For all of those on Medicaid

Nurses General Nursing

Published

I honest to GOD do not know, nor care, what insurance my patients have when I am taking care of them. I really don't. (FYI)

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

I've been speaking "from my experience" this entire thread. I'm sorry that wasn't readily apparent to you as it's been stated several times.

Something else you've missed that's been stated many times in this thread. We don't know the insurance status of patients until THEY make it known.

The only way I could know about my pt's insurance status is to check with registration, who don't get around to registering a patient often times until the patient is up for discharge or admission. Please tell me how I can alter my care based on their insurance status after all care has been completed?

If I know they're medicaid patients, it's because they're frequent flyers, in which case, yes, we take a 25 year old's complaints of chest pain (who happens to be on medicaid) less seriously, but it's because she's called 911 for the same complaint and come to our ER 30 times this year.

Or I know it because they state it. "You need to get me some Dilauded. I have Medicaid and y'all won't get paid if I don't get what I want. Also call the medicaid van for me."

Otherwise, I could care less.

ETA: I would be just as annoyed by a patient who said "MY BCBS is paying for this so you need to do XYZ!" There's just an extra sting when there's an entitlement mentality in someone who's throwing their free insurance in the faces of the people working to provide it. But this has already been said. How much of this thread did you actually bother to read?

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Specializes in Geriatrics.
It really annoys me that it seems so many people have so little compassion or understanding about people who are either not well educated, or middle class financially, or able to help themselves in other ways...I guess that would put the very people who lack compassion into the un-educated and unable to help themselves classes, so I'll work on growing more compassion for all of you who fit into those categories. I'm not saying I'm a saint, but really, why is it so hard for some people to understand that people who feel disenfranchised may act out a bit?

I am a Nurse, I put myself thru school working full time while going to school full time, helping to care for my sick Mom and raising 2 kids on my own. But, there have been times in my life when I needed help and had to go on welfare. I do not disrespect people for that. I was also on Medicaid for a while. I don't feel it was my fault, life hit me with a run of bad, it happens. However it did not give me the right to be rude & demanding. Bad maners are not a privilage for those who need extra help. I do not lack compassion for the under-educated, or those who believe they cannot help themselves. I believe in todays day & age, if you can work a cell phone, computer, WII, or IPod, then you are perfectly capable of inproving your education level. That you chose not to is your business, but I shouldn't have to pay for you to afford those items. I give all my patients the best care I can, it's the way I'm made. Do not expect me to stop giving care to a Pt in severe resp. distress to go get your glass of water, wash your face, or take you out for a smoke. When I am on the phone with a Dr. discussing a Pt who is s/p surgery x2 days and is presenting with high temp, extreme pain, swelling of surgical site, and elevated BP & resp. do not come into the nurses station to demand I stop "chatting" and get you a snack. These are the ones who try my compassion and my sanity. I have many Pt's on Medicare/Medicaid who are polite & respectful, and a very few who act like I owe them. Sorry if you think that makes me wrong, walk a mile in my shoes, then we'll talk.

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I think that as a student without actual experience it's probably easier to empathize, I know it was for me. My BA is in sociology/social work, and I felt/feel strong empathy for people who need and use government assistance. Currently, I'm a medical assistant at a clinic for low income women, and I have to admit -- it's draining! There is a huge entitlement mentality (not with everyone, but with many), which gets very old.

I also have a difficult time personally, seeing women on government assistance with insurance, food stamps, cash assistance, etc. with plasma t.v.'s, gaming systems, nice cars, etc. because I currently have no insurance, have VERY little left over at the end of the month for food, much less anything else, and drive a 16 year old car. Not because I made poor life decisions, but because I got a liberal arts BA, ha. What kills me, is that if I were to make the irresponsible choice of having children at this stage in my life, I would be better off in this respect.

I try very hard not to have these negative feelings and make generalizations. I want very much to maintain a non-judgmental and empathetic attitude. But, I'm human.

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Oh, I also work at a residential facility for pregnant and parenting teen girls -- all on state assistance and with HUGE entitlement issues. However, they are teens.. so that's a whole other monster. :uhoh3:

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Specializes in Health Information Management.
I've been speaking "from my experience" this entire thread. I'm sorry that wasn't readily apparent to you as it's been stated several times.

Something else you've missed that's been stated many times in this thread. We don't know the insurance states of patients until THEY make it known.

I asked a legitimate, non-snarky question because I was honestly curious about data that would back that sort of position. I didn't deserve the rude response. Certainly it is acceptable to speak from one's own experience, but making flat-out statements along the lines of "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" without prefacing them with some sort of qualifier to that effect invites confusion and argument.

There are in fact other ways for nurses to become aware of a patient's insurance status. For example, when a family member of mine was hospitalized for a week while uninsured, his nurse and tech on a certain shift became aware of that lack because each walked in while someone from the business office was grilling him on how he planned to pay for his care without insurance - three hours after he'd come back to his room from major surgery. I certainly will not claim that's standard operating procedure, but it's one example of how medical staff can become aware of such circumstances without the patient mentioning it. Moreover, if I'm on Medicaid (I'm not, but this is just a hypothetical), I shouldn't have to worry about whether my care will be affected if I slip up and mention my insurance/payment method - say, by requesting someone assist me in obtaining Medicaid transport after my treatment is completed. In no way, shape, or form am I supporting the entitlement mentality you describe (which as other posters have noted is hardly limited to the Medicaid population).

I did not mean to attack you, merely to seek information that had not been clearly provided in context. I will overlook your attack of me based on your clear frustration with this thread and topic in general. Thank you for the clarifying portions of your response and have a pleasant evening.

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my sister was admitted a few months ago with cellulitis. she was the only one in a semi-private room, at the end of the hall (ahh, quieter). they'd even let her significant other stay the night in a bedside chair. she complained to me, "they stuck me on this losers' wing and are ignoring me because i don't have insurance" (she'd recently lost her job & her insurance). i was incensed and set her straight right there. it started with, "are you safe and clean? are you in pain? have you gotten your medications? are your basic needs met?" and ended with, "believe me, your nurses/caregivers have no idea what insurance you have and don't give a darn. it has absolutely no bearing on how they care for you or anyone else."

i hope she was sick & not thinking straight. :rolleyes:

(she does not wear an entitlement crown, but if she did...)

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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.

Woohoo! You really hit the nail on the head. Of my group of childhood friends, I am the ONLY one who has ever had a job and the only one who is not living off the government. It really ticks me off to hear about them running to the ER every time they have a sniffle. And not one of them ever has to worry about paying a dime for all that care. One of their children coughs? Run them to the ER. Scraped knee? ER Splinter? ER

My best friend has spent the last 11 years abusing the medicaid system every way she can. She "had" a multitude of medical problems that required her to see a doctor at least bi-monthly and visit the ER at least every month. She recently got married and although she attempted to fool her case worker, she lost her medicaid. It is amazing, really, all those medical ailments she has suffered from for the last 11 years have all magically disappeared. She is also a fan of those oft-repeated phrases "I pay your salary" and "I don't care. I have medicaid"

If medicaid would stop paying for all this frivolous crap, maybe they wouldn't be running out of money so quickly.

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I think that as a student without actual experience it's probably easier to empathize, I know it was for me. My BA is in sociology/social work, and I felt/feel strong empathy for people who need and use government assistance. Currently, I'm a medical assistant at a clinic for low income women, and I have to admit -- it's draining! There is a huge entitlement mentality (not with everyone, but with many), which gets very old.

I also have a difficult time personally, seeing women on government assistance with insurance, food stamps, cash assistance, etc. with plasma t.v.'s, gaming systems, nice cars, etc. because I currently have no insurance, have VERY little left over at the end of the month for food, much less anything else, and drive a 16 year old car. Not because I made poor life decisions, but because I got a liberal arts BA, ha. What kills me, is that if I were to make the irresponsible choice of having children at this stage in my life, I would be better off in this respect.

I try very hard not to have these negative feelings and make generalizations. I want very much to maintain a non-judgmental and empathetic attitude. But, I'm human.

I have really been trying to wrap my head around this "entitlement" mentality. I really don't understand it. I mean, I live in a rural area with lots of welfare recipients and they all seem to have that "The world owes me!" idea going on.

A friend of mine has been on welfare for years, yet every car she has bought in the past several years has run between 25 and 30 thousand dollars, they are constantly going on trips and vacations, her kids are dressed to the nines, and she just built a $200,000 house. I can't figure out how she is able to stay on welfare....

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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.

I had a middle-aged man (the reason I quit adult nursing was middle-aged men. Now not ALL middle-aged men are drug-seeking donkeys, in fact I'm married to a very nice one. So I don't need all the middle-aged men that are and aren't nurses (or aren't nurses yet) to flame me for being judgemental of middle-aged men. But a large number of them finally drove me to my wit's end.) Anyway, middle-aged guy in for something or other, and he starts threatening to sue me. So I told him that was why I had , and threatening to sue me only made me more inclined to follow the doctor's orders to the letter, so instead of "sneaking" that narcotic to him 10-15 minutes early as I had planned, I was now going to have to wait until the exact time it was due, sure didn't want a lawyer questioning why I had given it a bit early! It wasn't my finest moment, but the guy was very nice to me the rest of the night, and didn't again threaten to sue.

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It's been very interesting to read all these threads, and it has made me do a lot of thinking.

I honestly don't personally have a problem with people doing things like going to an ER for a pregnancy test when they could've bought a test for a buck...I don't think this kind of thing is about the money, but that girl may have had a lot of other thoughts about that pregnancy, thoughts that she couldn't even express, but were upsetting to her, and she may have felt somehow drawn to the ER because she needed and thought she might get some kind of kindness, and that wouldn't have been available just by plunking down a buck for pregnancy test.

Of course in terms of money going to the ER for a pregnancy test doesn't make sense, and of course money is needed for other, more acute medical problems. However, my feeling is that a political issue, not a medical one, and I don't feel it is appropriate to make political judgements about a patient while working as a nurse.

I'm also trying to say that I respect working nurses for having their own, and possibly different opinions. It occurred to me that maybe it is easier for working nurses to feel compassion for patients who have visible medical problems, and maybe that is because nurses are trained more specifically to address those problems. Maybe it comes down to what kinds of problems are you most familiar with, which then would give you the most understanding of those kinds of problems.

I grew up in poverty, and was surrounded by people who made poor choices, and/or had varying degrees of mental illness, or character flaws (which is what I think of as spiritual illness). Many of these people also had big entitlement issues. When I see people with these issues, I feel sorry for them. I feel like I understand a lot why people have these kinds of issues, and that makes it easier for me to feel for them.

Just because I think I understand where a lot of people with these issues are coming from doesn't mean that I want to enable them. It also doesn't mean that I would stop providing medical care to another patient who had a more acute medical problem to the person with entitlement issues a glass of water. I would do triage as best I could, and provide care to the patient who needed it the most first.

I also generally don't get angry or lose my patience when I'm asked for trivial things and am in the middle of something more urgent. To my thinking, when an entitlement patient does things like demand a glass of water when a nurse is busy with a more medically acute problem, the fact that the patient couldn't understand this shows just how insensitive the entitlement patient is, and I see insensitivity as a real sickness of the soul. We all are insensitive at times, and usually don't even realize it, but we all have reasons for acting however we do at any given time. In a way, that entitlement patient isn't in his right mind at that time, and I don't take personally things that may be directed at me from some who isn't thinking clearly.

I wouldn't lose patience in this kind of situation just as I don't usually lose patience when I'm training a puppy not to pee on the floor, or teaching a child that temper tantrums won't get them what they want. I see these situations as all dealing with someone who is unable for whatever reason to react appropriately, and I see unwillingness as a form of inability.

I will try to remember that we all come from different backgrounds, and nurses who have different opinions on all this are reflecting what they've learned as a product of whatever background and education they've had. And just because somebody has the ability to operate some technological gadget doesn't mean they have what it takes to become truly educated, whether formally or informally. People need to believe they wouldn't fail in order to even try to obtain a formal education, and informal education takes a lot of self awareness that isn't always easy to face.

After seeing so many nurses responding in ways that make it clear how frustrated they are with rude patients, I am sorry to see these nurses taking all that so personally. You seem very compassionate about your work, and I can see you are probably over-burdened at work, and it is hard to show your best sides all the time under those circumstances.

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Specializes in ICU.
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

Regarding most abuse being from those on government funded programs, here are two articles, one about Washington and the other about Texas:

http://community.seattletimes.nwsource.com/archive/?date=20041011&slug=emergency11m

http://www.findingdulcinea.com/news/health/2009/april/9-Patients-Account-for-Nearly-2-700-Visits-to-the-Emergency-Room--Study-Finds-.html

Note especially further down in the Seattle Times article, it mentions how difficult some of the "high-use" patients are to work with.

The following link is to a Powerpoint presentation on ED use by Medicaid pts. Some of the highlights: On slide 16, it mentions that while 50% of ED visits were appropriate, one-third were for a non-serious illness. Also, 41% of parents listed purpose of visit as "reassurance" and only 37% as emergency care. Expensive reassurance. On slide 39, it points out that 47% of ER visits were for "nonemergent; emergent Primary Care treatable, or avoidable/preventable" issues.

http://www.dhmh.state.md.us/mma/pdf/2009/jun09/ED_Utilization_DHMH_052709.pdf

Found this stuff in 20 minutes on a google search. Not the most academic of sources, necessarily, but the handiest.

For the record, I don't know what kind of insurance a pt has or not unless they tell me. I don't care either. They get the same care from me regardless of their insurance. I can't sit here, though, and tell you that it doesn't aggravate me when somebody accuses me of providing substandard care because they have Medicaid when they can see I'm busting my tail to care for all my pts.

And it downright ticks me off when they have the nerve to say, "I pay your salary," complete with the entitlement attitude. They're not paying for a **** thing, my tax dollars are. And I resent having to work six months out of twelve to pay taxes to care for somebody that is ungrateful, especially if they are chronically lazy or chronically irresponsible.

BTW, I don't mind a bit that my tax dollars go to help people that are down on their luck or who appreciate the help. My heart goes out to the genuinely poor, especially the working poor, because my mom grew up with very little (think cracker soup for supper). There but for the grace of God...

:paw:

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Specializes in ICU, ER, EP,.
excellent. now, tell us how your experience as a nurse in the er or on the unit differs from ours.

may i hug you? until the "nay sayers" hang out for 8 hours on a friday night in the er, they simply have no idea what some, whom have real experiences are trying to say about these situations.

using medicaid/medicare does not equate to situations that nurses are subjected to... from those patients in the er in a frequent enough basis to see a pattern.

no where did i imply that everyone/ most/ all state card holders act this way, just about the experiences of nurses whom have those people that do.;)

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