Tag: Male

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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.

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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.

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I was probably a little rough on that lady…

NewImage.pngJust got a call from someone claiming to be a billing company for my GP.

I haven’t seen my GP in 7 months, so when she asked me if I’d gotten the statement I was all “What?”

Then she reads off the wrong address. AGAIN! and I got a little pissed off. My MAILING address hasn’t changed in 20 years! Even after the house burned down the mailing address didn’t change.

NewImage.pngThis billing firm and I have been through this time and again and they STILL haven’t gotten it right.

Part of it is the arrogance of the data entry people.

After all the one in 10,000 forms that they process, which has a post office box on it can’t possibly be right. The patient filling out the form would take the time to put the post office box number on the form, especially since it is completely un-necessary.

NewImage.pngShe said “I don’t know why the information is incorrect.”

I replied, “I do! It’s because you people are horribly inefficient and your data is corrupt. I will be bringing this up with the doctor the next time I see him.  It’s funny, I get mail from the doctor’s office with no difficulty.”

I disconnected.

Of course this begs another question. Since I haven’t seen the doctor in 7 months or so, what the hell is this billing company trying to bill me for? I thought we’d settled up long ago.

I see a complete review of my medical bills in the near future. It’s not unheard of for medical billing companies to send out duplicate bills long after the fact, in hopes of pocketing the excess cash.

NewImage.pngThis is one of the reasons that I prefer to PAY for the services rendered at the time that the services are rendered. I hate having some bullshit insurance company negotiation going on for months behind the scenes that results in a bill that I can’t verify because I don’t know how much the services are costing me in the first place.

This isn’t about Obamacare, this is about the way the insurance companies and the medical providers services have evolved. This is the kind of thing that government regulation could have assisted the people with.

As I’ve said before, I’d prefer to deal upfront. I’d like to know what the cost for each service and materials for that service are. Then I, as an informed consumer could choose which services and procedures I’m willing to pay for, and which services are perhaps extraneous.

DSC_0442.jpgAfter all, you don’t buy new brakes for your car at every oil change, why should you have an expensive and un-necessary service done every time you go into the doctor?  You & your doctor should be working co-operatively and that requires informed choices. Pricing and purpose of a test or procedure isn’t unreasonable to ask for.

The way the system is now, you can have billing that shows up literally YEARS after the fact and that makes it very difficult to figure out if you should pay the bill, or if the bill is even yours.

I guess I’ll know in a few days. When I get the bill I’m going to drop by the doctors office and have a little chat.

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There are times when I just want to scream!

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And not in a good way!

I’m a bit ADD. I know, I know, that’s become an overused cliché catchall that everyone and their brother uses to excuse anything from a hangover to a stroke.

Hear me out. I’ve been like this my whole life, and for me, this is completely normal. I’ve adapted to being this way because I’ve never know any other way to be. There are times when the ADD presents challenges, loud noises, crowds, bright flashing lights, can really mess with my calm and freak me out. Most of these challenges are manageable. If I feel myself being overwhelmed I’ll find a quiet spot to collect myself and then I’m good to go.

imagesOne of the biggest challenges ADD presents me with is listening to someone talk. If they have something to say and they keep on track I’m fine. If, however, they meander and pause the main thread of their story to fill in useless details or give me background that they should have given at the beginning of the story, then I’m likely to stop listening. In the worst case, the person doesn’t notice my eyes glazing over and they keep yammering.

This is usually when the ADD becomes a real problem. I respond first with annoyance, then hostility, then outright anger. The poor fool telling me, whatever they were telling me has no idea what they’ve done wrong or why I’m pissed off.

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Believe it or not, I feel guilty when I lose control and get angry because of the way someone is telling their story. It’s not fair to the other person. As far as they’re concerned they are telling a nice coherent little tale.

To an ADD person it’s annoying tedium. I can explain, I think using the following example.

The church made, because of the rummage sale, the church made, the donations to the rummage sale this year because, because of estate donations allowed the church to make,  One estate donated a teak modern dining set that was worth about 5000 dollars it went at silent auction for 2000, it was one of those Danish modern designs, I don’t know who bought it. The usual amount that the church makes on a rummage sale is $15,000 or so. This year the church made, oh there was a lot of very nice estate jewelry some of it brought in a lot higher than expected prices. This year the church made $30,000 although the final total isn’t in yet.

The story could have been summed up simply.

The church doubled it’s usual rummage sale income this year due to a number of estate donations.

Then if I was interested I could have asked what the total dollar amount was.

benefitsadhd2To an ADD person, the story, as first presented, is like fingernails on a chalkboard. The constant teasing about how much the church actually made, is annoying as hell.

There’s another level though that’s worse for the ADD person. It’s that for every one of those pauses we pause a stream of thought and start another one. Pretty soon your 2 minute anecdote has us nearing the maximum capacity of our brain power.

Think of it like trying to compute orbital mechanics of the entire solar system and keeping all the variables in your head.

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This is, I think part of the reason we ADD folk don’t like watching the late night news, it’s the constant teasers. If the 10 o’clock news really wants to piss of the ADD crowd; tease us for an hour and then never get to the story!

“Stay tuned to find out why your penis is at risk”

The way my brain works is probably best described as a corral of skittish horses. I have tons of thoughts running all the time and it requires an effort of will to harness those thoughts, put blinders on them, and then hitch them up to the wagon of a project I’m trying to do.

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A conversation like the story above tends to have an effect on my thoughts, that’s similar to what you get if a rattle snake suddenly appears in a corral full of skittish horses. After the chaos and dust clears, you’ve got horses spread to the four corners of the corral and none of them are going to do any work for the rest of the day.

I live with a person that tells stories like the example above.  That pisses me off by itself. (Come to think of it, my stepdad tries to lecture on science and technical stuff the same way; no wonder I dreaded asking him questions when I was in school!)

Unknown

What really pisses me off is when I catch myself telling stories the same way.

My ability to write today is gone. I’m going to go outside and run the weed whacker. I will avoid holding a fluffy pillow firmly over someone’s face.

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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.