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Very Hot Topic (More than 25 Replies) Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!! (Read 607 times)
Marine 13
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Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
02/01/18 at 22:18:05
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I have posted a message on Facebook with a request for everyone to share it.  Please read the message, and share it.  I need to pressure this insurance company to do the right thing, and ensure they do not treat others in the manner they treated my wife.

https://www.facebook.com/randall.hames/posts/1786998621310992

Anyone that is willing to help, you will have my eternal thanks and gratitude!
  

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red hawk
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #1 - 02/01/18 at 22:51:14
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God Bless You, Marine.  Prayers to your wife and you and your family.
  
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Lily003
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #2 - 02/02/18 at 03:31:22
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What is her underlying diagnosis (weakness, difficulty moving)?

Does she have blisters or other skin breakdown due to not being able to be kept clean?  These issues are very hot button now.

Can the hospital social worker try to intervene in the insurance situation?  She cannot expect not to be cared for or getting worse during the administrative process.

If she needs further long term care, won't that have to be under Medicaid if you cannot pay?

Lily003.  Cry
  
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Marine 13
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #3 - 02/02/18 at 05:27:19
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Lily003 wrote on 02/02/18 at 03:31:22:
What is her underlying diagnosis (weakness, difficulty moving)?

Does she have blisters or other skin breakdown due to not being able to be kept clean?  These issues are very hot button now.

Can the hospital social worker try to intervene in the insurance situation?  She cannot expect not to be cared for or getting worse during the administrative process.

If she needs further long term care, won't that have to be under Medicaid if you cannot pay?

Lily003.  Cry


The underlying cause is a bleeding ulcer, and intestinal  parasites.  The ulcer kept her from eating like she should, and the parasites gave her constant diarrhea.  The blood loss lowered her iron.  The diarrhea caused her to dehydrate, and severely lowered her potassium level.

She has open blisters on her backside, and around her waist.  The other areas are really red, and irritated.

The Social Worker is doing what she can, and there has been no problem with the hospital bill so far.  The problem will be when they move her to the rehab facility.  Medicare will pay 100% of her first 20 days.  After that, they drop to covering only 80% for the next two months.  But the way things are set up in VA now, there is no guarantee that Medicaid, which is Virginia Premier, will pay the other 20%.  Since, this rehab facility is separate from the hospital, their social worker can set up the placement for the first 20 days.  After that, it will be on me to work things out.  That is why I am pushing of Virginia Premier now!

If Virginia Premier will not pay, and I can't pay, they will simply send her home.
  

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DEW
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #4 - 02/02/18 at 07:59:30
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Marine 13, may the good Lord come to your rescue!  Blessings for your wife and you. 

I've never been on facebook.
  
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MoGal
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #5 - 02/02/18 at 08:43:21
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Prayers are with you. That is a very frustrating problem and I hope someone who has some "power" heeds your plight.  Sad, sad and I am so sorry this is ahead of you and has been with you.
  
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Lily003
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #6 - 02/02/18 at 08:54:35
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Are the skin sores from wetness on her skin?  Wetness and pressure?

If so, those are taken pretty seriously.  If any are open, and there is any possibility of infection, see if you can get it cultured.  In the hospital or rehab facility.

Does this Virginia Premier work like a Medicare supplement?

Lily003.  Sad
  
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bigmck
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #7 - 02/02/18 at 12:27:00
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Lily003 wrote on 02/02/18 at 08:54:35:
Are the skin sores from wetness on her skin?  Wetness and pressure?

If so, those are taken pretty seriously.  If any are open, and there is any possibility of infection, see if you can get it cultured.  In the hospital or rehab facility.

Does this Virginia Premier work like a Medicare supplement?

Lily003.  Sad


I found a link to it.  It is Medicaid.
https://www.virginiapremier.com/members/medicaid/
  
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Marine 13
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #8 - 02/03/18 at 21:11:01
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Lily003 wrote on 02/02/18 at 08:54:35:
Are the skin sores from wetness on her skin?  Wetness and pressure?

If so, those are taken pretty seriously.  If any are open, and there is any possibility of infection, see if you can get it cultured.  In the hospital or rehab facility.

Does this Virginia Premier work like a Medicare supplement?

Lily003.  Sad


Sorry Lily for not getting back with you sooner, but I have been busier then a one legged man in a room full of rocking chairs!  Or something like that.

Medicaid in Virginia falls under the Department of Medical Assistance Services (DMAS).  On January 1, they changed Medicaid to the Commonwealth Coordinated Care Plus program.  Under this program, there are six insurance companies that provide Medicaid services.  Each person enrolled in Medicaid were assigned to one of these companies.  Linda was assigned to Virginia Premier.  She did not have a choice at first, but she can change companies within the first 90 days.  All six of these companies were required to have insurance cards to their members NLT January 1.  Yet, Linda did not get hers until January 30.

Over the last month, we tried calling the company, and I attempted to use their website's contact form.  Still, they refused to allow Linda to see a doctor.  When her condition became so dire, that I was affraid that she would die, they grudgingly allow us to call a Ambulance, and send her to the hospital.  Now, they are claiming that they did not get the contact forms.  The only reason they would make that claim is because they are trying to weasle out of paying for their mistake. 

In the Commonwealth of Virginia, these insurance companies are required to pay any Medicare copayments.  That is unless the company can claim that Linda's problems are of her own doing, and not their mistake.  Medicare will pay for the first 20 days at the rehab facility.  After that, they pay 80% of the bill, and Medicaid is supposed to pick-up  the other 20%.  If they are sucessful in weasling out the paying this, then I we will be forced to pay about $200.00 a month in copayments. 

In my opinion, Virginia Premier should pay all the copayments, all the additional equipment that will be needed in the future, and compensate Linda for pain and suffering.  I will accept nothing less.  On Monday, I am getting a power of attorney so that Virginia Premier will not be able to deal with Linda directly.  I do not want them to be taking advantage of her.
  

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darroll
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Re: Virginia Commonwealth Community Care (aka Medicaid) Neglagence!!!
Reply #9 - 02/04/18 at 13:59:16
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That lousy facebook won't let me read the article.
It wants me to join facebook another communist company.
If I click on not now it gets my cookies dump. FThem
  
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