The other day, I got a call from the people at Byram Healthcare informing me that I will soon get a new Dexcom G5 system in the mail. That was a surprise to me that my last ditch effort to get a continuous glucose monitor, or CGM, actually worked! The failure of my Texas Medicaid insurer to find a multiple sclerosis specialist did not bolster my confidence in ever getting a CGM.
My last attempt at the Dexcom site to use minimal effort of submitting information and just forgetting it paid off it seems. Maybe that shows me that sometimes giving things time to work themselves out is better than constant stress and worry. This ought to be as lesson for me in life and make me more patient in trying to get things done, but I doubt that idea and lesson will stick in my head.
The way the whole Medicaid system works in Texas is enough to make anyone’s head spin. My understanding of the plan I am on now is that I am on the United Healthcare Community Plan by Texas Star Plus Medicaid. However, this leaves me wondering a few things about how the whole system works.
One thing is that for the first month I was covered by the “Traditional Medicaid” version of Texas Medicaid. Then, in May I was force to pick either the United or a similar but inferior for my needs Cigna plan. I chose the United because I got more benefits I needed compared to the Cigna plan that seemed more for older people. That judgment of the plans was just my thoughts in comparing the two, but I could be wrong.
In June under the United coverage I found that certain doctors I called to try to find a MS specialist said they take Traditional Medicaid but not the coverage I current on. The difference in those two plans is beyond my understanding and why they can take one Texas Medicaid plan and not the other is just baffling to me. What the state of Texas and the doctors get from offering coverage under one plan and denying coverage under the other plan I have no clue.
Also, every report that I can see after United posts the closed claim shows that not all is paid by insurance. Many show they were denied even on the reports page in my United plan member’s website. The thousands of dollars I get when I get when totaling the uncover amounts on the paid and denied claims leave me with a question. Why’ve I got no bills asking for the unpaid amounts in the mail?
The only thing I can think of is the Texas Star Plus Medicaid wind up paying those unpaid amounts on those claims. If the case is that Texas covers it under Traditional Medicaid, then why did I have to choose between two different plans by insurance companies? Does the state get a kickback or benefit from the money they pay them to insure me?
I pay no monthly payment or bill since I have diabetes and MS, and I assume they pay something to them to cover me. This system of Medicaid seems broken and confusing to me, but that is just my understanding of how it all works today.
My response was:
“Thank you Jessica for the reality and mental health check! We all need a reminder that the past is done and the present and future are what’s important. The continual growth mindset is something that has become my life. Physical and mental Illness is what I deal with everyday, and growing and learn from them is a education in its self.”
Folks can say they know a to cheat the time it takes to grow as people, but they often find that it more time and effort than they ever fathomed. For me growing, as a person is a life long difficult process that hurts and vexes us in so many ways. My appreciation for Jessica’s piece gave me a nice way to stop and reflect on what growth I experienced lately.
That exchange brought something else to mind about my development in life. Today I am a totally different person than I was before my MS and diabetes warped reality into how things are now. The new normal I spoke of for MS also can apply to my diabetes.
These diseases insulated me from the life I might have without illness. I realize now that my healthy eating and living and optimism are thanks to those two diseases. As horrible and life changing they might be I am who I am now because of them.
The life and physical state was before I was diagnosed with Type II diabetes. That unhealthy guy was 280 pounds and dreadfully unhealthy. That diagnosis was honestly as life rocking as the MS was twelve years later.
The diet I was eating was totally composed of carbs and sugar. That all had to change over night for me to improve my health. My eating habits slowly changed and evolved into what they are now.
Healthy eating is almost second nature to me now and thoughts of soda, candy bars, snack cakes, and countless other unhealthy foods that are sicken to me now. Diet soda even lost appeal to me around two years after I found that had Type II diabetes. The sweeteners in diet drinks are way too sweet for my taste now.
Unhealthy living before that discovery of diabetes was almost how I was. My body weight would be over three hundred pounds and who know what illnesses. Life now has new meaning and definition after that day in 2005.
The physical health and mental health journey I am on now is one of the usual ups, downs and setbacks that define life. Sooner I realize that I am now what I am as a result of the defects of health I have, the sooner I see that life is what it ought to be. Optimism and hope are and always were my life, and I just need to give in to know that I will be okay no matter what.
Like this Blog? Watch the Vlog! Coming Wednesday, September 18th!
(Shout out to Michelle Monet for the bio and the support!)