Yes, we lost insurance again due to bureaucracy

April 1, 2019 I underwent emergency eye surgery without insurance.

This is not an April fools joke.

This is government bureaucracy.

(Read about the first time we lost insurance due to bureacracy.)

Let me explain

Due to the confluence of many health problems and the pay limitations of my (honestly generous) little church our family has Medicaid coverage. Though embarrassing at times this coverage has really blessed us over the last year. Until March 31.

The document request

A few months ago in a fit of honesty I called Medicaid to report my cell phone repair income. They requested documentation of this income. Succumbing to laziness I put off sending the documents until they sent a stern letter on February 28th. Either send the documents by March 31 or lose insurance for my family!

Properly motivated I collected and sent every bit of documentation they asked for. Finally turning everything in by March 18th I set off with my family for vacation (a gift from a friend).

The policy

It turns out that FSSA (Indiana Family Social Services) has a straightforward policy for documents. Workers process documents in order received.

They logged my income documents received on March 18th but despite daily calls from me they did not get through the stack to my documents by March 31st. April 1 my insurance lapsed.

FSSA typically has a reasonable solution to my lapse. As soon as they get to your documents, they will (if everything passes snuff) backdate your insurance. This normally works just fine and services received will be correctly re billed.

The problem

The above solution works except for when you are scheduling an emergency surgery. Frantic calls to FSSA on April 1st ran into nonchalant workers telling me to wait until someone got to my documents. No one could elevate my need to an emergency status.

This resulted in major headaches as we scrambled to schedule surgery on Monday. Surgery centers saw me as uninsured and didn’t want to touch me. Finally one doctor recognized the urgency of my deterioration and admitted me for surgery. I had no idea if I was rolling into a covered surgery or a $12,000 debt.

The problem gets worse

Recovering from surgery I called FSSA multiple times a day. Still no change.

Monday and Tuesday we started to run out of supplies for my diabetic daughter and my child with Leukemia. Replacing those supplies would cost in the hundreds of dollars.

I literally told three different FSSA workers that my Type 1 child and my Leukemia kid needed meds. I simply needed them to review documents I sent 18 days ago! Everyone just told me to wait.

The solution

Today at the urging of my wife I called the local congressman’s (Larry Buschon) office. Explaining my situation and signing some forms I left them to it.

3:30pmThe Phone call

I received a call from FSSA. (They almost never call–It’s another policy.) A supervisor personally apologized to me for the run-around my family had received. They restored and reactivated all our insurance.

Conclusion

I own my laziness in not getting my documents in until almost the last minute. I also respect the right of FSSA to set policies for how documents are processed. Yet, there needs to be emergency pathways for someone to take to resolve an issue. We had a family medical emergency and they had all the documents they needed (13 days before the deadline)! We simply needed someone to officially read the documents and flip a digital switch.

Perhaps calling the local congressman’s office serves the purpose of an emergency medical solution. But it seems odd that the FSSA lacks an internal solution to this issue.

I feel very grateful to have insurance back. I also have hope that our Indiana FSSA will continue to improve.

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