Across and Inside my Universe

Utah Medicaid servers hacked!

ARGH. First, a year ago, we had information hacked off of Sony's servers, things like names, credit card numbers, account information, things like that.

NOW the state of Utah has been incompetent enough to install a server that didn't have the proper security measures in place, allowing hackers easier access . . . to all sorts of information, on my, my daughter, and 24,000 other Utah Medicaid people. I'm guessing there's more people on Medicaid in Utah than that, so it wasn't everybody; the state's response that they are going to send letters out to everyone affected, and provide credit monitoring services to those whose Social Security Numbers were exposed, indicates the same.

What is WITH these companies, entities, agencies, that are trusted with all this information, that they screw up like this? With Sony, they seem to have had a company-wide lax attitude; in Utah's case, it seems to be some technician's error of either installing a server that shouldn't be installed for such a secure situation, or perhaps someone ordered the wrong type of server and the errors began earlier. Human error, but . . . there should be triple checks, at least, on this kind of thing!

I am feeling very vulnerable, and very violated/exposed . . . .

16 years ago I had someone steal my checkbook and a few things from my wallet, and then they got a woman accomplice and made up a fake id with my name and her picture, and they went around writing bad checks, like for $200 of groceries, and other things. So I know a little about what can happen, although I know identity thieves can do worse.

How safe is YOUR state's Medicaid information? Or your health insurance company's system? Or your credit card company's, for that matter, I believe some big companies recently had hacks as well.

I think that something needs to change, as these are so frequent as to be ridiculous. Perhaps harsher consequences for both the hackers, and companies caught with their pants down. Perhaps laws to create or incentivize better checks and balances on this stuff, at least for government, if not for health insurance companies and other sensitive information as well.

Then again, hackers will get into almost anywhere, unless perhaps you have a government-sized budget to protect a Pentagon-level system. And even that one isn't perfect, no system is.

More attention needs to be paid to these things, because I'm fed up (wait, more attention needs to be paid because of ME? Lol, I'm not that arrogant, that's not exactly how I meant it.)

 

The Cheapest Care Possible

I don't want to offend any nurses out there, especially the ones who can prescribe.

BUT, when you have as many co-morbid (proper term?) psychiatric conditions as I do, AND especially when you have as many chronic physical health conditions as I do, you really would feel most confident having a psychiatrist, an actual DOCTOR, prescribe your psych meds, since you have so many conditions and medications that can interact with each other.

Now, as I'll apparently be seeing an A.P.R.N, which is a psychiatric prescribing nurse? I'm sure that they have extra education for that, and plenty of experience since they are working for the county's behavioral health system, and see the most disabled and/or severe cases, since they only serve those with Medicaid/Medicare. Lots of people on disability with either of those insurances, so this would be where they go . . . the LCSW I saw for intake interview went out of her way to reassure me that the nurses see severe cases and are very capable (does this mean she thought I was a severe case, or just that knowing they treat severe cases all the time means they are competent to treat anyone?). I got the impression that seeing a nurse instead of a psychiatrist for meds is something alot of people aren't the happiest about.

Anyway, while I'm sure these nurses are capable in many cases, I just feel like I have so much going on both mentally and physically that I'd only be really comfortable knowing a doctor was seeing me; how can I know that these nurses know enough about all the physical health stuff besides the mental health stuff to be able to manage all the issues?

Then again, who WOULD be happy that they'd be seeing a nurse for what they've traditionally thought is a doctor's role . . . I think this is partly based on that, but still . . .

There is part of me that feels like, because this is a government-funded mental health care system, as well as government funded reimbursement for them, that this is why they use the lowest-level providers possible; I was told that they do have ONE psychiatrist, but I'm guessing he only gets sent the most complex or resistant of cases. I was told I'd be seeing a nurse.

I feel like, because I am dependent on government assistance for this, that I will be receiving a lower, cheaper (not necessesarily incompetent) level of care than I would if I had private insurance. I don't think you can argue that these nurses AREN'T less expensive than psychiatrists, which means they are cheaper (although I am not trying to imply that their care is valueless or without dedication, expertise, etc. - it costs less and is less educated than a doctor/psychiatrist, though, is all I'm saying). This makes me feel like I am a second-class citizen, but then, without regular insurance, I kinda feel that way anyway.

I'm sure if something like this was posted over at Shrink Rap, there'd be an outcry from prescribing nurses, and maybe even non-prescribing ones . . . the thing is, though, I feel that prescribing nurses should SUPPLEMENT what a doctor does, not REPLACE them, and it feels like in this case they are being used as replacements. THAT is what feels wrong to me, what feels like I am being given the least expensive care they can get away with.

I'm also annoyed at all the hoops and forms I have to jump through and deal with just to see a nurse . . . I'm sorry if that offends anyone, nurses are very valuable, but I do NOT, I definitely do NOT see them as the primary provider of the medical side of my mental health care. I do not think that is appropriate.

I'd prefer something like initially seeing a psychiatrist, or a psychiatrist with the prescribing nurse present (they'd never do that last, too expensive) for the first couple of appointments and then see the nurse the rest of the time, with maybe a twice yearly check by the psychiatrist; more often if moderate to high problems come up. THAT seems like it'd be more, well, working with both a doc and a prescribing nurse . . .

I guess this post is amounting to a big whine, that might affront a variety of nurses . . . but it's how I feel, and I don't think REPLACING psychiatrists with prescribing nurses is a good thing for mental health care. Supplementing, okay, I can work on getting used to that . . .

I'll have to get used to seeing just a nurse, I guess, but I will not be happy about it. And here I thought I'd come to a new, more open mind about my next shrink, about being more open-minded, more open to different personalities and learning whatever comes to be learned from them. Turns out, I don't get a shrink at all. I'm feeling like I, and other Medicare/Medicaid people, must not be worth it, in the eyes of the government and the people who vote in the people who fund or restrict how such places are staffed.

 

"You Are Not a Resident of Utah"

That's news to me!

I knew I was expecting some forms in the mail from Medicaid or Department of Workforce Services, since my husband starts work at the end of the month and I needed them to send an employment information form to report the new job information to them.

As well I needed to know what they needed to get my daughter on my Medicaid.

So today I get a thick envelope, with a letter and form for the employment situation, and a letter saying what they need to consider my daughter.

But smack on top of the pile, is a NOTICE OF DECISION. Regarding me, and it says action taken is CLOSURE (of Medicaid benefits). Reason given? "You are not a Utah resident."

WTH? I've been living in Utah since the late 80's, people! I figured, after a few heart-palpitating moments, that since I had them amend my address last week (they'd been forgetting the apartment number so sometimes I wouldn't get my Medicaid cards), that the system now thinks the Apt. number is on the line of the address that city and state used to be on, so it thought that I'd left Utah since Utah wasn't on that address line any longer.

I called the guy I talked to last week (thanking goodness that I'd gotten his direct number, because he was layers and layers and layers in to the various recorded menus in that phone system) and he said that the computer shows that this notice was sent, but there's no reason for it. He said sometimes it messes up. He says my benefits are open, and not going to close, although they ARE waiting for the new employment information. But the benefits aren't going to close at the end of the month, and I asked him if I needed to appeal like the notice said and he said no.

I really, really hope he's right, because if I miss my time period for appealing something that needs it I'll be really angry and upset. Still, I can see that this could be a stupid computer error based on what I said above . . . . but WHAT an error!

Government can be so stupid sometimes. At least it was "efficient" in sending me all of these papers in one envelope.