Joyce šŸ Bowen Brand Ambassador @ beBee

7 years ago Ā· 4 min. reading time Ā· ~10 Ā·

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The Evils of Medicare and its Practitioners

The Evils of Medicare and its Practitioners

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Yes—I’m back—sort of. It’s been a rough several months. I’m hoping it’s nearly over. I broke my damn foot in a pedicure bath—I got terribly ill—then I fell in the street. https://www.bebee.com/producer/@joyce-bowen/the-saga-of-cracks-la-saga-de-las-grietas

Over the last several months, I’ve learned that even Medicare leaves me out in the cold. I’ve been on Medicare since 2006 due to disability. I’ve had no major events occur. Lucky me.

My fall on October 28th of this year has left me reeling. I’m a do-it-yourselfer. In other words, ā€œDo it yourself, Dammit.ā€ By the time I needed help and knew it, it was too late.Ā  I asked for it anyway. I told the Physician’s Assistant at Physicians’ Associates that I would not be able to take care of myself for a few days. I requested rehab. She declined. They kept trying to shove homecare at me. Problem was—I could not get from the third floor to the first floor to let them in. Is this a Medicare thing?

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I lay in bed—reassuring myself it would get better—while being able to provide myself with only one bowl of oatmeal in five days. I was simply in too much pain to move. I kept telling myself it would be over soon. I would heal. But a whisper kept echoing in my mind—I’m an old bag now. I found myself wondering how soon soon would be. Would soon come at all?

My body is considered to be frail. I have Autoimmune Disease. I’m obviously crippled through no fault of my own. And I’m on my own. My reclusive life has not served me.

Medicare slashes medical charges practically to pennies on the dollar, and then only pays 80% of that. It is necessary to purchase a rider policy to take up the slack. If you’re unfortunate enough to get on Medicaid, they want to know about everything you own in order to acquire your possessions if your expenses get too high.

I noticed the quality of my medical care declined when Medicare took me over. I had no choice. The healthy coverage I had enjoyed for years through my regular policy disappeared. They would only pay the portion Medicare would not cover—and sometimes not even that. Bills I had never experienced before piled up.

I spoke to a woman at Medicare, and after she discontinued spewing the rhetoric, she connected with me. We agreed that instead of being an avid do-it-yourselfer I should have let the people protecting me in the street call an ambulance. So essentially—instead of going off to make sure I was badly hurt, I should have cost the government more. I chose badly. Silly me.

Last night I went to our local outpatient at Salem Hospital. I’m not a fan of the hospital I had to go to, but my knee was so bad, I had to hitch a ride. In babying my left hip to allow it to heal, I had put too much stress on my right knee. I was afraid I had provoked inflammation to the extent I would need the knee replaced.

The staff in the outpatient first indicated they were going to send me away with a Motrin. Hell—I could have done that. When I told them I had no one to take care of me, they chose to admit me—on Observational status. Some of you may not know what that means.

Medicare Patients Sue HHS over
Observation Status Bills...

# Ctr for Medicare Advocacy and the National Sr Citizen Law Center
filed a class action lawsuit against HHS. Bagnall vs Sebelius -
challenging practice of placing hospital pts in obs status, an
alternative to admitting them as an inpt

# “Although Obs status can have significant negative consequences
for pts, hospitals have financial incentives to use it. And they have
been using it increasingly in place-of admitting pts, according to the
lawsuit.” Clarified - loss of an inpt so bill as obs.

¥ Payment for 1 OBS stay - 8 - 48 hrs = $650 flat fee for the hrs
with the loss of the ER EAM. No $ for PP to OBS to APC hospitals.

¥ Pending legislation/no action - Improving Access to Medicare
Coverage Act (HR 1548) ensures time spent under obs would count
toward the 3 day SNF qualifying stay
Increase in OBS claims- 22% from 2006-2008.

Increase in stays over 48 hrs - 70% more from 2006-2008


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When you are admitted as an inpatient, Medicare pays. When you are admitted as Observational, you pay—Medicare pays less.

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Medicare Outpatient
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The Orthopedist came into my room and told me good news. I did not need a knee replacement, and she recommended I move around. That was comforting. But then she told me they would send physical therapy to my home. I told her getting from the third floor to the first floor was going to be impossible. She blinked, then went on. She barely missed a beat.

I told her I was going to have to cancel my daily food deliveries and rest up on the third floor—avoiding stairs altogether.

She said, ā€œYou can’t do that.ā€

She then explained the care I’d have to take traversing the stairs—keeping my right leg straight and taking them one at a time.

Wait—isn’t this how I got into trouble in the first place? Keeping my left leg straight to heal my left leg? The Medicare lady told me she had a bad knee and cued me into how this could be a neverending cycle. I’d be juggling legs for a lifetime. I’d rekill my left leg curing my right.

I canceled my food. I’ll putter around the third floor when I can. Food can wait for me to heal. What is it? You can survive without food for three weeks. My son did say he would make me a meal when he gets home from work each day, and I’m grateful.Ā  (He's pretty much reneged on that.)

So those of you old codgers saddled with Medicare, watch your behind. And for those of you waiting to be inflicted by it, get your voting arm out.

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Succorstsl Personal Branding

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Copyright 2017 Joyce Bowen

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About the Author: Ā Joyce Bowen is a freelance writer and public speaker. Ā Inquiries can be made at crwriter@comcast.net

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Sobre elĀ autor: Joyce Bowen es unĀ escritorindependienteĀ yĀ oradorĀ pĆŗblico. LasĀ consultaspuedenhacerseĀ en crwriter@comcast.net

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Comments
#21
Terrific advice. Jumping up and down mentally. (Can't do it physically with my knee like it is.) Fortunately, in Mass, hospitals and doctors can't sue.for medical costs. Dentists can put it on your credit records--ambulance companies can do things... But we are more protected in Mass. It's hard to think clearly when you're angry. I hope there are those that will copy your advice and keep it in a drawer somewhere.
Thank you, CityVP \ud83d\udc1d Manjit for the shares.
#18
Kudos, Phil. In one of these articles, it clearly states that medicare blames this one, and the providers claim its that one's fault, and so on. The main problem is the loophole. Providers take advantage of it. The loophole needs to go. The hospital I stayed at clearly violated the law by not informing me of its impact. They really had no intention of helping me--just grabbing a few bucks. I'm fairly certain they do this lots. They were appalled when I called transport myself to get the hell out of there. They left me the wheelchair but sent the man away who could have wheeled me away. They held me up for an additional two hours (sitting in the hallway in a wheelchair, which I'm sure they believe they can charge me for. I did speak to Medicare for at least an hour deconstructing my problem. The woman was informative and kind. She was a hardass at first, and then comforting. I appreciated her efforts to help me. I just wish I had been able to go to my regular hospital.
I can see people are missing the point. https://www.nytimes.com/2016/08/07/us/politics/new-medicare-law-to-notify-patients-of-loophole-in-nursing-home-coverage.html http://www.theintell.com/ddf33e98-a98d-11e7-85ae-77e1559a4d37.html http://america.aljazeera.com/articles/2015/3/24/the-dangerous-medicare-loophole-of-observation-status.html http://www.hcpro.com/content/282385.pdf http://nysbar.com/blogs/lawstudentconnection/2012/02/observation_status_why_a_medic.html
#11
I do not believe my experience is unique. The graphics I present speak for themselves, Phil. Observation is a process by which profits are maximized. Had they informed me, I would have declined. I would have accepted the results of my X-rays and gone home with the same plan I had now. But they insisted I see the Ortho through this uniformed Observation process. She could have just called me at home today. They also prescribed Oxycodone, which I had informed them I wouldn't take. Just a personal preference. I thought they prescribed Percosett. They led me to believe rehab would be possible. Not so with the Observation process. You know you are correct about Medicare and Medicaid. However, here in Mass, these programs often go hand-in-hand. Poverty levels are so low here in Mass that it nearly impossible for elderly/disabled to qualify. Maybe it's different in Florida. I have chosen to pay my own way. It's what I've always done. I will do so for as long as possible. I just hope I run out before the money does.
#7
Problem was--they never told me. I simply confronted them with what little I knew at the time. Know a whole lot more after digging.
#8
Bullcrap. Do a little investigation before you respond.
#3
Hahaha--still laughing.
#2
Love those good vibes, Pascal Derrien. Hugging them now.
#1
Hope so, too, Ali \ud83d\udc1d Anani, Brand Ambassador @beBee. Going to try to do it right this time.

Ken Boddie

7 years ago#3

Hey Joyce, I hope this cheers you up. Santa Clause, the tooth fairy, an effective and practical Medicare manager and a drunk were walking down the street when they spotted a one hundred dollar note. Who picked it up? The drunk obviously because the others are purely fictional Characters. šŸ˜„

Pascal Derrien

7 years ago#2

Not overly useful but I am sending you good vibes Joyce :-)

Ali Anani

7 years ago#1

I wish you quick recovery Joyce \ud83d\udc1d Bowen Brand Ambassador @ beBee. We need your active presence. I hope things will improve vastly and fastly for you

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