I must vent. About Medi-Cal & such.

By way of background: After Dave left us, he also switched jobs and his health insurance that we were on (Blue Cross HMO) was set to expire at the end of September. With my new low income, I knew that the kids would qualify for Medi-Cal (state insurance for very low income people) or Healthy Families (where you get to pick an HMO -- for if you make a little too much for Medi-Cal). Meanwhile Dave put me on his new insurance, which was Kaiser -- an insurance that would not work for Ricky because he needs to go to Stanford for his CF and psych care.

At the time I applied, Misty's income was a bit higher due to the child support we get from Dave. So she qualified for Healthy Families. I was told that the boys did not have enough income and therefore qualified for Medi-Cal -- which is okay. We can still go to Stanford with that. Medications are a bit of a struggle with them but at least they're eventually covered.

On October 1, I got the boys' Medi-Cal cards. Yay! Just in time! I applied for California Children's Services (which covers expenses not covered by Medi-Cal or private insurance for people with chronic illnesses) for him and they told me that the computer said his approval was only temporary. I called Medi-Cal and they confirmed that this happens -- it takes a while to get the final approval. CCS said they'd try to get Ricky's expedited.

Ricky has had a few prescriptions filled with no problem. I tried to refill some of Andrew's the other day, though, and the Medi-Cal computer was apparently telling the Walgreens computer that we have an HMO and that the HMO should be billed first. BS!

This morning at work I called Medi-Cal to find out why they had in their computer that Andrew has an HMO and were not letting the pharmacy bill Medi-Cal.

And that's when the s*** hit the fan.

Turns out? The boys' Medi-Cal really IS only TEMPORARY while they determine whether the boys are eligible. And they have determined that I make too much money for Medi-Cal. That's right... It took them four weeks to figure that out. After the computer at the Healthy Families office (where people who make too much for Medi-Cal, get coverage), at the end of last month, said that Misty could get Healthy Families but the boys would have to get Medi-Cal.

I eventually talked to this completely clueless, completely un-helpful woman named Amy who is apparently our caseworker. She told me she'd gotten the file back from Healthy Families last Thursday, and now had determined that I make too much money for the boys to be covered under Medi-Cal. She could not explain why she seems to have a different table for calculations than Healthy Families does. I asked her why she had been sitting on this information for 8 days. She claimed that a week ago yesterday was not 8 days. Okay, I said, 5 business days. She claimed she'd been trying to get ahold of me. I told her I had not gotten a letter of phone call. She said she does not keep track of when she contacts people. Yeah, sure you've been trying to get ahold of me.

I eventually lost my cool and got very angry with her and she got upset at me for being angry with her, even after I explained repeatedly how my son has specialists he sees very often and thousands of dollars in medications he relies on to stay ALIVE. She said something like they couldn't give us coverage just because he sees specialists. OH NO SHE DIDN'T! I asked for her supervisor. She would not give me the supervisor's name and told me to call the main number and ask for "Amy Vu's supervisor".

I did that and talked to the supervisor, who had already been filled in by Unhelpful Amy. The supervisor said the paperwork would be sent back to Healthy Families on Monday, because it was too late for this week (maybe if they hadn't sat on it for 5 business days... you know, it's not like anyone's health or livelihood is in the balance...) and the fastest way to handle it would be for me to go down to Healthy Families (AGAIN) and reapply. I asked again why nothing had been done for 8 days and the excuse was apparently that I am not the only client that Amy has and that was just how it was. Umm. Okay. That may be true but that was no excuse, really. Then Miss Supervisor looked Andrew up in the computer for me and informed me that he had had Medi-Cal through the foster system and it was terminated last year. Yeah, that was the coverage he had LAST YEAR. When we were going through the crap with DFCS regarding Ricky's instability and out-of-home placement. What about the coverage we just applied for FOUR WEEKS AGO? Oh yeah, she found that. And she told me that it didn't say anything in there about an HMO. She also said, but wouldn't promise, that the "temporary" Medi-Cal for the boys would stay in effect until the Healthy Families transition was processed. Maybe. Didn't exactly make me feel better. She also had no explanation as to why Healthy Families would show one eligibility calculation while they showed another. She said they had that problem all the time. Umm, has anyone thought to figure out WHY?

By this point, I had gotten home (was talking to them on the cell phone on the way home). So I went inside and called the pharmacy and asked them to contact the caseworker. I gave them Amy's name and number. They called there and Amy refused to help them. She told them to call her supervisor but again would not give the name, just the number. I asked them to call me back when they got some answers.

A while later, while I was out with the kids, I got a voicemail from the pharmacy. They had contacted Amy's supervisor, who looked Andrew up in the computer... AND INFORMED THEM THAT HE WAS ON MEDI-CAL LAST YEAR UNDER THE FOSTER SYSTEM. That's right, she basically deliberately gave them incorrect information. I know she remembered us because I had spoken with her not 10 minutes before. She actually gave the pharmacy the number to the foster care social worker on call, who, when they got ahold of her, looked him up in the computer and found the CORRECT information that apparently the supervisor at Medi-Cal was too stupid to find. By this time, it was after 5 and the pharmacy could not call back the supervisor woman. So it is going to have to wait until Monday now.

Andrew will run out of his two psych medications on Tuesday. This had better be handled by then.

I am thinking of calling our County Supervisor's office on Monday. When we were going through the stuff with Ricky during the summer of last year, they were actually a bit of help. The incompetence at the County level just astounds me... Maybe the Supervisor can kick some ass and take some names.

Anyway, before I got that call back from the pharmacy, I took all three kids and went BACK to Healthy Families to reapply for it for the boys. I explained the situation to the intake worker. She looked at my newest paycheck... Which was about $300 more than the one I originally applied with... And said I was only $24 into the range of Healthy Families. Which meant with my old paycheck I definitely did NOT qualify for it (and the boys really should have gotten Medi-Cal) just as they figured out before. So that means somebody I talked to earlier today was definitely FULL OF S***. She thought the best way to handle it was to put in an "add" request to add the boys to Misty's Healthy Families file, combined with extensive explanations about how they do not qualify for Medi-Cal because of the income. I went to the post office that's open late and mailed that thing right away. It had better be processed in a hurry. As it is, Misty's coverage had a 20 day lapse with Healthy Families. I am afraid of Ricky getting sick in between... But he supposedly has Medi-Cal in the interim. Who knows?

And we are spending the night at my mom's tonight. It's late, so I had better get to bed, but I just wanted to get all of today's insanity typed out before I forgot about it. I sure hope it gets resolved.

I know I do not usually rant and rave on this blog, but thank you for bearing with me. I was just... insane with worry. I am trying not to freak out but it is damn hard.

P.S. Ricky sounds nasally and has been tired. But not enough for me to call the doctor today. I bet he is getting sick. I AM HOPING HE DOES NOT GET SICK. That is all.