Tuesday, July 9, 2019

Soonercare Horror Story Continued

Today gives me quite a bit to say about the HORROR STORY that is Soonercare and the Oklahoma healthcare system, which has cemented several of my suspicions of their motivation in creating such a system.

The Road So Far

So, here is the road so far that has brought us to this point, if you have not kept up with my social media or posts.  My wife has a herniated disc, which has been confirmed with prior MRI scans and more.  For years, we could not afford treatment, and she was handling her symptoms at home.  However, we finally got healthcare for her, when I lost my job and our income dropped to qualify us for Soonercare.  Prior to that, we would have had a 5000 dollar deductible under my work healthcare plan.  However, by this time, her condition was such that she could not sit up to go into an initial doctor visit.

Therefore, we tried to make an at home doctor visit but was told by them that Soonercare would not ALLOW us to make the visit without going through the Primary Care Physician, which she could not tolerate.  A month after that appointment, her condition flared up to the degree that it sent her to the Emergency Room, where they gave her enough pain meds to go to the PCP visit.  However, they said they could not do the MRI, because Soonercare required the PCP to see her first.

So, we saw the PCP, who agreed she needed an MRI and a Neurologist, right away.  Yet....Soonercare DENIED the MRI, even though it was requested BY the PCP they demanded it come from.  After many calls, we got the MRI done and covered.  However, the Neurologist was a 3 week wait for an appointment.  When we finally get into them, he confirmed that yes...her disc was herniated (as we said) but said it shouldn't be causing this much pain (even though he said that right after tapping her knee with no reflex response) and was not going to do surgery.  Instead, he was going to REFER her (yet another referral) to get a shot for her back and therapy...NEITHER of which they could do, there.  The nurse said that she was going to look for a referral from the PCP for those things, or she would need me to help her in getting them from the PCP...which means the PCP that SAW us would have to do the referral making this appointment a 400 dollar appointment (if we hadn't had Soonercare) for him to say...yup..it's bad.


Therefore, I must conclude all of the following about the Oklahoma healthcare system, and I challenge ANYONE to dispute any of these things.

1.  This Republican system is setup to pay doctors to do nothing.  We have now had 2 separate appointments and a scan by "doctors" and medical facilities without ONE of those locations DOING anything to help the pain, other than prescribe medicines that they say we cannot get more than a week of at a time....meaning more IN PERSON appointments, as the medicine refills can not be done over the phone.

2.  This Republican system is setup to pay as many doctors as possible.  It would have been possible for the ER to do the MRI, as other states do, but they said SOONERCARE kept them from doing it.  The PCP COULD have referred the back shot and therapy, but they said SOONERCARE required this procedure.  They could have given enough medicine to last a month, but SOONERCARE requires multiple in person doctor visits.  They could have done the shot AT the ER...or the PCP...or the Neurologist, but they need to do those by two MORE referrals to 2 more locations ...ALL of which get Republican state healthcare money.

3.  Finally, treatment of the patient is NOT a priority. She has been in pain for years with this and has seen multiple locations in the last 2 months.  If they had done the home doctor we tried to get 3 months ago, it is likely NONE of this would have escalated, as she would have been getting medicine and therapy THAT way.  Instead, we will have done an ER, a PCP 3 times, a Neurologist, a medicine treatment center and then....FINALLY..someone to give her therapy near her home, even though we will still have to do weekly visits to get pain meds, while needed.  Instead of actually treating the conditions, the state of Oklahoma has made sure you don't get SOONERcare but SLOWERcare than any other state in the nation.

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