The Medicaid Game
Daily Observer
Rigid Rules are Counterproductive.
How Rigid can the Rules Be?
I arrived at Lapius’s office just after he saw his
last patient for the day. He was busy
plucking at the small portable typewriter he kept near his desk. The staccato sounds beat an unsteady rhythm
until he had finished the letter. Only
then did he greet me. “Hello, Harry,”
without looking up. “Here, read these. They will bring you up to date on the final
letter of my correspondence, the one I’ve just finished.” He handed me a sheaf of papers. “They are in chronological order.” I started to read. The first was from Lapius to Medicaid.
Gentlemen: I
have a patient who has just been deprived of his Medicaid privilege. It seems that at your urging, he got a job
which boosts him above the minimum for Medicaid by $100 yearly. He is an asthmatic and requires weekly
injections of pollens for desensitization.
Without these his asthma is so severe as to prevent him from
working. When he can’t work he goes on
Medicaid. When on Medicaid he can afford
the injections that make him better and so, able to work. When he gets a job he is taken off Medicaid
and he can’t afford the shots. I offer
them to him for nothing, but he refuses, saying he doesn’t like to be in debt
to anyone. Without the shots his asthma
returns and he has to quit his job. This
makes him eligible for Medicaid again.
Is there anyway out of this dilemma?”
Sincerely yours, S.Q. Lapius, M.D.
The answer was as follows,
Dearest Provider: If your patient earns even $1.00
more than the minimum, he is no longer entitled to Medicaid. Sincerely yours, Ms. Eloise Smythe
Dearest Ms. Eloise Smythe: Your compassionate letter
touched me deeply. However, although it
answers my question, it doesn’t solve the problem of how I can provide medical
care for my patient. Is there not some
way in which the patient can be given a limited Medicaid allotment for his
asthma desensitization shots. After all
he only earns $100 over the minimum. It
costs him $150.00 yearly for the shots.
This in reality brings him below the minimum. Can Medicaid find $150.00 for this patient so
he can remain gainfully employed?
Sincerely, S.Q. Lapius, M. D.
Dear Provider: I have already explained to you that
the patient to whom you refer is above our minimum-earning rate. If he is no longer able to work, he can
return to Medicaid. In order for him to
return to Welfare rolls, you will have to fill out the five-page form
(enclosed). Sincerely yours, Ms. Smythe
Dear Ms. Smythe: We seem to be going in circles. Is there someone there who has more of a
grasp of the medical situation involved with whom I might correspond. Am returning the five-page form (enclosed)
since there is no point in filling them out because the patient is still above
the minimum. Yrs. Truly S.Q. Lapius,
M.D.
Dear Provider: I refer you to my superior, Ms.
Snyder. She is the secretary to the
manager of the unfilled Medicaid claims department and I am sure she will be
able to answer your letter. Truly yrs.
Ms. Smythe
Dear Ms. Snyder: Enclosed is correspondence to from
Ms. Smythe. Can you help me in this
matter. Please note that now it takes a
16-cent stamp to forward the material.
Sincerely yours, S. Q. Lapius, M.D.
Dear Provider: Statutes relating to your patient are
enclosed. I hope they will be of
assistance to you. Please to us if we
can help you in any way with your problems.
Sincerely yours, Ms. Smythe for Ms. Snyder
Dear Ms. Snyder-Smythe: Thank you for the
clarification. I read the statutes
carefully. Is there any way to get around
them. After all, for an investment of
about $150 yearly the United States Government could save about $1000 in
medical fees and an additional several thousand dollars in maintenance fees. This represents a profit of about four
thousand percent. Incidentally, is there
a higher up who could help circumvent the law?
Your obedient servant, S.Q. Lapius, M.D.
Dear Provider: Yes.
You could write to the director of the entire State program. Ms. Martin Milgrim. Sincerely, Ms. Smythe for Ms. Snyder
Dear Ms. Martin Milgrim: Enclosed is the
correspondence between myself and your office.
Can you help to find a reasonable way out of this dilemma. S.Q. Lapius, M.D.
Dear Provider: No, Sincerely, Ms. Smythe for Ms.
Martin Milgrim through Ms. Snyder
Dear Ms. Mss. Smythe, Snyder and Milgrim: Would you
be kind enough to note that my name is Simon Quentin Lapius, BA. LLD. PhD DsC
MD
Dear Provider: The code of our statutes prohibits us
from discriminating. You are a provider,
no different than any other provider of Health Care. Sincerely, Ms. Smythe for Ms. Martin Milgrim,
through Ms. Snyder
Dear Ms. Smythe et al. Is there a higher authority in charge of this
mish mash whom I might make this appeal?
DOCTOR SIMON QUENTIN LAPIUS
Dear Provider: God knows. Sincerely, Ms. Smythe
“Well,” I sighed, turning to Lapius. “That’s quite an informative
correspondence. What are you going to do
now?”
“Take it to a higher authority,” he said, handing me
the letter he had just finished typing.
God
c-o Prudential Insurance
Carrier for Medicaid
Dear God: Sorry to have to bother you, but this
correspondence was bucked upstairs.
Would you please review it and tell me whether there isn’t some way that
a common sense solution can be found to the stated problem. Sincerely yours, your obedient servant,
Simon, Quentin Lapius, M.D.
One week later Lapius showed me the answer to his
last letter.
Dear Provider: As you must know by now, I don’t make
the law. It is made in my name by
mortals. I am merely the enforcer. Most sincerely yours, God, (signed by Ms.
Smythe)