Medicaid HMOs

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Medicaid HMOs

Post by Tysus » Sun Jul 22, 2018 10:47 pm

My story speaks volumes about the problems with the healthcare system in America, particularly when using Medicaid HMOs. My hope from sharing it is to shed light, maybe ease the way for others, maybe even find help for myself. At the very least, let's call attention to the issues!
It starts in December 2011, when I discovered that my bladder, cervix, uterus, and rectum were prolapsed. I also had urinary stress incontinence (thank you childbirth), and developed gallstones. I had surgery on July 1, 2008 to remove the gallbladder and uterus, and to tuck everything else back in place plus strengthen the urethra. I was in surgery for 9 hours. They used mesh to tack everything back in place.
Fast forward to March 2015. I developed vaginal bleeding and discharge. After a hysterectomy, I shouldn't have bleeding, so this was alarming. I went from the primary care to an ob/gym who said I had two infections but after antibiotics, nothing had changed. She then referred me to gynecology oncology. Dr. Smith ordered some tests and found a mass in the pelvic region. She said she wouldn't know what was going on until she opened me up and looked. So on July 19, 2016, I went in for surgery. I consented to removal of any remaining "lady parts" as well as robot assisted laparoscopy and the possibility of open laparotomy. From my understanding, she found the mesh to be embedded in my pelvic organs. She also found a tumor on my colon. She called in a colorectal surgeon, Dr. Mancuso.
Dr. Macron felt the tumor was threatening obstruction. He removed the tumor (which turned out to be benign) as well as my sigmoid colon. He then decided to leave me with a colostomy. My brother was in the waiting room and I listed my father as the person to contact if necessary, but to my knowledge, no one was consulted before the colostomy was performed.
When I woke up, I was devastated. I went in thinking she was doing an exam under anesthesia to determine what was making me bleed, and I wake up with a colostomy?? I was horrified. I cannot count the hours I spent crying. They assured me that it could be reversed.
I spent nearly 3 weeks with a catheter because they had to repair the urethra. They left a fistula at the base of my incision that drained so much for at least 6 weeks that it would gush whenever I stood up. Dr. Smith did a colonoscopy to determine if everything was ok for reversal. He said it all looked good. Dr. Macron said there wasn't much left for her to do, as all my lady parts had been removed. Both doctors said the next surgery couldn't happen until they had an urologist involved to work with them for the mesh damage.
Well, despite my best efforts, I couldn't find an urologist that would accept my insurance that was at the same hospital as the other doctors. When I tried asking Dr. Smith office what to do, they said they couldn't even do the next surgery because they don't accept my insurance and he had only been able to follow up because it was an in surgical conference. Dr. Macron said I'd have to go elsewhere in order to include the urologist.
So, having been dismissed by the doctors who put me in this position, I set out to find a colorectal surgeon that takes my insurance. None do. I did find a loop hole. I found a general surgeon's office that has a colorectal clinic and even though the doctors running the clinic do not accept my insurance at their practice, they could accept it at the clinic of the general surgeon who did accept my insurance.
They said it would take a team of doctors to deal with the issues, however, because the mesh was in the way of the reversal. I went to a gyn who said it was too complicated and that I would need gynecology oncology. Insurance does not contract with any, or if any took it, they weren't accepting new clients. I pleaded with the insurance to help me. They sent me to someone who they claimed was gynecology oncology but they were actually general gynecology. But she referred me to an urogynecologist who said that yes, he could remove the mesh.
The problem is that the urogynecologist who will remove the mesh is at one hospital in one town, while the colorectal surgeon who will do the reversal is at another hospital in another town. I tried to work with insurance to find two doctors at the same hospital that take my insurance to do a joint surgery. I have finally conceded to the fact that this is impossible.
As of this writing, I still have bleeding from the mesh. I am still mentally traumatized from the colostomy. I cannot wear most of my clothes because I can't have anything around my waist and most shirts won't cover the bag anyway. Insurance only provides 20 bags per month so I no longer go swimming because you have to change the bag after each time if you do and I don't really have bags to spare. I have always had poor body image but now it's even worse. I hate going out in public because I'm afraid it will be obvious that I have this thing attached to my stomach. My quality of life sucks. Due to the bleeding, I can't have *. I'm only 43, I'm not ready to give that up.
It infuriates me that I am unable to get the care I need simply because I am limited to what the Medicaid HMO covers, and most places won't take Medicaid HMOs because they pay less than other insurance companies. Healthcare should not be a business out to make money. It should be about keeping people healthy.
Update. I spoke with Dr. Gyang's office, the urogynecologist who is willing to remove the mesh. His surgery scheduler told him I am unable to find a doctor to do the joint surgery with him and could we proceed with separate surgeries? He said no, it has to be joint surgery.
I called the Medicaid office. They are filing a complaint against Prestige Health Choice to make them more accountable for providing doctors. I don't know if that will work, if that will help, or how long it will take. In the meantime, I continue to bleed and I'm nearly out of colostomy supplies because the insurance denied the last request saying the prescription had run out. I had to wait 2 weeks to get in with the primary care to get the prescription renewed, and now the supply company is waiting for the authorization from the insurance to fill the order.
I never asked to be in this predicament. I never had problems with my bowel. But because one surgeon made a decision on his own, I am now stuck pooping in a bag on my side. He said he could reverse it and then he dismissed me from his care. As for the mesh, I have a law office looking into a case but they are having trouble getting records from the hospital where the mesh was put in place. And I seem to be powerless to resolve any of this. I need help. This country has some of the best medical care available, but it's not accessible unless you are privileged. That's just not right. I didn't ask for the mesh. I did nothing to cause it to erode my organs and create a tumor. I had no say in receiving the colostomy. And it seems I have no power in getting this resolved.

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Re: Medicaid HMOs

Post by Adam » Tue Apr 07, 2020 1:28 pm

To whom it may concern
My name is Louis and I hate to bother you with this letter but I am in desperate need of assistance for medical from my HMO.  I recently was medically retired after 20+ years of service.  Problem is my VA check doesn't cover everything.   I can't get a job because of the multiple surgeries that I have had since Afghanistan.   So if I don't get any assistance I along with my family will be living in our car.  I should be getting my Social Security Disability in September, so I would like to be considered for a grant if possible to assist me with health care from the HMO I am in.   Please feel free to contact me.

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