Been Head Down working

Healthcare reform

Tuesday I got a call from my normal doctor. I was expecting it…

The office staff called to tell me that the Doc wants to see me again. I look at the calendar and it’s been over a year. In truth I was expecting this call, the Doc is good about making sure he’s not just renewing prescriptions without seeing his patients.

While I’m on the phone with the staff, I remember that the insurance card I’ve been carrying around has proven to be completely useless and before I set up an appointment I ask them if they can verify that the insurance card will be honored.

Affordable Care

The staff says sure, and I give them my card number. About an hour later, they call back and tell me that they can’t accept this flavor of insurance. Yes, it’s a PPO but it acts more like an EPO and they’re not part of that network. They also told me to contact one of the attorney’s involved in the class action lawsuits against Anthem and to contact the Insurance Commissioner. Can you say this is a problem they’ve gotten tired of dealing with??

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I make the appointment anyway, By December I’ll have either come up with a real insurance carrier or I’ll not have insurance at all. Either way I’m going to see my doctor.

After a decade of him taking care of me I have no desire to have that relationship destroyed. There are damn few people I trust with my life outside my family. My Doctor is one of those people.

After getting off the phone with the Doctors office, I call Anthem and ask them what the hell is going on? Once again I’m assured that I have a PPO plan, once again I ask “If this is a PPO plan then why can’t I simply go to any physician that takes Anthem insurance?”

That’s when I get a lot of dancing around about how PPO plans have changed and that there are no PPO plans available in California because of ACA. I’m told that Cedars Sinai is now taking the PPO plan that I have and that Anthem negotiated with Cedar’s to make sure patients weren’t being excluded.

In other words, let’s put some more lipstick on this pig.

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After much discussion the Anthem representative tells me that I can’t make changes to my plan until open enrollment. I comment that since I’ve been unable to get any medical care under this plan I’ve been wondering if I wouldn’t be better off with a simple catastrophic injury plan.

The representative begins to tell me that if I had a catastrophic plan I might not be covered for hospitalization or emergency room visits. I retort that the definition of a catastrophic plan is a plan to provide those services. The representative does finally concede that perhaps, given my difficulties with their PPO plan I might consider a catastrophic plan during open enrollment which begins November 15th.

I spend the rest of the day researching my options…

Sigh, why can’t we just get the goods and services we pay for?

Health Insurance is consuming my life.

UnknownI know that many posts lately have been about the failure of Anthem due to the requirements of Obamacare.

I personally think that Obamacare is an utter failure that has imposed yet another layer of un-necessary  bureaucracy on insurers,doctors, hospitals, and the people in general. I hate bureaucracy and running round & round a maze of petty functionaries to get what I’ve paid for.

I’ve always been sensitive to insurance bullshit. I’ve always thought that insurance was the biggest con game on the planet.

UnknownReally? you want me to pay for your service which does nothing for me in my day to day life. The cost of your service will go up every year due to the actions of other people over whom neither of us have any control. The amount that the cost will go up is due to arcane mathematics worked out by some gnome in a basement with a HP-12C and that’s also not under my control.

This is for my own good?

I’d often wondered if I’d have been just as well off handing protection money to the Mafia.

Then I had a major event in my life where I was thankful I had insurance.

I was fortunate beyond words in that the insurance company I’d been dealing with simply PAID. they asked few questions, they just did what they were contracted to do and put the money in my hand.

images-4I’d been fortunate too in that though my work I’d managed to find an insurance company that just PAID. I went to my doctor, I went to a specialist if needed and I didn’t abuse the situation. Like most men, I fucking hate to go to the doctor in the first place.  ALL I had to do was hand the office bitch my insurance card and that was the end of it.

PPOs worked and were good.  I always went to the doctor of my choice and that was the end of it. The shit got paid for!  Now in addition to HMO, PPO, EPO, and god knows what else there are flavors of each plan.

images-2Doctors, are opting out of caring for patients based on the “Flavor” of plan within the broad designations that the patient has. But in general there’s no way for the patient to know if the flavor they have, is in fact a flavor the doctor likes.

Nerri.jpgENTER BUREAUCRACY!

All health care plans are supposed to be Obamacare compliant, that doesn’t make all plans “Obamacare”.

What it does is create confusion. I as a consumer don’t give a flying fuck about the underpinnings and nuances of interaction between the doctors and the insurance company. They EACH have a job to do and I expect them to perform their task. Once again I find myself on the phone calling the representative “Servicer

I’m paying $500 a month for an insurance plan that is all but completely useless because there is no clear way for me as a consumer to know which doctor will take what I have, or for how long.

imagesThe “Servicer” tries to explain that the insurance isn’t useless, but then can’t find a provider within a 100 miles that takes my ‘flavor’ of insurance. That’s even after he added back in all the Doctors for whom English was NOT their primary language.  He did tell me that perhaps I should learn Spanish. I retorted why not Farsi, or Hindi? Then I told him if I was going to learn any language, it would be German, Swedish, Dutch, or Norse.

I’m shopping for other insurance companies but all plans are essentially the same thanks to Obamacare. Technically, there’s no real choice. They all refer to a metallic code, Bronze, Silver, Gold etc.

images-1BEWARE! If you choose one of these insurance levels by metallic code, you’ve essentially consented to an Obamacare plan even if that’s not what you intended.

The insurance providers start throwing around levels of protection with associated deductibles and lumping them into a metal. So you, the consumer say, “Yeah the Silver level sounds about right,” and suddenly your insurance plan is fucking Obamacare.

I compared my old insurance card to the “new” insurance card. Both say PPO but the shitty card says “Pathway PPO” which is somehow different from just the normal PPO that I’ve had for years.

screen-shot-2014-04-20-at-5-42-09-pmThey bait & switched me and I didn’t realize it until I tried to obtain a more specialized service from one of the Jeff Spicolis of the medical world.

So now the problem is can I fix it? The preliminary reports say NO!

So where does that leave me? Well thank god my GP can take care of the dermatology things.

Well, he can for as long as he takes my “Flavor” of PPO. If he decides he doesn’t like my PPO I’m well and truly screwed.

Again with the Anthem BULLSHIT!

UnknownOK, Today I’m starting a search for new insurance carrier.

I had an appointment with a new physcian today. The operative word is HAD. I drive an hour to get to the appointment. I walk in, I’m early, and I’m expecting to fill out the obligatory paperwork.

I hand the little bitch behind the counter my ID and insurance card and she tell me that I have an Obamacare plan and they don’t accept those.

NewImage.pngI tell her my plan is not Obamacare and that given my premiums I expect a little privacy instead of her announcing that I have an Obamacare plan.

I’m LESS than amused. Since I, as a consumer cannot determine if the plan I’m paying through the nose for is Obamacare or not, at least not by looking at the fucking insurance card. However I’m really torqued out of shape about the “Announcement” that I have an Obamacare plan I don’t like the stigma associated with Obamacare.

NewImage.pngThis doctor will not be seeing me. I will not do business with a doctor whose staff is so indiscreet. I felt like she’d just told the full waiting room something like; “OH your lab results came back you have Syphillis!”

Lets be realistic the doctor patient relationships is a BUSINESS relationship akin to Client / Attorney privilege.

So I’ll be back on the phone with the damn insurance idiots this afternoon to determine if this plan is actually OBAMAFUCKINGCARE. If it is, then we’re going to have a conversation that may require a Valium on my part.

As I write this, I’m sitting on a patio at a StarBucks having a treat. Sometimes you just need to have some fun.

If the Arabs would shut the hell up it would be a perfect situation. I’m enjoying the eye candy sitting across from my table and thinking some seriously dirty thoughts.

Another Call to Anthem This time about Express Scripts

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Yesterday, some stuff at the pharmacy was… available, not available, available, not available … Please Call Anthem.

Sigh! 32 minutes on hold with Anthem.

“Hello”

“Hi there, could you please explain why I’m having problems at the pharmacy now?”

“On moment, Ah here it is, you haven’t Opted out of the Express Scripts Mail order service.”

“Ok, Let me explain something to you in no uncertain terms. If you force me to deal with Express Scripts I will cancel this policy.”

“Oh you’re not being forced to use them, you just have to opt out.”

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“In other words you’ve signed me up to use their mail order service without bothering to tell me about it. Otherwise I wouldn’t have to Opt out.”

“Oh no Sir, all our clients have the option to use Express Scripts, you just have to tell us you don’t wish to use this valuable service.”

Briefly, I think about going ‘round the maypole again but obviously the nice lady at Anthem doesn’t understand my meaning about needing to Opt OUT of something versus choosing to Opt IN to something.

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It would be a long conversation that dealt with the English language and fundamental rights, such as the right to privacy. Banking and credit cards spring to mind.

I’d, until the past decade or so, operated from the position that my account information, purchasing habits, or even the fact that I did business with a particular bank or credit card provider was private.  

Then I started receiving bank privacy notifications and forms that needed to be returned to Opt Out of them sharing my data with other companies.

While at the same time a certain bank of note started sending demanding e-mails and text messages once a quarter to Opt IN to their saving programs. Of course I’d like to save 5% on my purchases. Why do I have to re-affirm this every freaking quarter and WHY do they use words like madatory and Action REQUIRED in their quarterly reminders?

Why do they only bug me once a year, in very fine print to opt out of their selling my personal information? It seems backwards to me but then again I’m an old fuck.

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I decide that the Anthem girl probably wouldn’t get it. She sound likes she’s in her 20’s. For her my explanation wouldn’t make any sense.

She’s from an age where its common place for ex-boyfriends to put naked photos of her or movies of them screwing on the internet. 

Privacy means considerably less to her generation than it does to mine. 

I doubt that she’d even understand the subtly of difference between opting out of something versus opting in to something.

“Ok, can I please Opt out of this fine service?”

“Certainly Sir, here’s the phone number to call, Please hold; I’ll try to transfer you to them.”

While I’m on hold listening to Muzak, I’m thinking that If this is what I have to do to deal with the insurance company, then if I were a doctor multiplying that by 100 or 1000 I’d never get any work done.

As it is, just trying to keep the ballon of my personal insurance in the air is stressful and time consuming. I’m wondering, “what are they going to screw up next?”

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I’m also thinking it’s time for me to start shopping around for an insurance company that doesn’t require all this maintenance. Of course I realize that’s probably a pipe dream.

I begin to understand why so many doctors are just tired of the whole damn system.

I think of a childhood doctor, He was in private practice for a few years and I liked him. He’d been a military doctor, when he was just out of med school. After a few years, he gave up his private practice and went back into the military. I assume that’s where he finished out his career, by now he should be happily retired. I remember at the time wishing that he & my mom would start dating. I liked and trusted him.

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“Sir? I’m sorry, but that department at Express Scripts is closed.”

“Fine, thank you for trying. I’ll give them a call myself in the morning.”

I can’t help thinking that this is all far too complex to be in my best interests.

I’ve been on the phone with Anthem at least once a month since November.  They claim all this chaos is due to Obamacare.

I’m sure that at least part of it is, but I’m equally sure that Anthem and other insurance companies are making things more difficult for consumers.

After all what better way to have Obamacare repealed than to inflict pain on the consumers who also happen to be voters.

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I’m sure that the insurance companies aren’t losing any money due to Obamacare.

I keep thinking of the way gas prices go up. The oil companies jack the prices to obscene levels, then keep them there for a month or two. Then they drop the gas prices back to .20 above what they were before the run-up.

We idiot consumers breath a sigh of relief because the prices have dropped but we’re still paying more at the pump than we were.

I wonder if the insurance companies are attempting a similar gambit Obamacare jacks the prices and inflicts a lot of pain for the consumers. Then Obamacare gets repealed and the prices drop some and we think “ahhhh that’s better,” then move on to the latest idiocy of the Kardashians.

This morning bright & early I call the number I’ve been given to Opt-out of Express Scripts ‘wonderful’ service.

While I’m navigating the obligatory voice prompt system; I’m thinking that the local pharmacies have been taking it in the ass because of companies like Express Scripts.

Even the big chains are feeling the pressure and the little independent pharmacies are almost gone. Where is the protest against that? Right, I guess it’s not high profile enough to draw the ire of the Occupy protesters.

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“Hello this is Mark your pharmacy advisor.”

“Hello Mark, I need to opt out of your service.”

“I’m sorry to hear that sir, we do provide a more convenient service providing you with a 90 days supply of your prescriptions via mail. First I’m going to need to know who you are and your date of birth.”

Note to self: Date of birth has become a piece of data that should be protected. This guy is looking me up with my name and date of birth. Come to think of it that’s all the insurance company or medical practices ever ask for.

I provide the requested information.

“Alright sir, could I ask you to hold for a minute or two?”

“Sure,” I reply, wondering why it takes a minute or two for him to click a check box on a computer screen. But then again this IS Express Scripts and I know how royally fucked up they are.

“There you are sir, you’re opted out. I’d like to remind you that we’re here should you change your mind.”

ExpressScripts1“Not going to happen,” I growl.

“Might I ask why?”

“You people screw up all the time. You screwed up my RXs and changed the drug I was taking to another drug claiming it was the same. Look man, if the drug has different chemicals, they’re not the same, they’re different. Here’s an experiment for you, try taking estrogen instead of a testosterone replacement and tell me how that goes for you. They’re both hormones just a little different.  Then there’s the whole question of your being able to keep records. Your RX by mail online history was always wrong and that begs the question about your ability to detect a potential drug interactions. No, I will not deal with you. I’ll continue to go to my local pharmacy and be able to talk to my pharmacist. You might also want to note this, if mail order through your company ever becomes mandatory through this Anthem policy, I will cancel the Anthem Policy just to get away from you!”

“Er, Um… I’m very sorry for the difficulties you’ve had in the past. Please remember we are evolving and our procedures are getting better all the time. So if you ever change your mind we are here.”

I give him props for his recovery.

“Thank you. By the way, it’s nothing personal it’s your company.”

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“Have a nice day sir.”

“Thank you and you do the same,” I hang up. 

Hopefully I won’t have to call Anthem until later in the month, next month.I’ll wait 24 hours then see if all in my insurance world has returned to normal.

I have no need, as far as I know, to call Anthem. I’m penciling them into the calendar just because I KNOW something will go wrong and I’ll spend another 30 minutes to 30 hours dealing with them.

Back on the phone with Anthem BlueCross

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This is what, the 12th time I’ve had to call these people in 4 months?

Today it’s about receiving a couple of bills that make absolutely not fucking sense. I’m sooooo Tired of dealing with this bullshit!

Then there’s the little annoyances that tend to get you (alright ME!) amped up before you’ve even gotten into a hold queue wating for an agent that will probably fuck your shit up worse than it already is.

I swear every time I speak to one of these people they claim that everything is happy and good to go and then a month later I get something generated from a computer that makes it obvious something is still horrifically fucked up.

So in order to blow off steam before I actually talk to a human, here are the irritations in the order of encountering them.

Item One

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Bills (one each) for portions of a policy. Contained within these 3 page bills is one page with explainations of how I can have an interpreter and a phone number for the Department of Insurance.

This page is printed in Spanish, Chinese, Vietnamese, Tagalog, Korean, Russian, Japanese, Arabic, Armenian, Punjabi, Khmer, Hmong, and Persian.

The main bill is all printed in English and I’ve identified as being an English speaker, so I’m somewhat annoyed by the waste of 3 pieces of paper every month.

Actually it’s 9 pieces of paper every month because they are supposed to be billing this directly from my checking account.

What they’ve been doing is billing my account then sending me 9 pieces of paper telling me that they’ve billed my account.

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Item Two

Of course nowhere on this bill do they have a phone number to call if you have questions about billing. Instead they say you’re supposed to call the Member Number on the back of your insurance card. Only problem is:

THERE IS NO MEMBER PHONE NUMBER!

There is however a customer service number that puts you into the insanity of a voice prompted computer system that doesn’t understand standard spoken English.

Eventually I just start hammering around on random numbers until I get into a hold queue.

Item Three

The reminder that all representatives are still busy played every 30 seconds. Yeah I kinda figured out that you guys are busy BECAUSE I was on hold listening to shitty hold music! How about extending that notice to once every 90 seconds?

Then I hear someone answer the phone. Wow! I was only on hold for 45 minutes this time.

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I get to a very nice man in the Philippines. Yeah, the Philippines who is able to answer my questions. Really?

The folks in the Philippines are a very nice and gracious people but why aren’t we talking to Americans?

You know out of work Americans who are struggling to feed themselves and THEIR families?

Item Four

Anyway, the nice man explains that the two bills I have saying that payment is immediately due are because Anthem failed to debit my checking account again.

Apparently these bills are trying to catch up for 2 months of payments that are in arrears. He offers to bring the accounts up to date but wants to do it via a credit card.

I decline. I’m growing more suspicious of Anthem.

I mean really, if they can’t keep it straight that I’ve given them permission to take their payments right out of my checking account; this is the 4th time they’ve screwed this up since November, can I really trust them to pay for services to my Doctor?

Item Five

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The nice man tells me that one of the bills is for Dental insurance.

Uhhh, I cancelled that back in Feb. Then he explains… It’s for pediatric dentistry.

SAY WHAT? I thought that’s why my damn medical insurance when up after the fucked up implementation of Obamacare!

(I swear, if ever there was something that needed to be aborted, Obamacare fits the bill).

But since they’re sending me a bill for it separately, It occurs to me that I can refuse to pay the bill.

Item Six

As I’m thinking over this insanity It occurs to me the cost of my meds is 300 a month without insurance. If I go to Tijuana or use a Canadian pharmacy I could perhaps get my generic drugs cheaper. Even if I stayed in the American pharmacies I’d still save money.

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I wonder if I were to simply cancel the whole damn shebang and let our fucked up government BILL me for not having insurance if I’d be better off paying out of pocket.

I wonder if I can get a catastrophic policy just in case I end up in the hospital?

I find myself thinking of tropical beaches out of the US once a year taking a “Medical Vacation” to Indonesia, or Curacao.

The thought of a once a year checkup combined with warm sand and excellent diving is a cloying one.

I wonder if the math would work out.

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I’ve got till the 10th to decide what I want to do. I suppose I’ll think it over and run some math. Perhaps I’ll shop around for another private insurer who actually can keep the payment and billing straight on a month to month basis.

Been out of it for a couple of days… All I can say is DAMN!

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My ISP was having some difficulties with packet loss and their problems were affecting my ability to get email and upload to the blog.

Paraphrasing Poltergeist 

“I’mmmm BAAACCK!”

The question is what do I talk about first?

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The Bundy Ranch v the BLM?

I hate to even think about what could have happened if someone had squeezed off a shot during that standoff. That’s how really bad things happen really damn fast. I personally don’t think Mr Bundy has a leg to stand on legally. OF more concern to me is that we had an armed standoff at all. 

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When you start looking at issues surrounding the Bundy standoff. You can’t help but stumble over reports of other events where one could say that the US Government is overstepping its authority and behaving very much like a totalitarian entity.

There are currently issues over land between Texas & Missouri due to the ever changing nature of a river that had traditionally marked the boundary line between the states and ranchers in the area. The BLM is taking an interest and stands to usurp something like 90,000 acres without compensating either the states or the landholders.

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The EPA is attempting to assert control over many bodies of water, including watering ponds on farms and ranches. They are also making noises about assuming control of dry or seasonal creek and river beds.

Meanwhile The Border patrol has become a nuisance to Arizona ranchers whose property abuts the buffer zone between the US / Mexico boarder They’re doing things like cutting fences or leaving gates open without so much as a “by your leave.” 

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These supposed events are concerning because they’re in general, never picked up by the main stream media but are reported in local area papers. On an individual basis these seem like minor local issues but when you view them from the “orbit” of the internet it does start to look like a quiet conquest.

With government oversight, come government control. With government control, come fees, fines, and increased taxation (whether it’s called a tax or not.) This seems to be the source of the underlying embers that almost burst into flames at the Bundy ranch.

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The FDA is being reported as sticking their noses into a long standing arrangement (100+ years) between Beer Brewers and farmers regarding grain. The Beer uses the grain to make beer, then the waste material is usually given to farmers / ranchers to mix with feed stock. This arrangement takes care of the waste without requiring anything other than a farmer / ranchers willingness to haul the used grain away.

Now, the FDA is wanting to regulate this equitable arrangement in the name of public health even though there has never been an instance where the public or the animals have been harmed. Some old traditions bacme old traditions due to the test of TIME. It’s not in the best interests of Farmers or Ranchers to engage in an activity that is detrimental to their livelyhoods. So does the FDA really need to be involved? Probably not, but you can expect for their fees and inspections and whatever the hell else they’ll do to drive up the cost of a beer, and possible the cost of food too.

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The newest revelations about the IRS internal memos?

Just WHO is Lois Learner afraid of? She claims she’s in fear for her life and that’s why she doesn’t want to testify. REALLY? Can’t her employer The United States Government protect her & her family? Or is it the US Government that she’s afraid of?

The Ukraine?

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Does anyone really believe that Vladimir Putin is concerned in the least about what President Stompy Foot thinks? Don’t get me wrong Putin is not a nice guy but he’s doing what he things is best for his country ( Or Himself) and he’s not in the habit of asking permission. 

Potential for World War III?

There have been some writers comparing the flashpoint issues for WWI and WWII to what’s happening in the Ukraine.

I’m not sure that I completely agree with their assesment that WWIII could be in the offing but the correlations are interesting to read. I doubt Putin would move it to an all out war against NATO but hey no-one thought a strange little houspainter would end up Chancellor of Germany either.

President Obama’s trustworthy polls?

This one cracked me up. Approximately 60% of Americans believe that Obama is actively lying to them one way or another. Now that’s really gotta piss President Finger waver off.

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The President was on TV again today defending Obamacare and as usual took the opportunity to reiterate that Republicans are BAD and that their continued desire to revisit Obamacare isn’t in the public interest. Whoo Hoo 8 million people signed up. Lets see, there are approximately 313.9 Million people in the US. Does that mean a whopping 3% of the population signed up. Whoooo impressive!

I’d have been more impressed if this 8 million had ALL been previously uninsured people instead of poor schmucks that lost their insurance and had to find something on the exchanges.

I’d have been more impressed if there wasn’t a recent editorial by a lady that had called something like 92 doctors in New Jersey only to find out that her shiny new obamacare card wasn’t being accepted because the doctors didn’t want to deal with the smaller payments obamacare would provide for their services, and the increased overhead and oversight from the government.

I’d be more impressed if, instead of Pres. Stompy shaking his finger at Republicans he’d actually listen to what the vast majority of Americans are bitching about regarding having their health insurance screwed with.

I’d really be impressed if ALL of Congress, including that idiot Harry Reid had to sign up with Obamacare through the exchanges. (Hey Harry, let see if you’re smart enough to use the damn internet shall we?)

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I have no idea what the hell is going on anymore. I feel like I’ve walked through the looking glass into bizzaro world.

In short, HOLY CRAP BATMAN!