With a Little Help from My Friends


Last week was nutso.

Gateway dropped Caroline’s Primary Care Physician (PCP), which disrupted her Medicaid insurance. What does this mean? Well, in the insurance world—particularly in the Medicaid world—you must have a PCP to get anything done. The PCP is the doctor who writes referrals to all Caroline’s specialists, such as the neurologist, the physical therapists, pulmonologist, orthologits, and everything else.

The catch here is I only use Medicaid as a secondary form of insurance. I have health benefits through Health America with my job. Most families that receive Medicaid assistance are on welfare and use it as their primary source of insurance. We use Medicaid for the co-pay and nursing hours—mainly so I can work.

Well it seems the insurance company and the doctor’s office had a falling out and decided to part ways. Coverage dropped. The insurance company called and told me to change doctors. The doctor’s office called and told me to change insurance. This sucks! 

I’m the little guy who has to change doctors or insurance companies. This means get a guy that doesn’t know Caroline and not affiliated with Hershey Medical Center (where we have been getting our care), or change insurance companies and maybe lose most of my hard-won nursing hours.

Then to boot, I go to check out the new approved doctor and his office is in Hall Manor. OMG, like I’m taking Caroline to the ghetto to see a doctor! All the reputable places—the Camp hill and Hershey type places—are NOT accepting new Medicaid clients. I’m limited to ghetto city doctors!

I began attacking this from a few angles at once.

It turns out I know a friend of a friend that is tied into Hershey Medical Center—Joe Spogli , Steelton Highspire High School trainer and friend of mine. Called in a favor. Spogli connected me with the a VP in charge at Hershey Medical Center. His phone call got me into pediatrics department and the VP offered to come with me for a meeting with the pediatrics department to switch the insurance companies and KEEP OUR CURRENT PSU TEAM TOGETHER!

The Hershey Medical Center loves it that I need their team to continue to see Caroline. They are going to bat for me and Caroline against the insurance company to keep our current setup going. This is really great news and a lot of help. If you know anything about Medicaid insurance and big government, you know switching companies is no easy thing to do. Lots of paper work and calls to make.  Just very time-consuming. And time is the one thing I don t have to spare.

This VP stepping up for me is awesome! But what is really awesome is friends helping friends. We have a network of friends around us and when we need someone to jump in, they get the job done. We got it done now, but I wouldn’t have been able to do it on my own. 

Very cool.

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