A Tortuous Path to Care
In January 2021, I went for a routine acne checkup at my dermatologist office, where I have been followed for many years. Due to the severity of my condition, and the failure of more conservative treatments, my doctor (Dr. Blake*) recommended Accutane.
I was surprised to learn that my new insurance, through Kentucky Medicaid, required a referral from my primary care provider (PCP) in order to see a specialist. The Medicaid carrier then informed me that the provider to whom they had initially assigned me was retired. I didn’t understand why they had assigned me to a provider who wasn’t practicing. I was also told that I would have change dermatologists, since Dr. Blake did not accept Medicaid reimbursement, even for established patients.
The Medicaid carrier’s representative assigned me to a new PCP. When I tried to schedule an appointment with this new PCP, I discovered that not only was he a neurologist rather than a PCP, but he was neither in their system, nor was he located at the office to which I was directed. They couldn’t explain.
I contacted the insurance company again. They said they would find me a new doctor. I told them that given their track record, they needed to make sure that this 3rd doctor existed, was a PCP, and was located a reasonable distance from my home, since I don’t drive and transportation for me is a challenge.
After working through a dozen or so provider names, we finally found a PCP who was taking new patients. Unfortunately, her office was about thirteen miles away. I’d been on the phone for that day for around two hours, and was fed up, so I accepted this provider and scheduled an appointment for the end of July.
With significant delays on both ends, I took public transportation to and from my PCP appointment. The provider willingly generated a referral to the dermatology office, but asked me why Medicaid had suggested her office, since it was so far away from my home.
The following week I scheduled an appointment with a doctor in my dermatology office who was willing to see Medicaid patients, to begin my acne treatment. I then contacted Medicaid to find a (now 4th) PCP closer to home. Shockingly, they assigned me to the same neurologist (“PCP” #2) that they had before, and logged this into their system.
I next received a call from my dermatologist’s office, advising me that since my current PCP (the neurologist, PCP #2 and #4) was not the one who generated my referral (PCP #3), that the referral was invalid. They told me that I could not be seen until I had a referral from the same provider who was assigned to me in the Medicaid system and was listed on my insurance card.
In August, I called the Medicaid insurer once again. After about half an hour of going through doctors that weren’t even located in the city where I live, we finally found someone that seemed like a good fit. Based on past experience, I expected to receive a new insurance card reflecting my new PCP assignment. I did not. I was unable to access the insurer’s online portal to try to resolve the problem.
In September, I contacted the insurer again, as it appeared that they had failed to assign me to PCP #5. Their servers were down, no one could help me. I then requested technical assistance with their portal login. With some difficulty, I was eventually able to set up an account and select a provider online.
In summary, the policies, errors, and inefficiencies of Kentucky’s Medicaid system resulted in a significant delay in my quest for necessary care. The subcontractor’s site misrepresents medical sub-specialists, such as hematologists or gastroenterologists as internal medicine physicians (PCPs). In addition, a search for doctors within a 5 mi radius of my residence zip code incorrectly resulted providers throughout the state of Kentucky, hundreds of miles from my home. Ultimately, with an additional 3 hours of a family member’s assistance navigating the insurance carrier’s website and multiple calls to various primary care offices, I was finally able to secure a valid appointment to see a new dermatologist, 9 months after my original appointment.