8 November 2024
Quite a busy day Friday. I was ready for bed about 3 p.m.
Christina picked me up at 11:15 to make Joyce's noon therapy session at Golden Heights.
I asked Eric the RN if Joyce had gotten any pain medication yet because her therapy session was in 20 minutes. Nope. So I voted for the Tylenol, which has always been enough, and he brought it to her.
A nutritionist brought her in a main meal of "regular food" rather than the blended stuff she's been turning down. It was a bun with a fish patty and some tartar sauce and a tomato. Not very exciting but "regular" anyway.
They had been worried she was too weak to use utensils, which is why they had her on the "small bites" diet. Which she wasn't eating at all.
Cassie and Jayce came in to get her on the side of the bed and do leg exercises. She screamed she couldn't do it but they helped get her feet over the side and then her knees and sit her up at last. Then she stretched over to touch her knees and her shins and did leg lifts and kicks before insisting the session was over.
So she didn't get up on her feet.
Julian, who arranges transport for Golden Heights, came in to talk about Joyce's visit to the Plastic Surgery Clinic on Tuesday. Since he hasn't been out of bed and mobile, it would be transport on a gurney. That's $250 each way, he said, her deductible. And since she does this twice a month now, that would be $1,000 a month.
But it's also not what Mary Ann Ma, the patient care coordinator, said at the hospital when she was trying to discharge Joyce to a SNF. Because Kaiser contracts with Golden Heights (not to mention the ambulance company), her transport to the debridements on Nov. 12 would be covered. She told me she had gotten that approved.
So I had some phone calls to make.
Christina took me home, promising to pick me up again on Monday.
At home, I recalled the second of the three ER visits was billed by an ambulance company for a $250 copay so I called them to suggest it was covered like the other two. After all, she was taken to the ER, not a rave, and was admitted to the hospital, not released.
But the guy on the other end of the line named Mark said they just bill according to Kaiser's instruction so I'd have to talk to Member Services to get it resolved.
I've tried calling Member Services. It's the usual phone bank frustration. So I logged into Joyce's Kaiser account to:
- Send Dr. Tong an email about the $500 transport charge putting Tuesday's visit in jeopardy
- Send Member Services an email about the "non-emergency" copay for a hospital admission
Neither of which, I understood, would get a response today.
So, having some leisure time, I called David, the Kaiser-employed ombudsman to discuss these copays.
Actually I just wanted to get some clarification on the Tuesday transport. But when I happened to mention the other copay, he jumped on that too.
He knows Dr. Tong and said he'd contact that department to see if they arrange transport. He confirmed my understanding that the ambulance ride could not be classified "non-emergency" if she was admitted to the hospital. And promised to get back to me today on both items. I'll update this report after I hear from him.
But I have to say of all the people I talked to today, his was a voice of clarity. So much of the system is designed to stymie communication that it's refreshing to actually be able to convey information.
Just after I hung up, Nate from the plastic surgery clinic called about transport to the Tuesday appointment. He hadn't read my email to Dr. Tong, though. It was just a routine call. So I told him the story, which he found extravagant, too.
He said the SNF usually arranges transport but he'd pass this on to Rochelle, who knows more about it than him, to see if they can get it worked out on Monday.
We have four years invested in Joyce's wound care. It would be maddening to have it jeopardized by this.
℘
SO AT 3:30 p.m. David calls me back with not great news. He wasn't able to reach anyone at Member Services or Mary Ann Ma. So on both issues, no resolution.
Joyce's copay, he found out (as I knew), is $250 for non-emergency transport. But he wasn't sure if that was per trip or annually, although he thought it was per trip.
I had only remembered Mary Ann Ma's Nov. 12 transport deal after I talked to him, so I passed that along. And he found it in Joyce's chart. So her Nov. 12 trip should be covered, although with no one around he can't confirm it.
He asked how important the debridement is and I said since Joyce hasn't had her normal wound care for over a month, it's Dr. Tong's first chance to assess the level of care she's getting. So it's important.
He suggested we let the SNF arrange transport for Nov. 12 and do the debridement as a medical necessity. If we're later billed for transport, don't pay it but call him and he'll pursue the documented approval of the Nov. 12 transport coverage with Kaiser. Because it's documented, we should be OK. But worst case, we'll be out $500 but have had the debridement.
And in two more weeks for the next debridement? Let's hope she's home and can take the bus.