Patients on Medicaid - page 3
by DiEd 33,391 Views | 333 Comments
I hope not to offend anyone out there, but I would appreciate some feedback on taking care of young to middle-aged adults who are on medicaid. It seems that so many (I realize not all) are some of the most difficult patients to... Read More
- 0Aug 30, '07 by kanzi monkeyI gotta go to work, so I'll be fast (and perhaps inarticulate)
Many people in this country refuse to understand the gap between people with money and people without it--the bourge/the proles. Seriously. We are so backwards.
Most if not all industrial countries have some kind of socialized medicine--so HCP's don't ever have to consider financial status when providing healthcare.
- 14Aug 30, '07 by MAISY, RN-ERImagine a patient asking for tests and an extra day in the hospital...that used to be the norm, not the exception. Now, imagine this patient is on medicare with minimal access to healthcare. As that patient, I too would ask to get everything over with, asking for those extras while I was already there. There is nothing like trying to get a physicians appt or specialist to see you with medicare, unless things have changed they aren't required to see you unless you were seen by them or referred to them by a hospital.
As far as, asking for medical things that can be purchased in grocery store. You are right, it's cheaper to buy with your own cash-but medicaid will not reimburse. What if that cash is for your meals, or rent?
There is nothing quite as "special" as requiring any assistance. This is especially true of people who have never needed it! So, I can imagine the world of rudeness that awaits them due to their currant financial status can be frustrating, and just a little"unpleasant". That may explain any attitude you may feel from a medicaid recipient.
It's back to walking a mile in someone's shoes....when I was much younger, my ex left me with a baby and toddler. At that time, you couldn't get childcare for children that weren't toilet trained. I had no money, no insurance, a flaky husband who walked out and was really in a bind. I was in my mid 20's and had always had insurance. What an eye opening experience. I received wic and medicare-the grocery store clerks felt they had the right to treat me anyway they wanted to due to my wic checks and sure you could go to a clinic for pediatrics and sit there for 8-10 hours and maybe get seen that day or not. I was lucky that my personal physician(who agreed to take the very low medicaid payment) would see my children and care for them. He always gave me medicine samples-I wasn't forced to buy anything. I was lucky. I'd always worked, been a contributing member of society and was using a benefit that was there for people who got into trouble. It was a couple of years, then it was back to work as usual. I never forgot what those people like me went through....again...I was lucky, I never truly suffered.
Everytime I read a thread that beats on people that are poor I really get angry. A bad choice in life, a wrong turn, a bad marriage or life changing illness is all that stands between making it or not making it in life. It's easier to understand an attitude from a young nurse, but I have a problem with older nurses who have been around the human condition awhile longer. Everyone's experience is unique-we can only do our jobs without prejudice and advocate for those extras if the patient needs it.
Rudeness knows no socioeconomic class, race, religion, age, etc. , but it affects both medical staff and patients. Definately not reserved for poor patients!
"Judge not, lest ye be judged"
- 6Aug 30, '07 by StrwbryblndRNTwo years ago just before I was to start nursing school my husband was the bread winner and had the best insurance you could get. (hospitaizations were $0 and very little came out of his check to pay for insurance) We had plenty of money and had planned for me to go school and we would have no debt when I graduated.
Then all he$$ broke loose. He lost his job and could not find another for awhile and still had to wait 90 days after hire for insurance.
We went on medicaid for the children for awhile and it really hurt to be treated differently. We went to a large and very popular peds office that had Saturday and late hours of operation. Yet as wonderful as they may sound, I was treated differently. Being that I know they usually treated people well I would have just summed it up as just how there were with everyone. We ended up having to change offices.
I never know my patients insurance status. I do not want to know. It is not a part of my practice. Besides nothing should change my quality of care being given to my patients.
- 4Aug 30, '07 by cheshirecatReading all these posts makes me feel so sad.
People should not be judged by how much they have in their pockets/wallets.
Probably the rude medicaid patients would be rude if they where multi-millionaires, that is just the type of person they are. But I bet they are outnumbered by the nice people who are also on medicaid a thousand to one.
Thank god for socialised medicine. At least if I lose my job, I know that my families and my healthcare will not be compromised.
- 0Aug 30, '07 by jetscreamer101Is it possible that patients on assistance programs have been treated poorly in the past so they anticipate problems?
I've had to be on assistance programs many years ago. I was treated differently, and yes, it hurt. I can still hear some of the comments directed toward me replaying in my head.
With that said, I did have an experience in an ER. A woman and her young son (11-12) came into the ER because he had vomited yesterday. Was fine today, but mom thought he should be checked by a doc. If I remember correctly she was a frequent flyer.
- 2Aug 30, '07 by Susan9608In my PICU, a great majority of my patients are Medicaid, not so much because their parents are poor and on welfare, but simply because their medical problems are so complex and financially debilitating that to pay for their care without insurance would financially devestate their families.
One simple hospitalization can be enough to bankrupt someone. For instance, I had an emergency appendectomy last November. Because my surgery occurred so late at night, I spent the night in the hospital, even though an appy is a relatively simple/benign procedure. The total bill was $36,000 (outrageous, if you ask), and fortunately, my insurance covered all but $250. If I had to have paid out of pocket, it would have made a pretty big dent in my savings. So for someone without insurance (as a lot of small companies and/or self employed people don't have insurance) and without savings, that bill alone could have wiped out all of their assets.
As far as the attitude of Medicaid vs. private pay insurance patients, I have actually had the opposite problem of the original poster. Quite a few of our private insurance patients/families will make comments to me like, "Well, we're paying for this ourselves, so we shouldn't have to wait." Or "At least we're not a burden on society." I've also found that a lot of private pay or private insurance patients have an attitude of entitlement because they are paying for themselves or using their own insurance. Parents will call me into the room to do things like turn the tv/vcr on or bring them a glass of ice for their soda, and they'll say to me, "Don't you know how much I'm paying for this service?"
Of course, there are obnoxious people everywhere; that's a given. But even if Medicaid patients happen to be more obnoxious than most (not that I agree with that assessment), so what? Does that make them less deserving of good care? In a service profession like nursing, it seems to me that it shouldn't matter if people are angelic in behavior or obnoxious - they still need care. Nurses still get paid (at least in a hospital setting, as far as I know), so what difference does it make to us if someone is Medicaid vs. private pay vs. private insurance? Isn't it our job to take good care of all of our patients, no matter how unlovely they may be?Last edit by Susan9608 on Aug 30, '07
- 3Aug 30, '07 by woody62I have a rather unusual take on all these problems. When I delivered my daughter, NYS Medicaid paid for her delivery. Six weeks later I went to work and got health insurance under my employer. When she was eighteen months old, I changed employers, lost my insurance, purchased individual insurance and returned to school. Half way thru my program, I developed a medical problem. I was advised to stop working for six months but I felt trapped, as I would lose income that paid for my health insurance. I went to NYS to find out if I could qualify for Medicaid. Since I was an LPN, I was told no. Despite having health problems, despite bing told I had to cut down my work hours, they decided I was still capable of working. I continued to work and pay for my own health insurance until I moved here, to Florida, and found out what I was paying a quarter would be what I was expected to pay a month, for less coverage. I went without insurance. Fortunately I was fairly healthy. After I had my car accident and became eligible for Medicare, I opted on it as soon as I was eligible.
I have been called everything from a hard working woman to a thief for taking SSDI and Medicare. I've overheard people complain about those receiving Medicaid, such as myself, as being dregs on the hard working people. Of being lazy. I've heard people complain that their insurance is paying and they are entitled to xyz. About the only time I didn't heard complaints was when I drove to Montreal, every three months, taking prescriptions with me, seeing a Canadian doctor, get my prescriptions rewritten by him, getting them in a Canadian pharmacy, paying for them. The only time I had to be concerned was when I crossed back into New York State. I was breaking the law. I was bring medications, purchased in Canada, back here.
I have decided, I really don't care what people think of me. I paid my dues while I worked and paid taxes since the age of fifteen. I am only getting what I paid into and what I deserve. And if it is SSDI, Medicare, Medicaid, welfare. I paid into all those systems. I am a human being and I demand to be treated with respect and dignity, just like anyone else would.
Now I am stepping off my soap box.
- 1Aug 30, '07 by RNperdiemI think the Victorians called them the "undeserving poor". The patients you refer to are probably a small minority of the Medicaid population.
Many of the above posters have used public assistance as a temporary means of support.
Some people have so few social skills to get along in this world, are almost unemployable, and not responsible. They are probably well known to social services and the police. This is the hard core of poverty. I suspect the majority of people on assistance are just fine.
- 1Aug 30, '07 by HeartsOpenWideI have a question. When I worked in a Dr. office the pts insurance card (copy) was taped to the front of the chart so you knew what kind of insurance they had for billing and blood drawing purposes (which lab form to use). I really did not give it much though and always treated my pts the same. Now that I am in the hospital as a student (maybe I just do not know their chats that well) I have NO clue what kind of insurance a person has and could care less. It does not affect the care I give. What does the type of insurance have to do with it anyways? I have seen jerks and totally nice people with private and Medicaid/medi-cal. If anything I think health care workers should be the ones we are shaming here for treating people a certain way depending on their health insurance. Since I am in nursing school I had to get the "green card" (which is like medicaid but just for family planning) because I can not afford the $500 medication deductible my insurance requires (my parents are paying my insurance while I am in school and it is only for major medical. I use to have and HMO that took a big dent out of my paychecks but I am a full time student now) and I HATE going to the pharmacy to pick up my birth control because I do not want any one to see me with the "green card" because there is such a stigmata about it; and its wrong that I feel that way, but it is a valid feeling.Last edit by HeartsOpenWide on Aug 30, '07