Patients on Medicaid

[DiEd]

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 care for; they often are rude, demanding, and unappreciative of nursing care. I have cared for many who demand tests/procedures/an extra day or two in the hospital/supplies that they don't really need; doctors often admit to just giving them what they want, rather than arguing. I have had medicaid patients say to me after I suggest to them, they can probably purchase an item for cheaper at the store, "Oh I don't care, I'm on Medicaid". Recently, a woman openly admitted that she had another child because she wanted more Medicaid money. When a woman has six kids by different men, and lives off Medicaid, I asked myself, "how does this happen"; aren't there people out there monitoring this system". About a year or so ago, I was taking care of a woman - and because the census was extremely low, patient-nurse ratio was 2:1 (unusual but nice). Anyway, I took so much extra time visiting with, caring for and going way beyond what I really needed to do to ensure quality nursing care, and at lunch, her Diet Pepsi wasn't on her tray. She gets on the phone and proceeds to rant and rave about this to a friend. I could hear her end of the conversation. Yes, she was a Medicaid patient.

Wow, I was blown away and got quite upset. I can't believe these are isolated incidences. Many nurses I work with are able to identify Medicaid patients just by their behavior.

As I said earlier, I don't mean to offend, but I am interested to learn if others out there in the nursing world encounter the same type of thing. I realize it is not right to label or generalize people, and I don't let it affect how I care for people; I certainly don't like the way I feel when confronted with this behavior. Any responses are welcome.

Thanks.

[L P N to B]

to be honest i'm not RESENTFUL of anyone or what they may have or don't have....my FAMILY happens to be VERY wealthy.. and GREEDY at that... i understand they have worked hard to have what they have and i am working hard to have what i CAN have with no help from them...... and whether i am stressed or not has NOTHING to do with my reply to that post. it was just the fact that it made me upset to see people i look up to judging less fortunate people over health insurance. i just want people to understand that ALL medicaid people are NOT the same, we all have different situations. WITH THAT BEING SAID.... everyone is entitled to their own opinion... and thats what these forums are for, right? SOO i apologize if i came across as RESENTFUL

[Multicollinearity, BSN, RN]

I understand L P N to B's viewpoint. She's working full-time and going to school full-time while raising a family. She's working extremely hard and needed a bit of help (medicaid) and it just plain hurts to see others look down their noses at those on medicaid.

[L P N to B]

I understand L P N to B's viewpoint. She's working full-time and going to school full-time while raising a family. She's working extremely hard and needed a bit of help (medicaid) and it just plain hurts to see others look down their noses at those on medicaid.

Just wanted to say thank you. i appreciate your understanding!!

and again i DO apologize to anyone that i may have come across the wrong way to

[teeituptom, BSN, RN]

WOW. usually i enjoy reading posts in these forums but i HAVE to tell you, this one is hitting way too close to home and some of you people are UNBELIEVABLE. I have TWO CHILDREN and one on the way. I have been on WIC and my kids are on MEDICAID. NOT EVERYONE who is getting government assistance is RUDE, OBNOXIOUS, ABUSING THE SYSTEM, or anything else you want to STEREOTYPE. i am a VERY HARD WORKING UNMARRIED MOTHER. I get my BUTT up and go to work EVERYDAY, FULL TIME im GOING TO SCHOOL, FULL TIME..... to better my children's lives and MY OWN. i think it's disgusting that i am working SO hard to go into a field that i love, and seeing the "behind the scenes" opinions of the SAME people I am trying to become.

DONT GET ME WRONG... i DO agree with some of the things that are said. there ARE lazy people sitting around collecting OUR HARD EARNED MONEY. THERE ARE rude obnoxious people around. but those people are not not only walking around with MEDICAID cards... some of them are walking around with LIMITLESS PLATINUM VISAS tucked behind there about-to-burst money clip.

:angryfire:angryfire:angryfire:angryfire

I have agreed with you

[teeituptom, BSN, RN]

I'd rather spend a lifetime with people living on welfare and medicaid than one minute with paris hilton

I dont know if I would go that for Paris is kinda cute, but I would like more than a minute

[anderon830]

I have been an R.N. for 37yrs and have worked in various settings i.e. office, hospital, ER, psych, intensive care. I have also experienced an entitled attitude in many patients who are on medicaid. I believe its important to be aware of the insurance status of our patients in order to meet their needs. Unfortunately our Medicaid system has fostered this attitude by numerous unfair practices. For example in OB many private health insurance companies will not cover the epidural but Medicaid does. So you will see young mothers with healthcare coverage going through labor without the benefits of an epidural because they can't afford the $300-$600 charge. Most private healthcare companies require justification for any lab work ordered but not Medicaid. So we often see patients dictating what lab to do because of curiosity not medical need. The Doctors don't mind because they get paid either way. Then there's the self-pay patient who is asking about every procedure or equipment needed as to the cost and will go without to save money instead of providing for their comfort. I too feel strongly about not "labeling" any patient but when you have a system in place that allows these and many other unfair practices the outcome is as we see it. So don't feel alone in your frustration but always remember that your patients are unique individuals and continue to treat them so.

Sincerely,

Pat

[Happy2Beme]

........................

As I said earlier, I don't mean to offend, but I am interested to learn if others out there in the nursing world encounter the same type of thing. I realize it is not right to label or generalize people, and I don't let it affect how I care for people; I certainly don't like the way I feel when confronted with this behavior. Any responses are welcome.

Thanks.

I honestly didn't take the time to read too many posts because all the postmodern non-judgementalism was getting on my nerves.

Maybe SOME nurses can't manage to separate how they FEEL PERSONALLY, (something that, btw should be an absolute NON issue in your JOB, your employer isn't paying you for your emotions), but just because you have opinions, not acting on them doesn't make them non valid.

I work MAINLY with Medicaid clients and have for my long 27 years of nursing, in LOTS of ares of specialty, and I treat my patients very well.

That does not change the fact that there is ABSOLUTELTY an overwhelming attitude of entitlement among most of them and a total lack of concern about the cost of things.

Like stated in the OP, got the cigs in pocket and the etoh on the breath, but no tylenol for the kiddies.

Come into ED's and run up 500 buck bill for simple colds and skinned knees in these days of uber defensive CYA medical practice.

Sure there's jerks from all walks of life, but that's not what the OP was venting about.

Hon...I feel ya.......they get on my last nerve on bad days too, but they get my kid gloves, just like everybody else.

It's what I'm paid, and paid well to give.

[Dixiecup]

I can see this isn't really a question.

Do you think people with regular insurance or those who are private pay are incapabe of being rude?

My brother-in-law is a multi (multi) millionaire. He could buy and sell every one of us. He went into the hospital and paid cash for his open heart surgery. He had some minor complications and was in intensive care a little longer than expected. He acted like such an A$$ one of the nurses admitted to my sister we've never had a patient like this.

Or do you think they just don't take the Medicaid patients into account because they are all so horrible it's just a given you can expect them to be bad?

And what's this about staying pregnant to get more Medicaid money? I wasn't aware Medicaid actually paid out any money to live on.

When I am pregnant I use Medicaid (I have four children and another on the way and they have the same father...what a shocker) and I have been so grateful for it. One of the nurses on the maternity ward commended me on what an easy patient I was to care for. I know this is anectdotal but really all we can go by here are anectdotes. At any rate, I think it's accurate to say much of the medical community looks down on those who use government assistance, though I can't worry about that.

But you know, there could be a reason so many Medicaid recipients have a chip on their shoulders. Again, I'm using anectdotes but if I'm lyin' I'm dyin'. I went to school with a girl who was telling me about when her grandmother took her son to a doctor's appointment. She waited and waited and finally when she mentioned the long wait to him the doctor said, you welfare people beat all I've ever seen. You don't have a life, where did you have to go?

My best friend who happens to be a nurse told me about when her daughter was small and got (I think it is called) a trigger finger. The doctor condescendingly told her, Ms Smith, I can't afford to take care of this for you any more than you can afford to pay me to take care of it...of course, my friend said they could probably hear her down the street as she took her daughter and left out of that doctor's office.

Then, there was the time I was in LPN school. We were sent to a walk-in clinic and they actually had a dry erase board that was divided down the middle: on one side they had "Medicaid" patients and the other side said "Other". I kid you not, they would leave the Medicaid patients waiting until the very last, taking the "others" who came in after them first.

We finally heard a woman (Medicaid) become angry when he finally did come in to see her then we quickly heard him apologize for the student nurses because they had everything mixed up:angryfire

Thank goodness, they took the students off that rotation site.

After all, I don't like to see lazy bums who only live to bum off the system, but apparently they do meet the requirements to have Medicaid, and Medicaid is paying the facility to provide care to that person so we really shouldn't speculate or even be concerned with why they are getting government services.

That seems strange to me that physicians would do that. My best friend if a doctor and he says his biggest revenue is medicad patients. And he never has any trouble getting paid from medicaid, he says it's sometimes three months before the insurance companies get around to paying and then they are always denying payment on certain things.

[woody62, RN]

That seems strange to me that physicians would do that. My best friend if a doctor and he says his biggest revenue is medicad patients. And he never has any trouble getting paid from medicaid, he says it's sometimes three months before the insurance companies get around to paying and then they are always denying payment on certain things.

The problem with health insurance companies is they are in business to make money. You don't make money by paying out too rapidly or by not denying various items and claims. And making the doctors, labs, hospitals, etc, etc, etc work and justify every single thing they bill for. And when doctors and hospitals are denied on certain items, they

1. Just don't fight it and drop the charge.

or

2. Bill the patient and let him fight it out with the insurance company.

It is what is known in the trade as divide and conquer. Believe me, I do know what I am talking about. I use to do concurrent and retrospective audits for insurance companies.

Woody:balloons:

[sarahdeez, BSN, RN]

I believe if you have insurance available to you (ie at work) you should not expect your coworkers to pay for your insurance (ie medicaid). I know people at work who deny their insurance coverage (which may only be 60-80 a month) in order to get medicaid. I think that is taking advantage of the system. The only reason pregnant women qualify so easily for medicaid is because the majority of the public wants to be sure the baby gets the prenatal care it needs.

I also wish the people who come in to the hospital (especially ER) and are on medicaid realized that the nurses, doctors, and techs taking care of them are actually paying their bills. Without us, and other working Americans, they would have NO healthcare at all. They do not seem to show enough appreciation to realize that. If your neighbor took you to the hospital and told you they were paying your bill you would act with great humility and respect. That is because there is direct accountability. Medicaid (and federal government programs) does not provide that. I support community, family and church assistance which provides accountability and decreases the feeling of entitlement.

It's hard to blame medicaid recipients for acting that way because most of the people on medicaid now were born into it. It has become a way of life for them and they do not know any different. The only way they will learn different is to have it taken away or to have massive education on the fact that personal responsibility is the only way to move up in the world. Education should also focus on the fact that there are certain politicians who wish to keep the poor poor in order to control them and this is one way they are ensuring that.

Of course there are appreciative persons on medicaid who are on it for a temporary reason or true disability. Once it becomes a way of life and is passed through generations, it loses its true intent to help people and becomes a burden.

I also think there should be a time when noncompliant persons are removed from medicaid roles. Why should we try harder than they are?

[EmmaG, RN]

Wow.

There but for the grace of God...

By the way, if you are ever a patient, please remember that others are paying for your bill. I hope you show proper gratitude, appreciation, humility and respect.

[FireStarterRN, BSN, RN]

Wow.

There but for the grace of God...

By the way, if you are ever a patient, please remember that others are paying for your bill. I hope you show proper gratitude, appreciation, humility and respect.

Maybe I quote you???:welcome: