That Time BYU-Idaho Tried (and Failed) to Get Rid of Medicaid

Well, I'm awake now because menstruation is The Absolute Worst. Let's talk about the reason BYU-I has given for cutting off their students on Medicaid.

Now, they've said they're concerned about 'overwhelming' the surrounding medical community. What does that mean? As someone who has worked in medical billing in the past, I'm gonna tell you.

The Broken American Healthcare System

When I was a student at BYU, part of how I afforded my tuition was working for an LDS family I knew who had a private physical therapy practice in the suburbs of Baltimore. Their patients were primarily blue collar workman's compensation patients from factories and industrial settings.

The structure of their practice (which will become relevant in a second) is that they partnered with a couple of doctors who pulled in most of these patients. These doctors would then refer the patients to physical therapy, which was in the practice where I worked right across the hall. Anyone in private practice will tell you this is a dream situation. The physical therapist I worked for never had to think about where his patients were coming from. As long as the demands of capitalism kept hurting working class workers doing manual labor, they would never run out of patients.

So, let's talk about how medical bills work. When you go to see a medical professional, everything they do for you the second they start to treat you has a billing code. Each code is associated with a reimbursement rate that insurance companies have to/agree to pay. These reimbursement rates are set by something called fee schedules. Each state has their own fee schedule that control the maximum a medical professional can be paid for their services.

There are multiple billing codes for everything. If this is a game about making money, the billing codes are the pieces. How you use them will determine what the insurance company will pay for and how much you get. So, the physical therapists see a patient. They treat the patients and lay out the services they provided. There was someone whose job it was to draft the bill and submit it to the insurance company the first time.

At this point, it hadn't even reached my desk.

In an ideal world, when you submit a bill to an insurance company, they would pay what they owe in a timely fashion. They would do it without any hassle because we live in civilized society and it's the right thing to do, right?


Insurance companies don't pay for anything the first time a provider submit a bill. Or the second time. Or the third time. They don't pay for anything until you have hassled someone every other day for at least two weeks. That was my job. I sat on the phone calling insurance companies for outstanding cases. Mostly talking to voicemail. Their job was to hold onto the insurance company's money for as long as possible. Mine was to annoy them until they finally relented and paid what they owed us.

If you talk to any medical professional who has ever touched their own billing (which is mostly private practice people because hospitals have entire departments who do this for their doctors, who have often never even touched a bill) this the most aggravating part of what they do. For every hour they spend treating patients, they spend at least 2-3 hours trying to get paid. Paying additional staff to make sure they get paid. Hiring idiots like me to relieve their qualified staff, so they end up spending even more money trying to get paid.

Here's where Medicaid comes in

Not every service provider can just take in Medicaid patients. You have to see a Medicaid-approved physician. To become approved, it's an expensive, largely bureaucratic process that I won't pretend to understand.

Here's what you need to know.

Medicaid patients, through no fault of their own because they are pawns in a broken system, are a loss to most of the physicians who see them. That practice I worked at was losing money when they saw Medicaid (and to some extent, Medicare) patients. This is because Medicaid functions on a completely different fee schedule than private insurance companies. They reimburse very little money to the physicians for the care they provide. Far below anything that would cover operational costs, let alone be considered fair market value.

The physical therapist I worked for would had to have seen three or four of Medicaid patients simultaneously to make what he would've gotten by seeing one private insurance patient. That's why many private practice doctors don't bother to accept Medicaid patients. The physical therapist I worked for expressed to me that the practice only took Medicaid patients because it was a form of charity and giving back. The income they got from private insurance patients subsidized the care of their Medicaid patients. Without enough private insurance patients, they wouldn't have been able to do this financially. The reimbursement from Medicaid wouldn't have been enough to operate their practice.

THIS problem is why BYU-I is refusing to recognize Medicaid as an insurance provider for its students.

Here are my questions...

Why are the financial insolvencies of accepting Medicaid patients in private practice in the surrounding communities of eastern Idaho any of BYU-Idaho's problem?

Why do they think putting that cost back on poor students is the solution?

Off the top of my head, here's what they could be doing instead:
  • Advocate for updating the Medicaid fee schedule in Idaho so treating these patients isn't a financial loss anymore.
  • Make their student health insurance ACA compliant so it qualifies for subsidies.

It's worth noting that Medicaid insolvency in the first scenario goes away under a single payer system because healthy and/or wealthy people pay for sick people. Sure, this happens already. But it removes the bloated tick that is private insurance from the equation, freeing up the money being spent on making them pay their claims and do their jobs. But BYU-Idaho isn't going to support single payer healthcare because socialism? And of course, the requirements ACA compliance for their own health care plans would necessitate including comprehensive reproductive health coverage. Namely, contraception and abortion care. So BYU-Idaho doesn't want to do that either.

I don't know who the health care administrators are who are setting health care policy at BYU-Idaho, Deseret Mutual Benefit Administrators, or the Church Education System in general. But those are the people we should be looking for. Those are the people who are in control of this situation.

This policy reeks of the bureaucratic, paper-pushing, "please resubmit" (even though your claim is sitting on my desk), inhumane, callous indifference I dealt with on a daily basis until my head nearly exploded with rage and fear for the future.

Having Healthier Conversations about Fertility in the Church

If you're Mormon or Mormon adjacent, never underestimate how important it is to have healthy conversations about fertility with your kids.

I've known since I was a teenager that I would have fertility issues. My PCOS was still undiagnosed at that time, but the symptoms were already affecting my health. I suspected something might be up. Then it came up one day as I was studying my patriarchal blessing. As a result, I've known from the time I was 16 years old that I would have fertility issues.

I went through my Young Women lessons and my BYU dating experience already knowing this about myself. I dreaded the thought of getting married because I knew anyone who married me would probably miss out on parenthood. Thinking back over that point in my life, there was one person who had an open conversation with me about infertility that prepared me to be an infertile woman in the Church.

It wasn't a general authority, a bishop, a doctor, or a parent.

It was a girl from my freshman ward.

Her sister was already married and also in a student ward. She told me how her sister hadn't been able to get pregnant while she watched everyone else around her have babies. "She goes to church and listens to people go on and on in testimony meeting about how grateful they are that Heavenly Father trusts them with his children," she was explaining to me. "And she just sits there in silence thinking 'What's wrong with me? When is God going to trust me enough to parent?'"

Those words didn't fix my problem. But they prepared me to live in a community that has no healthy, compassionate discourse surrounding infertility and reproductive health. It prepared me to be bullied and misunderstood by the people in my own church.

Fast forward several years. I'm in my bishop's office. I asked him for a blessing because leaving my PCOS untreated for the sake of trying to conceive was unbearable. I'd spent my whole life being sick, and I wanted to know what it felt like to get better. To be normal. I wasn't willing to live on frustrated hopes anymore for something that wasn't going to happen. God was either going to cure my PCOS and allow me to conceive, or I was done giving any more of myself to the prospect of having kids.

Did I give God an ultimatum?

Yes, I did.

That blessing was the day I demanded a response from God because I needed one. And I got one. It was the same answer he'd been giving to me since I was 16 years old. Nothing had changed.

So, I let go of any hope or expectation that I would ever have kids. I stopped living my life in constant anguish over what I didn't and couldn't have. I started rebuilding and redefining happiness out of different materials than everyone else.

And you know what? There has never been a shortage of people in the Church who have found all kinds of reasons and occasions to tell me my life is wrong. That I'm doing happiness wrong. That my life should look more like theirs, that I should explain to them why it's different.

I tried so hard for so long to find happiness in the Church as a childless person. As a woman whose worth comes myself rather than external circumstances and conformity to everyone else's expectations. I tried until I had nothing left to give.

Being at Church felt like being held underwater. The environment wasn't made for me. To be in it, I had to hold my breath and find snatches of oxygen wherever I could. Take a gulp of air, serve in Primary. Take a gulp of air, sub in Nursery. Take a gulp of air, teach Young Women. A babysitter. That's what I felt like. A babysitter for other people's kids. Those were the jobs I was given to do because that's how the Church sees me as a women. Good to be a babysitter and not much else.

Part of why I served in the temple as an ordinance worker was because it was one of the few spaces in the Church where I wouldn't have to see any children. Even then, the workers and patrons were constantly asking me "Why are you a temple worker?" (i.e. Where are your kids?)

"How often could you have possibly been asked that question? Surely you're exaggerating."

My record was three times in one shift. I got good at pretending it didn't hurt, but that day I went home early and cried.

The idea of a compassionate, empathetic God is comforting. It does not, however, make it easier to live and worship among people who are, as a collective, very bad at this. You reach a point where you get tired of shedding tears because the people around you keep hurting you.

So, do we need Young Men and Young Women lessons on infertility and reproductive health? Yes. Because without them, they will grow into one of two kinds of adults:

  • The adults who hurt people because they don't know any better.
  • The adults who get kicked in the teeth when infertility happens to them.

If you never talk to your kids about the fact that infertility is normal and something that can happen to them, even when they "do everything right," you will send them into the experience thinking they did something wrong and it's their fault.
Infertility is not a personal failure. It's not a punishment. It's not a curse. It's not a reason for people to babysit your kids, or to have more responsibilities at church. It's not your narrative. You don't get to assign meaning and value to it.

For me in my life, I decided that infertility was a blessing. A gift. The road less traveled. The opportunity to lay aside everything old and ill-fitting from the way I saw God and the world around me. Infertility has given me freedom and independence from the constraints I would have as a parent. My time belongs to me, and I get the rare gift of deciding for myself how I want to spend it.

If someone, just one person, had been able to talk about infertility as an opportunity instead of a tragedy, the last ten years of my life could've been so different. 

Infertile people deserve that in all their interactions, but especially at church.

More Posts from Me

The Unimpressive Origins of Anti-Queerness in the LDS Church

"Sister Collins, why don't you believe being queer is a sin like the rest of the righteous, obedient Mormons?" Because despite...