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For all of those on Medicaid

Nurses   (15,341 Views 122 Comments)
by ShayRN ShayRN (Member)

ShayRN has 18 years experience and specializes in Corrections, Cardiac, Hospice.

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People who are on Medicaid and are considered to abuse the system by asking for extra crutches because "Medicaid will pay for it" may say that because it is easier to say that than to say that maybe she's afraid she can't get back if she something happens and she needs more crutches. Maybe in this case this person is suffering from too much anxiety - so, they too are deserving of compassion and understanding, because too much anxiety is a type of sickness.

And the mom who takes her son to the ER and demands he get a physical for camp the next day, or the woman who goes to the ER and demand a pregnancy test that they feel they need right away for whatever...I believe these people are also making poor choices, and although they be abrasive and come off as feeling entitled, their lack of judgement or selfishness is a type of sickness I believe that is due to character issues, what I would consider more of a spiritual sickness.

If people come to a medical facility of any kind and ask for help, no matter how abrasive they may in asking for it, on some level they need help, and so they need compassion and understanding and their needs met. It seems like it is not the needs of the nurses that are to be met in the role as nurse, but the patient. I'm still just a nursing student, so while I have dealt with plenty of abrasive people here and there in life and on the job (previous career), I do respect the working nurses who may have a different perspective than mine.

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839 Posts; 8,407 Profile Views

However, some on Medicaid (and other insurances) are the opposite of you, and it is especially galling to be treated outrageously by someone you are helping to provide coverage for.

Especially when they're wasting resources for their BS complaints (which they called 911 for and will be taking a medicaid van ride home to an apartment subsidized by the state all while supporting a 1-2 PPD smoking habit and playing on an iphone/blackberry) while the patient in the room next to them (who has been polite, grateful and is actually sick) is worrying about how he's going to pay for this visit because he can't afford insurance and doesn't qualify for help.

Most ER abuse isn't from the uninsured. It isn't even from the insured. It's from people who are on government sponsored health insurance.

(Let me clarify since some poster's critical reading skills are rusty: Not all Medicaid recipients abuse the ER; however, the majority of abuses come from medicaid recipients.)

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Neveranurseagain has 26 years experience as a RN.

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Wouldn't it be great if we lived in a society where healthcare was not driven by what insurance you have? This should not even be an issue, but sadly it is. In other countries the insurance question is not even asked! We shouldn't care if someone has Medicaid, Blue Cross or no insurance. Are we treating an insurance company or the patient?

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839 Posts; 8,407 Profile Views

People who are on Medicaid and are considered to abuse the system by asking for extra crutches because "Medicaid will pay for it" may say that because it is easier to say that than to say that maybe she's afraid she can't get back if she something happens and she needs more crutches. Maybe in this case this person is suffering from too much anxiety - so, they too are deserving of compassion and understanding, because too much anxiety is a type of sickness.

And the mom who takes her son to the ER and demands he get a physical for camp the next day, or the woman who goes to the ER and demand a pregnancy test that they feel they need right away for whatever...I believe these people are also making poor choices, and although they be abrasive and come off as feeling entitled, their lack of judgement or selfishness is a type of sickness I believe that is due to character issues, what I would consider more of a spiritual sickness.

If people come to a medical facility of any kind and ask for help, no matter how abrasive they may in asking for it, on some level they need help, and so they need compassion and understanding and their needs met. It seems like it is not the needs of the nurses that are to be met in the role as nurse, but the patient. I'm still just a nursing student, so while I have dealt with plenty of abrasive people here and there in life and on the job (previous career), I do respect the working nurses who may have a different perspective than mine.

I have explained the woman who is a G11 P 9 who comes in for a pregnancy test "because my medicaid will pay for it" that it is an abuse of the system that has very limited resources, and that there are people who are sick who can't get help because there isn't enough money to go around...AND that a pregnancy test costs one dollar at the Dollar Store and is exactly the same as the test we use, and that she's running up a $1000 bill.

The answer I get: "I don't care. I have medicaid."

There's no reasoning or explaining or teaching that will fix willful ignorance.

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839 Posts; 8,407 Profile Views

Wouldn't it be great if we lived in a society where healthcare was not driven by what insurance you have? This should not even be an issue, but sadly it is. In other countries the insurance question is not even asked! We shouldn't care if someone has Medicaid, Blue Cross or no insurance. Are we treating an insurance company or the patient?

In the ER we treat everyone regardless of complaint or insurance status.

Many of us have just noticed a frustrating and disturbing trend. Most of us don't know and don't care about a patient's insurance status until THEY make it known.

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"In my experience" does not equal "All medicaid recipients."

Please show me what part of "in my experience" was tripping you up and I'll try and clarify for you.

Acutally, none of your post wast "tripping me up" nor do I need clarification. I think your posts are speaking for themselves.

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Acutally, none of your post wast "tripping me up" nor do I need clarification. I think your posts are speaking for themselves.

Excellent. Now, tell us how YOUR experience as a nurse in the ER or on the unit differs from ours.

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BrnEyedGirl has 18 years experience as a BSN, MSN, RN, APRN and specializes in Cardiac, ER.

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Sunny, I appreciate your compassion and your sense of wanting to understand and care about the whole person. I'm even going to go out on a limb here, at the risk of being flamed till I'm charred and crispy:smokin:,..and say that you are a strong Christian woman. It shows. I pray that you never loose that compassion and can always step back and see things from another's point of view,....it will serve you well.

However,...we live in a world of limited resources. It doesn't matter if we don't like it,.or are doing all we can to change the system to insure help to all,...it is a fact. I agree that many of the pts I see have psychological issues that dictate their behavior. I agree that these folks are in need of assistance, but my playing into their already ill thought process isn't helping them. I can't think of any logical reason why Medicaid should pay for an ER visit for a pregnancy test for an early pregnancy with no c/o. Yes,..it might make my pt feel better at the time, but again,.I'm just encouraging her to continue with her "ill" thought process and behavior. The money and time spent with that pt could be put to so much better use. Would you not agree that this pt, at 17 and pregnant needs to learn some responsibility and accountability ASAP? Just because you have a mental illness doesn't mean the rest of the world should excuse your behavior and play along with you. What would this same girl do if we were allowed to tell her that Medicaid won't pay for an ER visit that isn't an EMERGENCY? Would she just never get a pregnancy test and never get on WICC and starve during her pregnancy so she had a poor outcome? I think not. She would go to county health department, planned parenthood etc and get her pregnancy test.

Just because a person has a mental illness or is young and inexperienced doesn't mean we should waste precious resources to make her comfortable and feed into her already lacking thought process. I have to believe that people who harm their children have some sort of mental illness,.but I in no way feel they should be excused and allowed to continue harming a child. I also believe that people can change. I believe that it is my duty as a nurse, a Christian and a human being on this planet to assist in any way I can to help people change, but feeding into their illness isn't helping.

Sorry,.I've gotten way off topic here. I do agree with a previous poster that the system is messed up in that it allows this type of behavior therefore encourages the people to continue on as they are.

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BrnEyedGirl has 18 years experience as a BSN, MSN, RN, APRN and specializes in Cardiac, ER.

1,235 Posts; 18,627 Profile Views

Wouldn't it be great if we lived in a society where healthcare was not driven by what insurance you have? This should not even be an issue, but sadly it is. In other countries the insurance question is not even asked! We shouldn't care if someone has Medicaid, Blue Cross or no insurance. Are we treating an insurance company or the patient?

I think for the most part insurance isn't an issue until the insurance company makes it an issue. For example, I don't know how many times a doc has to change his plan of care because XYZ insurance company won't pay for this med or that test. I understand the need to keep control over how our limited resources are spent, but I would like to believe the doctor should be able to make those decisions based on what his expert opinion is of what is best for the pt. If the girl in the previous post had BCBS, they would refuse to pay an ER visit for a pregnancy test, but Medicaid will pay for it. The system is messed up.

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Excellent. Now, tell us how YOUR experience as a nurse in the ER or on the unit differs from ours.

It actually looks like you are the one in need of clarification. I'm not a nurse and I clearly said so in my initial post. I am the mother of 3 children that are on medicaid and have been on both sides of the fence with insurance.

I think this thread was iniated in good faith however it has become an argumentative "soap box".

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839 Posts; 8,407 Profile Views

I think for the most part insurance isn't an issue until the insurance company makes it an issue. For example, I don't know how many times a doc has to change his plan of care because XYZ insurance company won't pay for this med or that test. I understand the need to keep control over how our limited resources are spent, but I would like to believe the doctor should be able to make those decisions based on what his expert opinion is of what is best for the pt. If the girl in the previous post had BCBS, they would refuse to pay an ER visit for a pregnancy test, but Medicaid will pay for it. The system is messed up.

Actually Medicaid won't pay for it either. People who abuse the system have wised up to this and now come in with complaints of "abdominal pain" because they know from experience that all female abdominal pain patients who are of childbearing age get pregnancy tests.

It's pretty obvious as well who is there for a pregnancy test and who legitimately has abdominal pain.

It doesn't do a damn thing, but I document like crazy about a patient's desire for a pregnancy test. It makes me feel better and less likely to say something entirely inappropriate.

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Doc Lori, R.N. specializes in Dialysis,M/S,Home Care,LTC, Admin,Rehab.

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Personally, I feel that the only time it plays into the care of the patient is when care has to be coordinated between facilities, etc. One needs to know from a case management point how to "direct" that patient's referrals in terms of what is "covered". From a bed side nurse's perspective in a hospital care setting, it matters none. Patients are demanding and at their worst when they are sick, and that's when we see them, whether they (or their employers) pay for a top shelf plan, or are on state assistance. My opinion is.. the opinion and pre conceived notions and mind sets of the nurse is to be at question, and is the ultimate issue, not the innapropriate behavior of the patient. In other words, it is how we choose to perceive it.

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