For all of those on Medicaid

[ShayRN]

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)

[CrazierThanYou]

I had a patient who was a young man in his 20s with 2 kids explain to me that his Medicaid was not active because his mother had his paperwork. He had no idea who his caseworker was, no idea how to get the the social services building downtown, and honestly, no idea how to take care of himself/ his future. How are you raising children if your mother is still responsible for your Medicaid? I bite my tongue and try to help but taking some responsibility for your own affairs would be nice.

I hear things like that all the time. I have a friend who has three kids but she really doesn't have to take any kind of responsibility for anything because her mother is always right there, holding her hand.

When she failed to turn in her food stamp paper work and didn't get her food stamps that month, she reported her case worker to the supervisor. It just wasn't fair that she didn't get her food stamps. Doesn't matter that SHE failed to turn the paper work in.

When she missed her WIC appointment and didn't get any formula vouchers and couldn't get another appointment right away, she called the WIC director up and cussed her out and whined about how "My baby is out of formula and I can't afford to get more". The WIC director said "That's why you show up for your appointments".

Her kids Medicaid got canceled because she didn't turn in the paper work. Not her fault. The social workers are all against her!

It really is enough to make one sick.

[Tina, RN]

I hear things like that all the time. I have a friend who has three kids but she really doesn't have to take any kind of responsibility for anything because her mother is always right there, holding her hand.

When she failed to turn in her food stamp paper work and didn't get her food stamps that month, she reported her case worker to the supervisor. It just wasn't fair that she didn't get her food stamps. Doesn't matter that SHE failed to turn the paper work in.

When she missed her WIC appointment and didn't get any formula vouchers and couldn't get another appointment right away, she called the WIC director up and cussed her out and whined about how "My baby is out of formula and I can't afford to get more". The WIC director said "That's why you show up for your appointments".

Her kids Medicaid got canceled because she didn't turn in the paper work. Not her fault. The social workers are all against her!

It really is enough to make one sick.

I have a family member that is exactly like this. *sigh*

[subee, MSN, CRNA]

You know, a lot of us have family members like this and that's probably why this topic presses so many buttons for so many people.

It seems (to me anyhow), similar to people who are all fired up against drug addicts and alcoholics (even if they're nurses). I always want to ask, "Which relative in your family is an addict?" Getting emotional about this stuff doesn't help. How can we empower young girls into believing that they can do something else creative and worthwhile besides having babies? I'm getting better at stifling my resentment of the "gimmies" and just remind myself how petty and means most of their lives are. Now to mean that I don't ever

want to ***** slap them and say "Wake Up!"

[SharonH, RN]

NOPE med/surg/geriatrics.... you lack the ER experience to make that statement, we're not talking about general inpatient care with those who need/require it, you're off base. I have worked many years in an ER and have real experience, so let me explain:

I have no idea who has what insurance, no time in the ER... the ambulance pulls up with a 26 year old woman with 4 kids in tow, with full blown hair done, fake nails, cell phone to the max with the designer purse and tells me her baby is dying, it won't "shut up" and she's sick of it.

baby is stable, they all get off the ambulance and go to the waiting room, three other kids run wild, disturbing the true sick in the peds waiting room. I try to get them back, all others more urgent, no rooms.... 26 yr old mom does the sashay up to me, head wandering in every direction and tells me she'll have me fired in 10 minutes if not seen, her kids haven't had dinner, get them meals and where can she plug in her cell phone?

now, we're not KFC and in fact I can't get a meal without an admission order so I offer crackers and juice..."You gonna do me like this, you wanna TAKE ME ON... just cuz I got the card... you starve the babies?"

(see where this goes... this is every night.. several times a night... and it ends up with someone with "a card" firing me to get seen quicker because they need their motrin/tylenol script and a taxi voucher back home).

This is what goes on in the ER... I suggest everyone work and volunteer several shifts before they waste another once of band-with and type another word.

This is not predjudice,I never ever had a second to look at insurance, treating others poorly is done by the patients and family... it is nurses being treated as dogs who are fed up with the treatment and abuse of the system....

while the acute 40 yr old MI without insurance rolls in who gets the same care... only is the one that needs it and will loose everything from that need.

I'm impressed that you are able to discern what my experience has been from a tag line on a message board. In fact, I am NOT an ER nurse but I have worked in the ER and many areas of health care so I will give my opinion on this matter, like it or not.

Besides, whether or not one has experience working in an ER is largely irrelevant to my post. OP seems frustrated that he Medicaid patients are defensive; I merely pointed out that there is good reason. Your post and many others on this thread support my POV.

As to your anecdotes, please don't bore me. For every story of abuse you offer, I can counter with one of sacrifice and humility. Your example proves nothing. You think you are not prejudiced, clearly you are. And the attitudes of your patients and family towards you reflect that.

Consider that my 20 years' experience encompasses the care of all stripes of Medicaid recipients from the elderly to the young disabled, the inner city poor and the rural poor and I've worked in large inner-city hospitals, border hospitals, community hospitals, clinics, prisons, home health and various work settings in between. If you think that only Medicaid recipients are rude, demanding, etc then you have your eyes closed and you could probably benefit from some different work experience yourself as you sadly lack perspective. Good luck on that.

[SandraCVRN]

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.

sorry but we need a "what the heck" button.....

[Copper4]

In case management I need to know patient's insurance coverage and advocate based upon needs, and resources available- I try to treat all patients with respect and dignity-- having said that I have become much more conservative as I grow older.

I recently had a patient come to the ER, he had recently come from Vietnam and had a dx of malaria. I am only authorized to provide $75.00 for medication if a patient has no other means of obtaining it...he could get the other meds at Walmart but one particular med was twice my authorized amount.. the doctor yelled at me, and I explained that was all I could do, the patient needed to pay for the other portion of the cost... the pharmacist contacted his supervisor and had the med paid for and provided by the hospital.

My issue is that this man chose to come to America, and apparently came without a dime in his pocket? I have a friend who had to sponsor her mother to come from Poland, that required her to prove she had significant funds to provide for her family member to come on a long term visa...apparently this is not across the board. I find myself now wondering why this is acceptable behavior.. America is a melting pot, but is it our responsibility to care for people who chose to come without a means of supporting themselves? I guess I digress.

The medicaid issue has just recently hit me on a personal level. My spouse is heavy, and has really not been able to lose weight the traditional way (less calories in, more output) , I think he may benefit from gastric bypass or banding, even though the thought of it scares the hell out of me... My SIL had the procedure about a year or two ago, she had been unemployed for > than 2 yrs and because she has young kids qualified for a state subsidized program. Oh yes, her husband has also been laid off for quite some time now- guess what, her procedure and all associated Md/ counseling visits were covered. I work for a nonprofit organization/ self funded, and they do not pay for bariatric procedures. I am glad for my SIL, glad it was successful. My MIL actually offered to pay for my husband to have the surgery, but having worked in insurance I am aware that this could be a very awful situation.

If a procedure is not a covered benefit , then any and all subsequent issues related to that procedure are also not covered. I cannot let them pay for such a thing, knowing about potential complications. Anyway, how come this is fair? I work, my husband works, and we are insured and cannot get the care we need, but my inlaws can on medicaid- this is a situation when it kind of just does not seem fair. Thanks for allowing the vent...

[PostOpPrincess, BSN, RN]

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.

You have a positive attitude and I am glad that you will not be wrinkly when you are older. However, I also think you must've done some drugs because your rosy colored glasses is making you foggy. Where the heck are you coming from?

I also think you are very idealistic and hope that you won't get a really rude awakening when you don't reconcile reality with your "belief" in the "sicknesses of the soul."

[sunny d]

OK, to those who won't ask "where the heck am I coming from", well just from a lot of experience dealing with people. I've actually gotten more optimisitic about people the longer I deal with people, especially the ones with problems. And yes, I've been in jobs with lots of stress, very rude people, and various life and death situations on the job, so these kinds of situations are not that unique to nursing. And no, I've never done drugs. I'm not unique, but maybe you just don't see that much of this kind of attitude on this forum, which seems to have a lot of people venting a lot. I also see a good amount of positive attitudes here, but it seems like there is more posts that are just venting. Relax, you can have any attitude you want, I was just posting my opinions.

[GadgetRN71, ASN, RN]

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.

But see, there are those who actually enjoy cheating the system...there is no shame about it either. There are people in my family who see it as an accomplishment if they can make the state pay for that pregnancy test. Ask why they are having another baby when 1) they aren't married and 2) can't afford the kid and they laugh. They laugh even harder when you say that you can get the pregnancy test pretty cheap at the store. Nope, all about getting something for nothing.

[Zookeeper3]

OK, to those who won't ask "where the heck am I coming from", well just from a lot of experience dealing with people. I've actually gotten more optimisitic about people the longer I deal with people, especially the ones with problems. And yes, I've been in jobs with lots of stress, very rude people, and various life and death situations on the job, so these kinds of situations are not that unique to nursing. And no, I've never done drugs. I'm not unique, but maybe you just don't see that much of this kind of attitude on this forum, which seems to have a lot of people venting a lot. I also see a good amount of positive attitudes here, but it seems like there is more posts that are just venting. Relax, you can have any attitude you want, I was just posting my opinions.

sorry, laughing myself in stitches.. we've all been there, but we at least post our position.

[Zookeeper3]

I'm impressed that you are able to discern what my experience has been from a tag line on a message board. In fact, I am NOT an ER nurse but I have worked in the ER and many areas of health care so I will give my opinion on this matter, like it or not.

Besides, whether or not one has experience working in an ER is largely irrelevant to my post. OP seems frustrated that he Medicaid patients are defensive; I merely pointed out that there is good reason. Your post and many others on this thread support my POV.

As to your anecdotes, please don't bore me. For every story of abuse you offer, I can counter with one of sacrifice and humility. Your example proves nothing. You think you are not prejudiced, clearly you are. And the attitudes of your patients and family towards you reflect that.

Consider that my 20 years' experience encompasses the care of all stripes of Medicaid recipients from the elderly to the young disabled, the inner city poor and the rural poor and I've worked in large inner-city hospitals, border hospitals, community hospitals, clinics, prisons, home health and various work settings in between. If you think that only Medicaid recipients are rude, demanding, etc then you have your eyes closed and you could probably benefit from some different work experience yourself as you sadly lack perspective. Good luck on that.

Sorry for the wasted space friends, but wanted to allow the post to show whole. Listen med/surg... geriatrics, you can pretend to be anything you wish on the internet and it not only bores me but your lack of knowledge insults me. Your 20 years is clearly not as a case worker RN, nor your supposed "er" experience. Your falseness is so clear, that I'll leave your lies and nonsense alone.

Although the fact that you claim to work with the poor impresses me, as I do that on a daily basis. It is indeed challenging to meet their socioeconomic needs with those that truly need them.. vrs those that are stealing the klenex, boxed lunches and demanding the taxi vouchers for the sore throat that brought them here.

Sorry, we'll have to agree to disagree, but when I admit the real deal, with no insurance and treat the constant BS with the state card... I have the experience to see where the system is wrong and my tax dollars are wasted.

The pure fact that you defend this abuse, speaks volumes about you.

[DolceVita, ADN, BSN, RN]

I've only ever had people who have state insurance tell me "I'm paying your salary by being here! My medicaid pays for you."

I've never had someone say to me: "My Blue Cross/Kaiser/Cobra/etc pays your salary!"

The Medicaid families single themselves out, unfortunately. The bad apples spoil the bunch. Regarding medicaid though, it's been my experience that the bunch is by and large bad apples. The respectful and grateful are few and far between.

Look I don't like this sort of generalization. What do you do? Go and check their insurance status?

Has it occurred to you if you only have this "problem" with people on medicaid that the only other common thing, apart from medicaid, is you? As you clearly know how they are insured then it is entirely possible that you treat the medicare patients differently and they are reacting to that?

If you think people do not sense contempt you are very wrong.