Medicaid. Is it being abused? - page 12

Medicaid was a great idea when first introduced to assure that even the very poor could get quality health care. I just wonder when I see someone drive up in a newer car come up to the triage desk... Read More

  1. by   kadokin
    Quote from angel337
    just because a person is broke does not mean they have to look it. i understand the whole idea of brand new cars and jewelry and this used to upest me to, but i realize that you never know what life experiences a person has had and it is unfair to judge them off looks and possesions alone. when i was a medical assistant( a long time ago) i had to apply for financial aid. i was an independent student, living alone, no children and no help from my parents. when i sat down with the counselor she made a comment about my coach purse and said that if i could afford an expensive purse like that, i obviously could afford the tuition. she pointed out that she did not have a coach purse and she worked full time. she also assumed i had children. i politely told that idiot that the purse was a gift form my grandparents for my birthday and that i lived alone with no dependents. well let me tell ya....she apologized after picking her face off the ground. she went on to explain about other girls in the program and how they had this and that and were applying for financial aid. she was making assumptions and generalizations for alot of reasons i don't care to discuss (it will be a whole other thread). i can't concern myself with what other people APPEAR to have. sometimes the more people have is just an indication of how much debt they have. i mean, how well can you really live off a medicaid check? a nice car and jewelry does not always equate a nice quality of life.
    Hey, no kidding, a gov't stipend is not exactly a windfall. Then again, there are people receiving it that make big bucks under the table. I see TOO many people abusing the system, while others work hard, are un- or under-insured and can't afford a doctor visit or hospital stay no matter HOW sick they are. And as to the system itself, I'm not a big conspiracy theorist, but, if someone is paying your bills (i.e., the gov't), that person/entity has you under it's control to a certain extent. . .Something to think about.
  2. by   kadokin
    Quote from lisaloulou
    Is Medicaid abused? YES
    Can citizens who have temporarily fallen on hard times qualify for it- often not.
    Can women come from anywhere in the world and give birth and have their child qualify for the best in medical care,PT,OT,medications,home health,DME, transportation to and from appointments? YES

    My son who made $8000 one year and ended up with a $12,000 hospital bill could not receive one cent worth of "free" anything- monthly RX was over $250. They continue to pursue him to the ends of the earth for money even years later. The hospital has a religious foundation, but couldnt see fit to reduce the bill through charity for a 23 year old male who couldnt work at the moment because he made 8K the previous year.

    Same hospital,family brings in a non resident alien family member who receives inhouse care for several weeks- they go home with bill forgiven,free meds and DME and home health visits.

    I see this stuff on a daily basis. If you know the system, it is very easy.Why live in a third world nation when you can come here and live even without official documentation and enjoy what everyone else has to work for for free?
    Just keep those babies coming......
    NOT FAIR
  3. by   kadokin
    Quote from veetach
    I once had a pt come in with c/o "toothache". while she was there she said her son needed his finger looked at, I checked him out and he had a hangnail! I asked her if she really wanted to pay for an ER visit for a hangnail and she quickly informed me that she had Medicaid and she didnt have to PAY for anything in this hospital..... alrighty then...
    There's your answer right there, OP. A resounding YES!:angryfire
  4. by   hipab4hands
    Absolutely. If they can get a script for an OTC, then they get it for free or small co-pay for $1.
    I'm grateful that we have a system that does provide aid for those that need it. However, like any other system, the human race will find a way to cheat and manipulate it.
    What I resent is those families, who continue to have kiddies that they know they can't afford. It doesn't take a brain surgeon to figure out that if you can't afford baby #1, then having baby #2 and so on, isn't going to change your situation.
  5. by   kadokin
    Quote from kiyasmom
    I am so sure you do not mean your reply to sound so offensive and judgemental, so please excuse me if my reply seems laced in ice.




    First, I don't do ER visits. I've been in the ER ONCE in my life, two years ago, when my OB/GYN thought I was experiencing an ectopic pregnancy. BTW, my husband had Kaiser insurance. You didn't pay for my visit. :angryfire

    Second, I shop with coupons. Every time. I shop off-brand stores like Aldi. I don't do large chain stores like Wegman's because I know the value of a dollar or food stamp for that matter.

    Third, if I have a headache, I jump my *** in my vehicle and go to the drugstore where I buy my own damn Tylenol, without a script, out of my checking account. Yea, my husband gets a check, I am not on full welfare.

    I do not believe just because a person is down on their luck, they should have to suffer completely with no pleasures at all. I don't go out to eat, I don't go to the movies, I don't have hair extensions although I did PAY to get my hair done for the first time in 6 months yesterday. I pay my bills, and I am an upstanding citizen.

    I don't do drugs, smoke cigerettes, drink alcohol, or drink caffeine.

    *I AM USING CHILDCARE ASSISTANCE TO GO TO SCHOOL TO BE A NURSE SO THAT I DON'T HAVE TO RECEIVE ASSISTANCE ANYMORE*

    Please don't judge me or say comments in regards to saving thirty dollars to buy my own meds.

    FYI, I bearly qualified for the assistance I do receive, and that was only AFTER they did reductions for the hella child support my husband pays for his three from a previous marriage. One of which is not even his! (Yea, he's not a deadbeat father on drugs, either).:angryfire :angryfire :angryfire :angryfire

    I shared my story to show a point, not to be flamed or judged.

    God bless the poor.
    And God bless you and all the others (I was one once), who work hard to get themselves OFF pulbic assistance. The fact remains, what the previous poster wrote about is all too TRUE and it makes the folks that are REALLY TRYING look bad. It's not right and it's not fair that some people work hard for what they need, and others suck up whatever is available feeling that they are entitled to it. My .02.:angryfire
  6. by   mercyteapot
    We're hearing about patients who are coming in to the ER when they shouldn't be. That is but a small part of Medicaid. Yes, there is some misuse of Medicaid. But you're not telling us anything about the hundreds (or thousands) of patients that you've seen in the ER that didn't misuse Medicaid. And you're not even addressing the fact that Medicaid covers a wide range of services, of which ER visits reflect a fairly small percentage of total costs. Medicaid pays for transplants, cardiac care, chronic conditions, meds, DME, surgeries, AIDS treatment, psychiatric care, the list goes on. Even if there is a 50% rate of Medicaid misuse in the ER, it isn't as big a piece of the pie as some posts seem to imply.
    Last edit by mercyteapot on Jan 6, '06
  7. by   hipab4hands
    Quote from grannynurse FNP student
    never had a patient present demanding a pregnancy test. Guess I have just be extremely lucky. But then again, I haven't worked in 15 years and perhaps the public has changed since then. But then I would wonder why someone was coming in at such an hour and do something a little more then provide them with a list.

    Grannynurse
    Yes, patients have changed in 15 years. People use to have common sense about when to go to the ER/ see a doctor/ etc., Nowadays, there is a sense of entitlement. I can't tell you the number of times a day that I have to hear the phrase, " I pay X amount of dollars for my insurance, I deserve to get ___________. Or my personal favorite, "I'm on Medi-Cal, it doesn't cost me anything.'
    I could write a book about the excuses why people with non urgent needs go to the ER--anywhere from "I just want to know if I'm pregnant to "I'm too busy to go to my doctor's office, so I just decided to come to the ER."

    By the way, one of our local ER's is triaging patients without urgent medical needs, out of the ER. If you show up for a routine pregnancy test/ cold/ flu/ sore throat without any urgent symptoms, then you are referred for a next day appointment with a local doc or clinic. If the patient insists on being seen right away, then they are referred to an Urgent Care clinic, where the wait time can be several hours. They are finding there is a decreased in the use of the ER and many patients decline to wait in the Urgent Care clinic and leave.
  8. by   Multicollinearity
    Quote from hipab4hands
    Yes, patients have changed in 15 years. People use to have common sense about when to go to the ER/ see a doctor/ etc., Nowadays, there is a sense of entitlement. I can't tell you the number of times a day that I have to hear the phrase, " I pay X amount of dollars for my insurance, I deserve to get ___________. Or my personal favorite, "I'm on Medi-Cal, it doesn't cost me anything.'
    I could write a book about the excuses why people with non urgent needs go to the ER--anywhere from "I just want to know if I'm pregnant to "I'm too busy to go to my doctor's office, so I just decided to come to the ER."
    I do think part of this is a scavenger mentality. I think it is derived from the stress of the health care costs. I know for example I have gone to the ER *very sick* to wait 8 hours (I understand triage system mentally but emotions are what they are when you are sick) to recieve less than optimal care, then all that can rage in my sick head is "I have a $2000 deductible I'm going to pay for this?!" It's enought to make a sane, compassionate person like myself explode.

    Also, when your coverage is ending and you will be out in the cold with no coverage soon, you can be pushy to get what you know you need before you won't be able to. Not that this is ER staff's problem. But this is the reality. And then of course there are just irritating people who don't appreciate what they receive. And lots in between.

    A few months ago I took a friend to the ER. She didn't have coverage and in addition to pain, she was stressing to no end over the bill. Of course it doesn't help that the uninsured get billed about 4X the rates of those with insurance.

    Another friend, a Canadian RN tells me they don't have patients acting like this very much in Canada. Of course they don't have to worry about paying the actual bill and losing their coverage. I think this is why we have some of the entitlement/scavenger thing going on here. It's like, "If I'm going to get a bill for thousands of dollars YOU ARE GOING TO LISTEN TO ME." And unconscious thoughts like "I work at the job I hate ALL DAY EVERY DAY just for the health insurance so now that I'm using the da%$ insurance you better give me what I want." Thoughts like taht.
    Last edit by Multicollinearity on Jan 6, '06
  9. by   grannynurse FNP student
    Quote from multicollinarity
    I do think part of this is a scavenger mentality. I think it is derived from the stress of the health care costs. I know for example I have gone to the ER *very sick* to wait 8 hours (I understand triage system mentally but emotions are what they are when you are sick) to recieve less than optimal care, then all that can rage in my sick head is "I have a $2000 deductible I'm going to pay for this?!" It's enought to make a sane, compassionate person like myself explode.

    Also, when your coverage is ending and you will be out in the cold with no coverage soon, you can be pushy to get what you know you need before you won't be able to. Not that this is ER staff's problem. But this is the reality. And then of course there are just irritating people who don't appreciate what they receive. And lots in between.

    A few months ago I took a friend to the ER. She didn't have coverage and in addition to pain, she was stressing to no end over the bill. Of course it doesn't help that the uninsured get billed about 4X the rates of those with insurance.

    Another friend, a Canadian RN tells me they don't have patients acting like this very much in Canada. Of course they don't have to worry about paying the actual bill and losing their coverage. I think this is why we have some of the entitlement/scavenger thing going on here. It's like, "If I'm going to get a bill for thousands of dollars YOU ARE GOING TO LISTEN TO ME." And unconscious thoughts like "I work at the job I hate ALL DAY EVERY DAY just for the health insurance so now that I'm using the da%$ insurance you better give me what I want." Thoughts like taht.
    I took a telephone call for my daughter today. She is covered by my SIL's employer's health care coverage. At the end of August, she had to undergo a cervical laminectomy. Since it was non-work related, she received no loss wages benefit. She went almost three months without income. Only my SIL was able to work. And I helped as much as I could. The caller wanted her to call about the remaining $10,000 balance and when and how she would pay it. My daughter has better health care insurance then I do but she is being squeezed for payment. I am frequently squeezed for a higher payment of my $800 plus deductible for my last hospitalization. I do not think that I or anyone else I know have a sense of entitlement

    I have been in the ER at least six times in 2005 and hospitalized twice. I have never heard another patient or family make the demands that have been alluded to here I have over heard staff dealing with sick children and older parents and deal with them respecting their dignity, even when a member of the family is upset. I can understand why some people get demanding or pushy. And I understand that many get this way because of the stress they are under. When someone has no control over their physical situation, they tend to lash out at those they perceive to hold all the power. In the case of ER visits, it tend to be the nurses. Some need to remember this and deal with it in a professional manner. And not to assume control , as if they were dealing with a child. And as I have said previously, tax payer or not, no one has any say about my use of my Medicare or the ER. Nor do they have the right to judge anyone else's use of their coverage, be it public or private.

    Grannynurse
  10. by   grannynurse FNP student
    Quote from hipab4hands
    Yes, patients have changed in 15 years. People use to have common sense about when to go to the ER/ see a doctor/ etc., Nowadays, there is a sense of entitlement. I can't tell you the number of times a day that I have to hear the phrase, " I pay X amount of dollars for my insurance, I deserve to get ___________. Or my personal favorite, "I'm on Medi-Cal, it doesn't cost me anything.'
    I could write a book about the excuses why people with non urgent needs go to the ER--anywhere from "I just want to know if I'm pregnant to "I'm too busy to go to my doctor's office, so I just decided to come to the ER."

    By the way, one of our local ER's is triaging patients without urgent medical needs, out of the ER. If you show up for a routine pregnancy test/ cold/ flu/ sore throat without any urgent symptoms, then you are referred for a next day appointment with a local doc or clinic. If the patient insists on being seen right away, then they are referred to an Urgent Care clinic, where the wait time can be several hours. They are finding there is a decreased in the use of the ER and many patients decline to wait in the Urgent Care clinic and leave.

    I use the same ER for all of my medical problems. Since the hospital changed the location of its ER and the doors to the treatment area are locked, unless one arrives via EMS, they must be triaged, after they have signed in and listed their complaint. I hate it. Why? Because I am having a problem beathing and I need treatment now, not five, ten, fifteen or twenty minutes later after being triaged. I told my nurse this, just the day before yesterday, after having waited twenty minutes to be triaged. She told me the next time I come in, to tell them I was having severe breathing difficulties and need treatment immediately. She hopes that would work. Of course, I could come in by EMS but that to me would be a waste of my Medicare benefit. And another patient, in greater need, might be unable to get a rescue squad because I was using it.

    I don't want a metal, my chest is too crowded with all of my past ones. I just want people to recognize that there are reasons, some of which may be very silly but they are reasons. And it is not anyone's place to judge. And, by the way, if you had come into the ER I was working in for a pregnancy test, you would have been told it has to be the first voided specimen of the day. And at two in the morning, that is difficult.

    Grannynurse
  11. by   hipab4hands
    s. I just want people to recognize that there are reasons, some of which may be very silly but they are reasons. And it is not anyone's place to judge.
    Grannynurse[/quote]

    Sorry, but I have to disagree. Whoever is paying for those non emergent visits to the ER , either through public assistance or private insurance, has every right to judge the appropriateness of the visit.

    In the end, all of us pay for these high costs- these services are not "free". We all pay for these visits through higher taxes/ higher insurance premiums/ and cut backs in other benefits or services. Unfortunately, most people have not made this connection.

    I would love to see an Universal health system take place here in the US, but until then, we need to carefully use and monitor the use of our healthcare dollars.
  12. by   ednurse17
    I use the same ER for all of my medical problems. Since the hospital changed the location of its ER and the doors to the treatment area are locked, unless one arrives via EMS, they must be triaged, after they have signed in and listed their complaint. I hate it. Why? Because I am having a problem beathing and I need treatment now, not five, ten, fifteen or twenty minutes later after being triaged. I told my nurse this, just the day before yesterday, after having waited twenty minutes to be triaged. She told me the next time I come in, to tell them I was having severe breathing difficulties and need treatment immediately. She hopes that would work
    Your level of triage would definitely be a level 2, most urgent. I would take you before all the others if you were sitting in my triage area. Unless we're really busy we don't have people sign in, when we do, they do not list their complaint. My triage LPN quietly goes to the patients and assesses their needs. If you are struggling for a breath, you won't even be triaged, you'll be taken straight back to a room, a hall bed, somewhere quickly and treatments will be started. I do understand why some hate to be triaged, for whatever reason, its just important to the doctors that they know what the complaint/problem is so that they can better treat the patient. They need to know what meds you're on, your allergies, your medical conditions. We wouldn't want to jeopardize your health by NOT knowing something. I do understand the need for privacy. I wouldn't want to broadcast to everyone my reasons for being there or at the doctors office. Its the same anywhere you go. When you call your dr. office to make an appt, they ask you why you need to be seen. At least mine does. I would much rather you utilize the ambulance service than someone who uses it for a stumped toe. (yes, I have seen that one too) Your condition warrants it if needed. The others just don't have a ride, out of gas, etc. Yes, times and people have changed alot in 15 yrs. I can only remember one time I ever used the ER. I was 18 and had been vomiting for 2 days. My father couldn't take it anymore, he drove me there, we waited 4 hours to be seen. The same ER I work in now. But times have changed for the better too. We don't make those wait long or at all if we can put them somewhere, get a line started and give them something for their nausea. Next time that you do have to come into your ER for breathing difficulties, tell someone, security, a nurse, a volunteer, anyone. I promise you'll be seen quickly!! Sometimes the triage nurse is busy with someone else and can't look up at the moment you walk in. Trust me. It works!
  13. by   ERnights
    It most certainly is appropriate for my to be asking you if you smoke. It is my business the moment you come to our ED requesting whatever it is you may need. No I'm not going to defer this to the Doc. Not everyone that shows up at triage can be brought back in, I need to decide the severity. When I look at a pulse ox that's less than normal for nonsmoker, this may bring the severity up as opposed to a copd patient with a pulse ox of 93% and everything else is wnl.
    I also will ask you if you drink alcohol and how much and how many. This is our business too. We want to know if someone is going to start with the shakes once they sober up.
    This mentality really gets to me. I dont invite anyone to come see us in the ED, people come because they want us to help them. I can't stand when I ask someone to take off their coat or to get undressed when being brought into a room and they ask why. Well, I want to say, you can wait for the doctor with the xray vision or maybe it would be quicker for the normal doc who's on today to see you.
    Many people come in with an antagonistic attitude. They withhold important information from us making our job difficult. Then people complain that their care was less than ideal and their wait was too long. I'm so sick of people complaining about the wait. I want to tell people to look around at the waiting room full of people that are abusing resourses in the ED. I'm talking about those who could of waited to see their pcp, but it's not convenient or lord forbid in the day and age of fast food treatment, they have to wait. OMG! And people with medicaid do utilize the ED more I feel. When I go to the ED I have a $50 copay, sorry I wait to go to my PCP. There is no financial burden to medicaid recipients regarding using a ED. This is a huge problem. It eats up our staff, services and causes delays for people that truly need us. Not to mention the cost. Who does everyone think is paying for the cost of people overusing ED's. Well I'm done now, I dont post often but this subject gets to me. Everyone have a nice day.

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