Kayla James

Mom of 2. NICU baby, ruptured uterus, lost 2 liters blood, emergency C-section. Documenting our experiencea with American healthcare.

[Kayla James @KaylaJameyd]

Friday at 3, I get this online message low key saying I can't see my medical provider unless I pay $76. For a visit 8/4/23. I was pregnant with UTI symptoms. Got billed for it 13 months later. Blue Cross Blue Shield of Alabama denying urine culture, paid $$$ other things.

[Kayla James @KaylaJameyd]

Time on hold: 15 min. The pharmacist is calling the doctor to get a diagnosis code. Total value of needles: $18 over the counter at Walmart

[Kayla James @KaylaJameyd]

I'm on injection medication. I require needles to inject it. Pharmacy unable to fill. Call to doctor for advice = "call your pharmacy". Called Medicaid pharmacy, who stated "only my pharmacy calling Telligen can get needles filled because needles are durable medical equipment"

[Kayla James @KaylaJameyd]

Per Idaho Medicaid rules, if I pay for the prescribed needles out of pocket, I am kicked off Medicaid.

[Kayla James @KaylaJameyd]

Total time for MTM transportation to reimburse me for mileage: 28 min on phone and counting. They hung up. App crashed.

[Kayla James @KaylaJameyd]

Call from my brain med doctor's office. Adderrall is ducking approved! Fuck yeah!

[Kayla James @KaylaJameyd]

@mjshally Roll To Disbelieve blogger keeps close tabs on SBC, fyi

[Kayla James @KaylaJameyd]

So my cardiologist said trying a stimulant is ok. Stimulants provide vasoconstriction which help fight Dysautomnia condition called POTS. My sleep study doctor said best treatment for non-OSA is CBT. My psych med manager prescribed Provigil. Medicaid denied. No denial letter.

[Kayla James @KaylaJameyd]

Live x-ing of tryna get a stimulant that concurrently treats 3 diagnosis of mine: POTS, hypersomnia, ADHD. Currently on minute 19 on hold with Medicaid. #Medicaid denied modafinil/Provigil stating CBT is sufficient treatment for hypersomnia bad enough that cannot drive >15 min.

[Kayla James @KaylaJameyd]

Short time on hold, total time 7 min. There's no prior auth and representative gives me fax number to give to my provider. I'm to tell provider that "electronic submission is not effective". Send mychart email to provider with this info.

[Kayla James @KaylaJameyd]

I have Postural Orthostatic Tachycardia Syndrome affecting my heart, require med to calm racing heart beat up to 160bpm when standing. My heart doc sent prescription to pharmacy along with necessary #priorauthorization. Here's what I do to get this prescription

[Kayla James @KaylaJameyd]

Called that number, got into a automated AI system that had no "push keys to respond", repeated myself multiple times, by some miracle wound up with an actual person on the line. They very polite. Spell the medication for person, twice. Spell my name. Twice. Get on hold.

[Kayla James @KaylaJameyd]

Called other number specified for provider on back of insurance card, eventually got transferred to third person who never heard of Appeal Form but has a Claims Form. That'll be sent to me. Total time on calls to get this: 26 min. Blue cross blue shield of Alabama is insurance

[Kayla James @KaylaJameyd]

Blue cross blue shield of Alabama denied vitamin d they my rheumatologist ordered bc I have symptoms of this. The number supplied gets me to Teladoc

[Kayla James @KaylaJameyd]

My son was born at 29 weeks gestation. He has cardiac issues. He had trouble breathing and was in NICU 60 days. Blue Cross Blue Shield of Alabama refused to cover his RSV shot. RSV is a major killer of infants, esp. preemies.

[Kayla James @KaylaJameyd]

Two weeks post discharge from NICU, and this many explanation of benefits with denied coverage for wee one and myself. This is Blue Cross Blue Shield of Alabama repeatedly refusing to pay necessary medical treatment for my NICU baby, and my ruptured uterus. #thisisamerica

[Kayla James @KaylaJameyd]

@LeVostreGC @chalainakroll Word + "e" = this post

[Kayla James @KaylaJameyd]

Wee one is home and doing great.

We should owe about $5k total because max out of pocket.

Insurance keeps nickel and diming us by denying lower-cost things.

It's probably deliberate. They want us to think "oh it's just $$ and appealing is hard so just pay".