail what I want and don’t want in a chair and why I like the kind of chair I have. The P.T was completely cool, agreeing with my assessment. She had me get down on a mat, and I said I hadn’t been looked over so carefully since I was about 10 - literally. The wheelchair vendor was a rather amusing, opinionated woman who couldn’t get over how dirty and gross my chair was. (Okay - I’ve had it cleaned!) It was agreed that I should keep this chair and have it remodeled, with the back moved back, so I’m not thrust forward with my legs splaying, etc., and with more supportive footrests and a better cushion.

I was told that it will take several months for Medi-Cal to process the request for this remodeling, which makes more sense to me. It also fits with what a few people I have spoken to about this have theorized - the is, that Medi-Cal is more likely to take longer with and perhaps deny requests that are more common. In other words, unlike with a wheelchair or wheelchair repairs, it is easier to get a Vmax, despite its high expense, because the demand for it isn’t high. This sounds backwards, but it makes weird, logical, bureaucratic sense. (I was once told by Medi-Cal that I couldn’t get a new wheelchair, because I was getting too many repairs on the one I had.)

This is probably what’s behind the decision to stop Medi-Cal funding for dentistry, except for extractions, when California’s finances got even worse last year. Everyone on Medi-Cal needs dental care, making the demand all but overwhelming and, thus, too difficult. Speaking of Medi-Cal not paying for dental care, I recently called the dental surgery center where I have work done (I have to be put to sleep) and asked what I would have to pay. The answer was a shock: $1,200.

I thought briefly about going to the free medical and dental clinic going on now at the sports arena in Los Angeles. Thousands of people are going there, many coming from far away and waiting hours and even days, and thousands were turned away when the clinic took place last year. Then I remembered having to be put to sleep (because of my uncontrolled movements). Besides, I don’t want to wait in that line. Am I spoiled? In any case, the pictures of people waiting in line and getting care in factory lines, all in one of the world’s richest cities, is an eloquent answer to the loud, angry questions about why healthcare insurance reform is needed in this country.

1 comment:

  1. good luck getting your voice machine! on a separate note, look 4 a friend of mine who recently moved to Claremont: Katrina... a Quaker and peace activist. (Is that redundant?!)