Joyce 🐝 Bowen Brand Ambassador @ beBee

4 years ago · 3 min. reading time · visibility ~10 ·

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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, “Do it yourself, Dammit.” By the time I needed help and knew it, it was too late.  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 Multiple Sclerosis. 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.

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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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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, “You can’t do that.”

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.  (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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Copyright 2017 Joyce Bowen

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

Sobre el autor: Joyce Bowen es un escritorindependiente y orador público. Las consultaspuedenhacerse 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.

Phil Friedman

4 years ago #18

#19
What is necessary, Joyce, is to require every hospital to have a Patients’ Advocate to ensure that the hospital administration chooses by default viable options that minimize out of pocket costs to the patient. Doctors will tell you they’re too busy. They provide services and leave the billing to ithers. But I wonder how many lives have been destroyed by reckless medical billing. Hospitals rarely care a whit. Sometimes it’s not even a matter of greed, but of incompetence and lack if caring. This is not intended as legal advice. But my approach in such cases is to refuse to pay (after you’ve been discharged), wait for them to sue, then offer a settlement equal to what you would have paid had they billed it correctly. And if you are capable represent yourself. They will almost slways become more concilliatory when you start serving notices to depose dictors and ither staff involved. For it costs you little and it costs doctors and highly paid administrators big bucks to spend their time being deposed during discovery. Oh, yes, and pepper them with requests for copies of internal documents . They hate that like the plague because of the possibilty of having errors exposed. Of course, if one has access to a good advocacy group, that is the way to go. Cheers!
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.

Phil Friedman

4 years ago #15

#14
No, Joyce \ud83d\udc1d Bowen Brand Ambassador @ beBee, you are missing the point. The NYT article that you cite clearly says that the HOSPITAL failed to inform the patient that she was not being admitted as an inpatient, then later refused admit that she should have been so admitted, which is why Medicare could not under its own rules pay. I'd bet 10 to1 that Medicare would have paid, if the hospital had simply admitted to an error and reclassified her as an inpatient for the stay. This kind of intransigence is common in my experience. I once ended up with a hospital bill for more than $6,000 for an emergency room visit because the hospital insisted on coding me as an outpatient instead of an emergency patient, which would have resulted in my paying zero out of pocket, since emergency treatment was covered 100% under the terms of my policy. The insurance company even agreed to pay 100% of the bill if the hospital would simply correct the coding, which the hospital refused to do. So I told the hospital to go pound sand when they billed me. They eventually sued and I beat their butts in court, embarrassing them in the process. Since they ended up with nothing and in paying my costs. But again the core point is that it was not the insurance company, but the service provider who was at fault. As is the case in the NYT article you yourself cite.

Phil Friedman

4 years ago #14

#12
Joyce \ud83d\udc1d Bowen Brand Ambassador @ beBee - I'm sure that your experience is not unique. But that is not the point. Medicare is a government-operated insurance plan much like private plans. And like private plans, Medicare has rules that result in different costs to the patient, depending on how the doctors and hospitals code the services provided, for example, whether the hospital treats you as an inpatient, outpatient, or emergency patient. The sad fact is that sometimes because of in-house rules laid down by greedy hospital administrators and sometimes out of sheers indifference or incompetence, hospital personnel fail to advise a patient how best to proceed in order to minimize out-of-pocket costs. But that is on the hospitals, not on Medicare, which rarely if ever questions the way services are coded by the provider. (cont.Pt II...)

Phil Friedman

4 years ago #13

#12
Joyce \ud83d\udc1d Bowen Brand Ambassador @ beBee, Pt. II... A patient has always to be on guard, whether Medicare or a private insurer is involved. A couple of years ago, my daughter needed an MRI. Her doctor wrote the prescription and, because she was part of a hospital-owned medical group, her nurse sent my daughter to the hospital's Imaging Center. My wife, who accompanied my daughter, became suspicious when the tech in the Imaging Center said a co-pay was not necessary, as our policy specifies a flat co-pay for an MRI. Upon further investigation, my discovered that the hospital's Imaging Center wanted to treat my daughter as an outpatient, which would have resulted (because of our deductible) in an out-of-pocket cost to us of $2,700. So my wife and daughter walked out of there, went to a freestanding independent Imaging firm around the corner, and paid a flat $200 co-pay for the very same services -- all according to the insurance company's rules. There is no doubt it's complicated. And there is a failure to provide counsel to patients to assure that their case is handled in a manner that minimizes out-of-pocket costs to them. However, that is a failure of the service providers, the doctors' groups and the hospitals, not of the insurance companies or of Medicare. And while I do not question that you were not well treated, I reiterate my original assertion that you are blaming the wrong party.
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.

Phil Friedman

4 years ago #10

#9
Sorry, not only have I researched the matter in choosing my own coverage options after reaching Medicare age, but my wife was for many years the Programs Director of a private non-profit agency that distributed federal and state funds to programs that served the elderly of Broward County, Florida. As such, she also liaised with the Medicare Administration and state Medicaid, as well as with several agencies that assisted elderly and infirm patients with securing the benefits they were entitled to under law and regulation. What is it specifically that I've said which you believe is incorrect?
#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.

Phil Friedman

4 years ago #7

Joyce \ud83d\udc1d Bowen Brand Ambassador @ beBee, I sympathize with your difficulties, but what you are doing here is not right. Medicare is medical insurance provided by yhe government. It doesn’t have any medical “practitioners”. Medicare is a distinct program from Medicaid, which latter is primarily a program for the very poor or nearly indigent,, and it has limits for qualificatio that include maximum tangible personal assets to prevent people from owning, say, a million dollars in real estate, while receiving Medicaid benefits because of low income. I have no doubt that you may have been treated badly, but that is on the doctors , the hospital, and the social workers. It has nothing to do with Medicare itself. And it is wrong for you to potentially mislead the uninformed into thinking Medicare is a bad program. For it is not. As I and many if my acquaintances know from experience.
#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

4 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. 😄

Pascal Derrien

4 years ago #2

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