Health Care Form - getting worse

Remember Al? Remember how I was optimistic about him getting dis-enrolled out of "GreenCare"? I was wrong to be that optimistic. Al, a Tasks client, is now caught in the dysfunctional managed care plan which will not provide him the medical care he desperately needs...


Al has a bright and experienced Tasks Unlimited Case Manager, Peg (not real name), who is now advocating for him full time. Since her involvement, I thought that she could help spring him from the clutches of "GreenCare" on Aug. 1, 2008. But I was wrong; I underestimated how difficult it would be. Turns out that it is easier for a court-committed patient to escape from Anoka State Hospital than to dis-enroll from managed care.

• In early July 2008, Al's Case Manager, Peg, had him send his GreenCare Coordinator the dis-enrollment form. But Peg was informed that it was the wrong form.
• Peg requested that the correct form be mailed to her, but the Coordinator didn't have the correct form and referred her to someone else
• The other person didn't have the correct form either.
• This went back and form several times, until it was determined that the correct forms didn't exist. A letter would be sufficient, but it had to be sent to someone else at GreenCare.
• Peg sent the letter as directed, but that didn't work either. The recipient suggested sending the letter to "someone at the State," but she wasn't sure who.
  

Meanwhile, July has ended and August has begun. As I write, Al is still enrolled in GreenCare and is still without the medical services he needs, and still ineligible for M.A. because the funds the government would otherwise use to pay for his health care are still going to GreenCare. Peg will continue to advocate on Al's behalf; maybe Al can get his health care restored in September but I'm now cautiously optimistic.

My theory? There are no procedures for dis-enrollment. During the planning stages of privatization, I (and others) asked about dis-enrollment and were repeatedly told that anyone could dis-enroll at any time, and they continue to insist that this is true. No one at GreenCare, or at any other insurance companies, bothered to come up with a dis-enrollment process. They don't even have the forms!

To the insurance companies I ask you this: If you can't take care of one person, how do you propose you will take care of everyone on M.A.? I want them to explain to Al why he can't get his post-operation check-ups and why all the promises they made don't apply to him.

Healthcare Reform - better?

In 2007, legislation, promoted by Governor Pawlenty, was passed pointing towards privatization of our previously public mental health system. The proponents of this legislation say it will be "better". I guess that could be possible, but what scares me is that, no one has ever articulated a single, clear, compelling reason why we ought to privatize. I've heard lots of different reasons, but they are vague and ever changing. It kind of reminds me of when we invaded Iraq.



Privatization began this past spring when various private health care plans launched something called Special Needs Basic Care Plan, or SNIBS (don't ask). SNIBS are voluntary; consumers don't have to sign up for a SNIB. Preferred Integrated Networks (PINS) are scheduled to roll out January 2009 which will be less voluntary and eventually involuntary. SNIBS have begun soliciting (some more aggressively than others) people with serious mental illness to sign up. So far, the skeptics that we are, Tasks has been urging our clients to be cautious about giving up their Medicaid (M.A.) for private insurance.


But Tasks clients tend to be free thinkers, so one, Al (not real name), signed up with a SNIB, GreenCare (not real name), on 6/1/08. Al's troubles with getting medical care began immediately:

• Al is currently on medical leave due to a recent heart surgery but his surgeon is out of the SNIB network. Now, he has to find a new surgeon.
  
• Al receives case management from Tasks Unlimited (he is currently on medical leave recovering from heart surgery) and Tasks has a contract with GreenCare to provide Care Coordination for clients who enroll. We submitted the list of clients to GreenCare but did they check the list for Al's name? Nope.
  
• All routinely receives occupational therapy through M.A. The GreenCare rep told Al it would be covered. What he neglected to say was that Al's diagnosis excludes him from this coverage. Will he have to go without therapy?
  
• GreenCare promises free transportation to doctor appointments, and their Care Coordinator insists that this is true. But Al has been unable to navigate the automatic reservation system and the Care Coordinator suggests that "something is wrong with Al that he can't do it." A Tasks staff member has tried to navigate the automated system and even she found it difficult.
  
• SNIB rules allow dis-enrollment at any time. When we heard about Al's difficulties, we encouraged him to dis-enroll. He called his GreenCare coordinator on June 26 and submitted a request the paperwork. Oh, by the way, dis-enrollment is more difficult than enrollment so we assisted Al in completing the paperwork and mailed it back on July 3. But it turns out that Al can't dis-enroll until the end of the month, so he won't get his M.A back until Aug. 1. Meanwhile, Al goes without the medical care he needs. Tasks will provide Al a ride to see his psychiatrist, who, thankfully is in-network.
  

I had, optimistically, anticipated that some Tasks clients would have good luck with privatization, and others would experience various problems. I never imagined that our first, volunteer guinea pig would encounter every possible problem.


It may be early on but so far, privatization doesn't seem "better" to me. You know what scares me? Al will have to go without medical care. How many people will we lose to this health care reform?


Email me for more information or for ways you can help actually make the healthcare reform...well, better.