Medicaid cutting back funds - Help

[tishbite]

Just got a letter in the mail saying that due to budget reductions for 2011-2013 medicaid health care services are limiting the amount of non-emergency visits to the emergency room to 3 per year. After those 3 clients may be responsible to cover costs for those visits. I am so unclear on what is considered a non-emergency visit. Right now my crohn's is far from in control and I have been in and out of flares now for months. It's beyond painful. Is a crohn's flare/extreme pain considered a medical emergency? Should I call my GI doc first and get a recommendation saying I be seen in the emergency room? This is really scary for me because as much as I hate the emergency room it has provided a lot of relief for me and my crohn's.
Does anyone have a good grasp on what is considered to be an emergency and what is not? :sign0085:

 

[jesseiam2]

I cant say with any certainty, but I did come across this:

Good Reasons to Go to an Emergency Room:

Loss of consciousness.
Signs of heart attack that last two minutes or more. These include: pressure, fullness, squeezing or pain in the center of the chest; tightness, burning, or aching under the breastbone; chest pain with lightheadedness.
Signs of a stroke, including: sudden weakness or numbness of the face, arm or leg on one side of the body; sudden dimness or loss of vision, particularly in one eye; loss of speech, or trouble talking or understanding speech; sudden, severe headaches with no known cause; unexplained dizziness, unsteadiness or sudden falls, especially when accompanied by any other stroke symptoms.
Severe shortness of breath.
Bleeding that does not stop after 10 minutes of direct pressure.
Sudden, severe pain.
Poisoning (Note: If possible, call your local poison control center first and ask for immediate home treatment advice-certain poisons should be vomited as soon as possible while others should be diluted with water as soon as possible. Such preliminary home treatment could save your life.)
A severe or worsening reaction to an insect bite or sting, or to a medication, especially if breathing is difficult.
A major injury, such as a head trauma.
Unexplained stupor, drowsiness or disorientation.
Coughing up or vomiting blood.
Severe or persistent vomiting.
Suicidal or homicidal feelings.

Bad Reasons to Go to an Emergency Room:

Earache.
Minor cuts where bleeding is controlled.
A minor dog or animal bite where bleeding is controlled (but see your doctor–a rabies shot may be necessary).
A broken bone (call your doctor to see if he/she can treat you the same day, if not– or if bone is showing, limb is deformed–go to the ER).
A sprain.
A sunburn or minor burn from cooking.
An insect sting or delayed swelling from a sting (if there is breathing difficulty, go to the ER).
A skin rash.
Fever (if there is a convulsion, go to the ER).
Sexually-transmitted diseases.
Colds and cough, sore throat, flu.


***If you are admitted to the hospital, it has to be a good reason to go, lol***

 

[tiloah]

This is really scary for me because as much as I hate the emergency room it has provided a lot of relief for me and my crohn's.

This concerns me. Your Crohn's should not be so out of control that you have to use the emergency room that often. If you do end up in the ER, you should receive acute care there and then see a GI or at least a GP to discuss long term solutions/treatment. If you are utilizing the ER often enough that you are worried about this, something is seriously wrong that the ER cannot fix.

The rule is not intended to screw people with genuine medical need. Its intention is to weed out people who are going to the ER in lieu of a doctor's office for non-emergency services in an attempt to avoid the cost. (Like to treat the common cold and such). If you have a genuine medical emergency I wouldn't worry about being labeled "non-emergency use." The ER or your GP will also likely try to discuss your ER usage with you if they think you are violating the rule, before they report you.

 

[tishbite]

Thank you, thank you. That was actually very reassuring. My problem with my crohn's is that we have tried so many things to get it under control and nothing seems to be helping. The Remicade did for awhile until my body just stopped responding to it. It's all very stressful and methotrexate isn't enough on it's own. I almost feel like I should get some more input from another GI doc just to be sure. I am seriously considering surgery at this point just to alleviate some of the symptoms and pain. I feel like my body just wont respond to anything I or my doctors try to do to help.

 

[ThanksP]

Go see another GI doc if you want to. You never know, another perspective might be all you need to find the solution. That's what I ended up doing when my previous GI doc ran out of ideas. So far, so good.


On a sidenote: so you aren't supposed to go to the ER for a broken bone? Really?!? I would have thought that was a good reason to go.

 

[tiloah]

Thank you, thank you. That was actually very reassuring. My problem with my crohn's is that we have tried so many things to get it under control and nothing seems to be helping. The Remicade did for awhile until my body just stopped responding to it. It's all very stressful and methotrexate isn't enough on it's own. I almost feel like I should get some more input from another GI doc just to be sure. I am seriously considering surgery at this point just to alleviate some of the symptoms and pain. I feel like my body just wont respond to anything I or my doctors try to do to help.

Surgery is an option. Not making any changes is not, because what you're doing right now is clearly not working. I ended up having surgery because of an abscess that medication just wasn't going to work to heal.

I hope you find something that works for you. I know how stressful it can be, which of course doesn't help because stress exacerbates the issue. Good luck!