How Was I Supposed to Know?

Three weeks of frustration came to a resounding end when a client finally (FINALLY!) figured out the last issue with her medical insurance.  After coming in multiple times a week with new information, spending countless times on hold, leaving numerous messages with different agencies, we finally figured out what the last holdup was.

It was truly a team effort of the client, the pro (Karen) and the rookie (me).  She is one of my first clients that I did a complete intake on and had her continually meet with me.  I have felt so bad for this woman as she is constantly telling me the story as I'm taking notes and then looking at Karen with my deer in a head light expression.  What do I do next?  Who do I call next?  What information do I need now?  The biggest question we still haven't figured out is how do we put our phones on speakerphone?

So what exactly was the hold up in this?  First, we had to change the client's medi-CAL insurance to Ventura County.  This process started before she left her previous county and was still not completed by the time she moved and needed to see a doctor and get prescriptions for  very serious medical problems.  Finally, a very nice man at the medi-CAL office told us about the Omnibus Office that can enroll in the plan over the phone and grant emergency medical access.  If this client hadn't come to us, would she ever have found out about this office?  Maybe.  How did it take us so long to find about this office? We didn't talk to the right people.  How do you know who the right person to talk to is?  I have no clue.

First hurdle was cleared, but second hurdle came when medications could not be picked up due to no prescription coverage.   What?  I thought we figured all of the insurance out when we called the Omnibus Office!  Well medi-CAL and Medicare don't communicate.  As Karen is talking to her girls in public health and the client am I are on the phone with a very nice medi-CAL worker we have the light bulb go off that it's a plan that ended on September 30th.  We're talking to the wrong agency and we need to call Medicare.  The irritated Medicare worker and I get cut off due to lack of speakerphone skills.  We try again and the Medicare worker explains that yes that plan ends, yes she is enrolled in a new plan to start December 1st and yes we have enrolled her in a new plan until that one starts.  Excellent! She should've been notified by letter, but no letter was received at the current address.  Medicare takes so long to process changes of address, the letter was most likely sent to the previous address even after a month's notice of change.

So now we have a happy client that has medical coverage and insurance coverage, but she looked at me afterwards and simply asked, "How was I supposed to know?".  We have no answer for that.