More proof that things never go as you plan

The weather today is blah. Which is fitting, since that is my general sentiment toward life, at the moment. I have briefly touched on the issues that we are currently battling, regarding Piper’s health care, in other posts. Tomorrow will be the culmination of a wrestling match between us, the hospital administration, NY State, our insurance company and Piper’s social worker. Piper has been at Columbia, since the benefits covering rehabilitation facilities (like the one in NJ, where she was doing so well) expired, in June. Piper is eligible for a certain type of medicaid that would totally cover her expenses in this type of facility. This specific type of medicaid is available to anyone, regardless of household income, after they have been contiguously hospitalized for 30 days or more. The application for this coverage was submitted by a social worker at the hospital months ago. Actually, it was supposedly submitted once before then also, but was mysteriously never received by the medicaid office. After repeating the paperwork and submission process, when the medicaid office finally did receive the application, the hospital was notified that Piper had a medicaid number “pending.” Since the program is will cover her retroactively for 90 days of the activation, we were hoping that the place in NJ would take her back. Well, they wouldn’t. No where would, for that matter, until this week.

Under huge amounts of administrative pressure from Columbia, Blythedale (yes the place where she almost died last time), has agreed to take her back. Well the story gets better. The medicaid that was applied for, was not even the right type. What? By the way, I discovered this myself yesterday, after calling everyone under the sun, and finally reaching someone in the NYC medicaid office. Why hadn’t the social worker already discovered this, or even attempted to look into it? Everyone was so stumped and mystified, but no one even bothered to check it out. So Piper was denied, pending a $26,000 spend down. In other words, we would have to incur, and pay out of pocket for $26,000 in fees before the program would cover her. Sweet. We are not sure if it was the incompetence of the social worker, or the medicaid office. The bottom line is, we are not happy about it, at all. I think that Piper is pretty pissed off about it too.

The upside to the story (if there is such a thing) is that we are currently working with a third party firm, that contracts with the hospital (yes, someone who actually has a little bit of accountability for their work product), regarding an SSI application for Piper. Come to find out, if Piper is found eligible for SSI (social security disability insurance), she will automatically be approved for medicare disbursements, sans any additional applications. WTF? Why didn’t her social worker bring this to our attention in the first place? At this point, Piper’s application is in. The third party firm is having it expedited for us. The only caveat is that since Piper’s medicaid application was denied, some red flags may be set off. It may now take longer, or have a spend down qualification again. So, not only did the social worker, not help us, we may actually be worse off, at this point, than if the application had just been mysteriously lost, again.

Brief recap: Piper was denied for medicaid (the application was sent for the wrong kind), Piper currently is being considered for SSI, but coverage may also be denied or qualified with a spend down because of previous cockup and rejection. So….. Piper will not have any insurance coverage when she is discharged from Columbia tomorrow. Blythedale, has agreed to take her, on the chance that SSI will be approved and subsequently, approve medicaid disbursements also. If not, I’m sure that they plan to try to bleed the annual $26,000 out of Reagan and I, or sue us for it, so that they can collect the rest from medicaid. If things go the way they did last time she was there, she will get deathly ill in a week, have to be sent back to the PICU, and never even incur $26,000.

As one can fathom, I was not particularly comfortable with the current arrangement under which Blythedale is re-admitting Piper. Nor am I even comfortable with that facility. It was a terrible experience last time, and lets face it, she almost died from it. Let me rephrase that; She did die from it, 3 times and had to be resuscitated. As a result, I was fighting the administration at Columbia Hosptial on their insistence that she be moved back to Blythedale, coverage or not. It escalated to them threatening to go over my head and have her transferred anyway. Awesome. Ever been strong armed by a doctor into sending your kid somewhere that almost killed her last time? It is a really, really good feeling.

Phew. So there it is. Tomorrow morning, Reagan and will be at the hospital around 9 A.M. Piper is scheduled to be transferred around 10 or 10:30. I guess we will see what lies ahead.