It's all about health-care lately. Who pays for what. Where you can go. Who gets to "off" grandma and so forth. For the record, I'm a complete socialist in this fight. But enough about them. Let's talk about me, shall we?

After my divorce back in Feb/Mar, I needed to get health-care arranged for myself. I've been disabled since I was 15, and on Medicare since 1993, although I've never once used the benefit. I've always been covered by near-full-boat health insurance--either someone elses' or my own through an employer--so there was never really a need.

I remember going to the doctor as a kid, and never having to pay for anything out-of-pocket. I didn't know what a co-pay was until the 90's. My father's insurance was very comprehensive (being a supervisor in a massive Midwestern factory that had lots of work from the auto industry) . Oddly enough, a few months ago, a family member sent me an envelope full of all the bills and insurance paperwork from my diving accident and resulting hospitalization/recovery/therapy. In 1983/84, this bill was approximately $120,000 all said and done. Of that, it appears that my father paid roughly $2200 out of pocket. Today, using the Consumer Price Index, the bill would be roughly $260,000, with (an assumed minimum) doubling of out-of-pocket expenses equaling roughly $4400 or so. I'm certian that in this day and age of HMO cost-cutting and buck-passing, the out-of-pocket number would actually be much higher. Were we to have been under-insured like so many today, it could have easily destroyed our family financially. Thankfully, that wasn't the case.

Back to the now.

I don't have too many lingering health issues with regards to my disability. It'll be a limiting factor the rest of my life--true--but it's not like it requires much by way of medication or treatment. The chronic conditions I do need to be treated for are, unfortunately, of my own making. High blood pressure from being obese, arthritis and tendinitis aggravated by the same. The things I really need are simple maintenance and preventatives like any guy my age. Prostate check, annual physical, vaccinations, etc. Really boilerplate stuff. That and access to my psychotherapist. So I just didn't see the big whoop about starting out using my Medicare.

Man, was I wrong.

I started out trying to see my psychotherapist. She was helpful in suggesting that we do a "dry run" billing to see if Medicare would accept it, then if they did, I'd just come in and use the time already approved. Well, that very quickly failed. She was told that there was no ability to authorize me because I wasn't "in the system". I was a bit dumbfounded by this because the little card in my wallet said I'd been "in the system" since 1993. Many calls later, my level of frustration was at an apex. I was getting nowhere, and ran up a $60 overage on my cell-phone bill by sitting on hold talking to no one! I decided to go to a local volunteer organization that aids seniors and the disabled by helping them navigate Medicare and other social services. The following is an excerpt from the email I sent my therapist:

I met with a SHIBA representative yesterday, and while he was extraordinarily UNHELPFUL (the guy knew less than I did, and seems inordinately preoccupied with breathing through his mouth), he did have a secret number to a red phone somewhere in the Medicare bunker that got me to the friend of an uncle of a Medicare person who quickly explained that I needed to inform a small gnome hidden under the basement stairs of the annex of a derilect building Medicare no longer uses in a box marked "BEWARE OF PUMA" that I was no longer covered by [my former insurance plan]. It now looks like Medicare should cover at least 50% of the cost. They said wait 14 days from the call, so after the 1st should work. Let me know what the bastards say...
And we have yet to hear back. Seriously, I've gone through every stitch of literature that I could find--both in print and on-line--on starting this coverage, and nowhere does it say that you have to inform them that your old coverage is gone. I asked the representative referenced above about it, and they said "Oh, it's probably not available to you. It's just our policy..."

What the Effin' F?

Seriously. This level of bureaucracy just stuns me. You're expected to comply with some rule you've never heard of from an agency that won't tell you about it until you call a secret number that isn't actually listed anywhere?

Anyway, the short form of this is, it looks like my primary coverage by Medicare is actually starting up. I will still be paying for Medicaid (Supplemental Insurance) out of pocket, but that has hoops to be gone through. Actually, while writing this blog, I tried to apply for Medicaid and Oregon Health Plan, but two iterations of application attempts and botched PDF submissions later, their on-line system failed me, so I just called to have a hard-copy application mailed to me. Meanwhile, the decission on school is also in process, and will have its own blog post shortly...

1 comments:

Steve said...

Well, you cover a lot of ground here. I'll start on the cost side of things...

You estimate that the cost would now be doubled since you were a teenager. The NCHC (.org/facts/cost.shtml) points out that premiums have increased 119% in the last 10 years. Another source I cannot find referenced a 400% increase in procedure cost. That means your $120,000 bill should be more like $500k, and the cost to your father would now be more like $9k.

As for bureaucracy - remember that it's in place to STOP people from accessing the service. If you get money, they lose. That's not to say that they're trying to do poorly by you, but in their fervour to avoid ineligible claims they're causing those in need to suffer. Whatever happened to Ben Franklin's "100 guilty men go free than 1 innocent man be imprisoned"?

If ever healthcare reform comes up in discussion, tell people to look up the Bismark system. It's the only way.