For all of those on Medicaid

Fribblet · Jul 7, 2010

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".

Exactly. You have no experience as a nurse.

Just another poster who isn't a nurse who gets on their soap box instead of letting nurses vent their frustrations.

Just another non-nurse telling us we're so bad because we vent about our experiences (which, to those who aren't stellar readers take to mean everyone in a particular group). Yet the same one who goes out of their way to point out not ALL people of that specific group are like that (after it's been mentioned time and time again in the thread that not ALL people of the specific group are like that.) now makes the same sort of judgements about the posters venting in a thread that she(or he) admonishes the posters for.

Guess what? A lot of medicaid patients are entitled, abusive, and obnoxious. We know that some are not. We're talking about the ones that are. Get over it. Our job is frustrating. Sometimes, it's good for our mental health to vent.

Cherish · Jul 7, 2010

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.

Your right about the pregnancy test at the dollar store. I went to Dollar General the other day to buy my puppy a new collar, they had an aisle long pet area that I was amazed with. But anyway right as I was checking out at the register they had pregnancy tests at the check out. I was surprised but thought it was cool and they had Excedrin Migraine tabs too, everything was a dollar. Most Dollar Generals.Family Dollar, 99 cent store, etc, are in every city and town and usually more dollar stores than hospitals so it would have been cheaper even with gas or bus ticket to go to the dollar store as there may have been one closer to her, without a wait in the ER.

cb_rn · Jul 7, 2010

In my facility we don't know abiut a patient's financial status. Sometimes I'll ask at D/C if they'll have problems with the treatment plan. BUT, I once put a woman on crutches, the doctor mentioning that she had requested them but didn't really need them. The patient requested a second set in case she wore them out. When I said that was an unesacary expense, she said "Medicaid will pay for it." I answered in shock "so that's where my tax dollars go!" Now that's or some variation is my standard answer to unreasonable requests with the entitlement mentality. I'm now disabled and have been on welfare belfore.

So I've had medicaid before when I was young and not a nurse and was scraping by on minimum wage with a child by myself so this is not some over-generalized statement. I was grateful for the help I received, it was a huge relief to be able to take my child to the physician when he was ill. I never abused the system, kept my appointments, and got off of medicaid as soon as I got a job with insurance.

Many people (though certainly not all) that utilize medicaid are under educated and do not understand that there is actually money being used to pay for the services they receive. Even if they understand that there is money exchanging hands, so to speak, I honestly believe it does not dawn on some of them that the government receives money by taxation.

I would have said something here as well too. I see no problem in matter of factly telling patients things like this. It doesn't make me a bad nurse as long as I say it gently and appropriately and do not treat them any differently (even though I try my hardest not to pass judgement mentally, I am only human) no matter what they may say.

Fribblet · Jul 7, 2010

Your right about the pregnancy test at the dollar store. I went to Dollar General the other day to buy my puppy a new collar, they had an aisle long pet area that I was amazed with. But anyway right as I was checking out at the register they had pregnancy tests at the check out. I was surprised but thought it was cool and they had Excedrin Migraine tabs too, everything was a dollar. Most Dollar Generals.Family Dollar, 99 cent store, etc, are in every city and town and usually more dollar stores than hospitals so it would have been cheaper even with gas or bus ticket to go to the dollar store as there may have been one closer to her, without a wait in the ER.

I know. I was surprised, too! Didn't know that until I started working in the ER (wish I had known that in college. It would have saved me $15 )

The thing you have to realize is the ER visit costs her nothing but time. For her to keep receiving benefits from the state, she has to have proof that she is pregnant, and taking a home pregnancy test to the Medicaid office won't work. So, by coming to the ER, she gets her piece of paper that states she's pregnant and the free pregnancy test in one shot. If she's played her cards right, she'll get a script for pre-natal vitamins, phenergan, and maybe tylenol #3 for her fantom abdominal pain.

If she took the $1 pregnancy test, she'd have to make an appointment with an OB/GYN and pay a co-pay for her official paper.

This is why waiting in the ER is preferable. Also, female with abdominal pain without discharge or urinary symptoms technically should be leveled a 3, so they get back a little quicker. Although, if I'm in triage, I'll make them wait while I bring back sick patients first.

steelcityrn, RN · Jul 7, 2010

Some of these people on medicaid spend more time trying to beat the system than just getting a job and earning their way through life. Its sickening!

fungez · Jul 7, 2010

None of us care what insurance, if any, the patient has. We just don't like the entitlement mentality.

When I worked the ER some idiot used EMS to come in for her UTI. Didn't have a ride. When the doc mildly said "don't abuse the system" the woman got on her high horse and threatened to "turn him in." Oooo, scary.

Calling EMS for non-emergent c/o, or using the ER for a pregnancy test, is an abuse no matter what insurance they have. It raises everyone's rates. It sucks everyone's resources dry.

An ER doc told me once Medicaid reimbursed him six bucks for a patient visit. Not sixty, but six bucks. So he has to raise everyone else's costs to make up for it. Which is why the ER is so expensive for everyone, especially the self-pay. They are the ones getting it in the teeth.

Fribblet · Jul 7, 2010

When I worked the ER some idiot used EMS to come in for her UTI. Didn't have a ride. When the doc mildly said "don't abuse the system" the woman got on her high horse and threatened to "turn him in." Oooo, scary.

Whenever I'm walking someone out the door who is cussing us out and threatening me with bodily harm because they didn't get the narcs they wanted, and they threaten to sue saying "I'm going to hold you responsible if something bad happens to me," I always laugh and tell them to go right ahead and contact a lawyer. It seems to irritate them.

subee, MSN, CRNA · Jul 7, 2010

This has got to be one of the most stereotypical statements I have ever read. Granted, I do see that you tried to soften the blow.
My children have medicaid. I had medicaid when I was pregnant with my youngest (now 2), but no longer qualify and now have no insurance because I can not afford it. For 10 years I worked for an engineering firm and had BCBS as well as AFLAC (making $50k per year). Going to the doctor was no problem. I decided to relocate to be closer to my mother. Partly because one of my children (yes, I have 3), has severe respiratory problems and has been hospitalized a few times (he's only 4) - even been tested for cystic fibrosis (inconclusive results). I secured a position making $8k less per year, but still a doable salary. Unfortunately, I was let go in my probationary period (probably because i missed work due to my son's illness).
Three months after being laid off, I realized I was pregnant. Kind of hard to find a job period in this economy - even worse when you are pregnant. I waitressed at a small restaurant (something I had not done since I was 16) on the weekends before the baby was even 6 weeks old to try to make a buck. Luckily, I did eventually find a job with a decent hourly rate (still $8/hr less than what I made before). I do not get sick leave nor do I qualify for health insurance, but I do the best I can.
I have to admit, that it is a relief to know that I don't have co-payments to worry about or unexpected Rx costs but sometimes it is downright embarrassing. Comments like yours are an example of why. Even though I know I am not what people perceive as the typical medicaid recipient, I AM a medicaid recipient. People are going to look at that and create their own opinion. Should I care? Probably not but as a human being I do.
I start NS in the fall and I hope that I feel the same way as the OP. I hope that I give the highest standard of care - regardless of whether or not the patient is a "bad apple" (be it perceived or actual).

I'm sorry you have a sick child - that's a burden I wouldn't wish on anyone. However, you got pregnant again while unemployed and seemingly, unemployable. And that was your third baby! It's enough to make anyone wave their hands in the air while saying "another dysfunctional, chronically pregnant women wants to go into nursing!" Please think about why you need to be pregnant so that you aren't creating barriers against your future success and straining a medical system that is already broken.

TDCHIM · Jul 7, 2010

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.)

On what non-anecdotal source or sources are you basing that assertion? That's a genuine question, not a snide rhetorical remark, by the way.

Concerns those who are on Medicaid or are uninsured have about the quality of care they receive versus that given to other patients appear to have at least some basis in fact: http://www.medpagetoday.com/CriticalCare/GeneralCriticalCare/19831

Cherish · Jul 7, 2010

I'm sorry you have a sick child - that's a burden I wouldn't wish on anyone. However, you got pregnant again while unemployed and seemingly, unemployable. And that was your third baby! It's enough to make anyone wave their hands in the air while saying "another dysfunctional, chronically pregnant women wants to go into nursing!" Please think about why you need to be pregnant so that you aren't creating barriers against your future success and straining a medical system that is already broken.

Yikes...um...ok, understandable but kind of a low blow, don't you think :cool: . But anyways off topic but I went to Dollar Tree again today, I needed rawhides for my pup but they had ovulation tests too. I'm still in nursing school but that's cool to know for the future in case I meet any patients that are financially strained or just want to save some money and would like to have a pregnancy test or for those who want to have a child so they can know their ovulation schedule I can suggest that they check those stores out. Well for the patients who don't need documentation of pregnancy but rather for their own piece of mind without additional expense. Of course I wouldn't be rude to a patient if they wanted one when they are being seen by a doctor but could suggest it for the future in a polite way :idea: .

ProBeeRN, BSN, RN · Jul 7, 2010

Actually, I DO care what insurance my patients have. In fact, it directly impacts my job. In my HH agency, we are responsible for knowing our patient's insurance, explaining copays, and obtaining insurance authorization. We are not to make visits without proper authorization because then the agency will not get reimbursed.

The thing that gets me though- is how much Medicaid covers compared with private insurances. There is a particular patient on services who gets a nursing visit daily. DAILY. To administer LANTUS. She has aides in the home (covered with Medicaid) but they cannot administer the insulin due to scope of practice. No family. She can administer herself- but for a while she was bruising herself due to unsteady hands so a nursing visit to administer is considered justified. And so she remains on services with no end in sight. And Medicaid covers it 100%

Now I'm not debating the validity of the visit itself. But it burns me when Medicaid covers services like this and then I turn around and explain to the 93 year old lady with hemiplegia that her insurance will only authorize 6 nursing visits (at a $15/visit copay) and cover aide services for 2 days a week for 3 weeks and then hey, she's on her own. Or I explain to the woman with the gaping diabetic ulcer that her out of pocket cost for a wound vac is >$100/day- and applying to Medicaid isn't an option because her husband is still working- you know, so they have a roof over their heads.

The system is broken. :down:

dreamin' · Jul 7, 2010

I always laugh and tell them to go right ahead and contact a lawyer. It seems to irritate them.

That's because medicaid doesn't cover lawyers visits.....

and they know that there's not a lawyer anywhere who's gonna take their case... even the "ambulance chasers" would run chasing one in the opposite direction;)