Sickness and Insurance

It has been a learning experience to learn how to take care of myself. For over 20 years there has been an administrative person in charge of making sure that I comply with all the regulations that medical practitioners must abide by.

We need to renew our license; narcotics permit; malpractice; continuing medical education certificates… Medical records need to be electronic these days. There are dozens of software programs available. It takes months of study and trial and error to decide on which one best suits a particular doctor’s needs.

Hanging over your head is the constant fear that there is one form; one test; one rule that you have inadvertently ignored.

The consequences are grim.
You can be breaking the law without having the slightest idea that you are not compliant. The fines and consequences are daunting.

That being said, the licensing hassles are minor compared to what I experienced when I had to provide health insurance for me and my wife. I have been eligible for Medicare for a while. I have paid my premiums (which are substantial for a high earner like I have been) for several years, even knowing that I would rarely need to use this insurance because my employer already covered me.

Once I left full-time practice I had to assume control. I knew that I needed a supplement for Medicare. I would need dental and vision insurance. My wife is not eligible for Medicare; she would need to find her own policies. I did my research; I applied well ahead of the deadline; I enclosed all pertinent documents. My wife did her research. She could apply for COBRA coverage; it would be a lot cheaper than going through the health insurance exchange. We heaved a sigh of relief. This was not going to be complicated.

A premature sigh. The person in charge of COBRA told us that we had to apply as a group. I could not keep my Medicare and supplement. I had already applied for my insurance; I was concerned that if I changed my mind I would not be covered by the time that I needed insurance. We decided to go through the marketplace to cover her.

The number of choices is reasonable, but it concerned me to see some of the questions that had to be answered. I did not think that the average person could easily navigate through these waters without help. I decided to call a friend who sells insurance. He guided my wife through the maze. The rate is expensive, but we figured it would be. We signed up. Another sigh of relief.

No! Wait! My application for Part D Medicare came back. Another document was needed. I had to answer by February 16. I received the letter on February 18. I provided the needed information; for sure the people who sent me the letter would understand that I was late only because they had failed to notify me on time. Wrong!

Three days later I received a letter saying that I had to
pay a monthly penalty on my Part D premium.

The plot thickens. I was busy at the office on my last few days. Before I had a chance to complain about the Part D decision I received another letter. I was denied Medicare supplement insurance. Their records showed that I was still employed and covered by someone else.

This letter arrives after the deadline to be covered by March 1.
Even though I had clearly stated and sworn to the opposite.

Now my sighs are those of a very anxious person. I’m running out of time.

I called the insurance company. A twenty minute hold. The lady on the phone was very understanding. The kind of sympathy you get from someone who knows that I’m not lying; someone who has dealt with the same issue hundreds of times in the past. She will rush a new application to me. If I fill it out and sign it right away, and if I enclose an official letter, and if I write and sign a check, I will be covered as of March 1. Because of the “expedite” that she places on my case I should get this new application in… ten days.

What?

“I am putting a “rush” on this.”

I’m leaving town. How about me getting the letter in two days?

“If I expedite the mailing it will take ten days. Maybe seven.”

I hang up. Maybe I won’t hit the ICU in March. I start searching for prayers that are designed to prevent illness. At this point they will help me more than the insurance that I can’t get.

Another letter the next day. I won’t have to pay the Part D premium after all. I don’t dare utter a sigh of relief this time.

I need some medical supplies to take on my trip. I drive to the medical supply store. I know that my Medicare supplement won’t be active, but at least I have Medicare to cover the cost. It pays 80%. I can afford to pay the balance.

Can’t get the supplies. My prescription needs to be renewed. No problem; all of my doctors are my friends. I make a call.

Can’t get the prescription. There has to be a face-to-face encounter documented in the record.

Again; no problem. I call the doctor’s office.

Please fit me in today.

Of course they can do this. We go back almost 40 years. I rush to the office; I get examined; the prescription gets sent. The next day I go back to the medical supply store.

“We can’t give you your supplies.”

But you got the prescription yesterday.

“We also need a copy of the office visit note. To prove that you were there.”

You did not say that yesterday. I could have asked for a copy and brought it with me had I known.

Silence. A blank stare. Of course I get a blank stare; the person who’s talking to me was not there yesterday. She’s doing her job. Why am I being hostile?

I call the doctor’s office again. I ask them to drop everything they’re doing; to go to the computer; to print out the note; to Fax it to these people who won’t give me my supplies.

They’re very sweet. They get it done.

Another sigh of relief?
Of course not! Ten minutes go by; I wonder why it’s taking so long. Out of an inner office comes a third employee of the supply store. This one looks official and serious. She’s flanked by a man. Probably to protect her. She has two pieces of paper in her hand.

“We can’t give you your supplies. Medicare is not your primary insurance. Your employer insurance is the primary.”

Out comes piece of paper number one, from Medicare, stating that they are not my primary insurance.

I’m no longer employed. This coverage ended yesterday.

Out comes piece of paper number two. From my employer’s insurance. That’s says that I’m still covered.

OK. That’s easy. Just give me the supplies and bill it to the employer insurance.

“We can’t do that. We’re not a provider for that company.”

So if I went to this other company they would give me the supplies?

“They will need a prescription. And the copy of the face-to-face encounter.”

And you can’t Fax this to them?

“There are HIPAA concerns…”

I can’t bring myself to bother my doctor’s office again. And drive half way across town.
How much in cash for the supplies?

“If we went with the bare minimum…”

I paid. I called Medicare. A fifteen minute wait; the government actually beat the private insurance company. A very pleasant lady; she apologized four times for the delay and the mistake. I was assured that my coverage would be active. In ten business days.

I began to say something about the supplies that I needed, but I decided to shut up. She has been very nice. She had nothing to do with the mistake. She’s trying to help.

So is everyone; all of them trying to help.

What the ___? How do people manage? I’m a polished professional; I have clout with my doctors; I understand what I need and when and why. What happens if you’re old, and alone, and a bit befuddled?

How can we in good conscience say that we’re doing our best here?

I tune in to the Republican debate.

The people who say that they can fix this mess are calling each other names, and discussing size of genitals.

I’m visiting my sister in Spain soon. Should I apply for permission to stay?

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This Post Has 8 Comments

  1. Joe Kickham

    Paco – Your frustration is something most of us experience with finding insurance and dealing with the government. Welcome to our world. I needed a refill the other day and found out my primary doctor for 40 years retired. Now I need to find a new doctor w/o a referral from my primary doctor. Sound familiar. Happy Retirement😃

  2. Lois Allen

    Retirement is a scary thing. Not only are we expected to save enough money to get us through, but we are supposed to place our trust in a government that is untrustworthy. I am sorry you are having such a terrible time. Most of us do know what it’s like already. Long phone waits. Paperwork lost or incorrect. Frequently, the people designed to help us could care less. I am at least minimally computer savvy. I don’t know how people function who don’t have or don’t know how to use computers. That doesn’t even include those who can’t afford them. Of course at this point only 40% of the workers in this country are paying for insurance. The others are getting medical care free from the government. It goes on and on. I hope you are able to make your trip and actually come home again. Hang in there.

  3. Francis J Ginorio (Joe)

    Paco- this is too rich – a great story; working with the government always takes patience and planning. I’m finding that doing things online and following up with a call seems to keep things moving forward – you are clearly very sensible and patient with the whole thing. I’ve found that most government workers are concienses and do their best. They’re following processes they did not design – also, had a wonderful lunch with Margarita and Rob in DC – a most pleasant afternoon – they too seem to have great patience. – all the best – Joe

  4. Jorge Gonzalez

    Mejor no podías expresarlo. Otra vez felicitaciones por un gran escrito. Jorge

  5. vannessa

    Paco, welcome to the “Real” world!!!

  6. Judy Parkin

    At last! Now you know what it’s really like being a nurse. 🙂 Unfortunately, red tape usually delays healing.

  7. I get nervous also. To be fair, Germany had a well-developed paramilitary group in force long before Hitler rose to power. Which he used indiscriminately. We are not at that point, but the semblance of some collegial dialogue would be helpful. Also to be fair, most of my difficulties were brought on by two private insurance companies, not the government.
    Government does a good job of managing the military; building highways; funding cutting-edge research; responding to household emergencies such as burglaries and fires; and yes, providing for people who cannot take care of themselves. We cannot live without it.

  8. Betty Townsend

    The longer I’m retired the more I hate the “business” of living. It seems that every thing is a hassle. I know some is my age but some is also the complicated world we now live in.