Medicare, I Hate You
One Woman’s Opinion
By – Sheri de Grom
I don’t want Medicare, not Part A or Part B. My husband doesn’t want Medicare either. However, federal law requires we enroll in and pay for Part B. Part A is automatically granted to everyone when they turn 65. If you aren’t familiar with Medicare, Part A is the portion which pays toward hospital charges while Part B pays a portion of out-patient visits, medical tests and other ancillary needs.
Here’s where our government sticks it to the men and women of the armed forces who gave the best years of their lives by serving their country with a minimum twenty-year career. If these retired armed forces veterans don’t enroll and pay for Medicare Part B, they lose their TriCare benefits.
I thought our TriCare benefits were paid for by my husband crawling through the jungle in Vietnam as I wondered if the man I loved would come home alive or in a box. If he did return alive, would he be the same man I had married? I also thought our benefits were paid for when my husband spent week upon week training troops in the ice and snow of northern Germany and during subsequent war games in various countries. The military told him they hadn’t issued him a family, and they said so often.
Some say we should have to pay for Medicare like everybody else. My position? I’ll pay for it if I have to—but I don’t want the so-called benefits. My husband and I are the same as everyone else who’s worked their entire lives; we’ve paid into Medicare with every paycheck. I still don’t want Medicare. Give my benefits to someone else.
Many of you who follow my blog know I’m retired from the federal government. I made many of my career choices based upon having access to health insurance benefits I could afford and that would cover both my husband and me.
Each congressional member, both House and Senate, have access to the same health insurance I paid for during the years I worked and that I continue to pay three-quarters of the premium as a retiree. The exception is that congressional members receive the same healthcare coverage without paying any premiums. That’s a benefit I would love.
I understand most federal retirees drop their insurance coverage once they retire. Most can no longer afford to pay the premiums.
Technically, my husband and I should have full healthcare coverage with Medicare and TriCare. Should is the operative word.
The lower reimbursements provided to hospitals, physicians, and other caregivers by Medicare will eventually cause these same providers to stop taking Medicare-covered individuals. They will be forced to lower their standard of care due to the rising costs of maintaining their practice or they’ll be forced to consolidate into health management organizations wherein the patient has no say over the care they receive or when.
All of my providers of care and I are cheated when the government forces me to enroll in Medicare. I choose to pay for full coverage Blue Cross/Blue Shield (the gold standard of health insurance). Last year before I was eligible for Medicare, my providers were paid appropriately for my care.
Because of the required enrollment in Medicare, it becomes the first or primary payer of all medical care I receive. Medicare pays at a substantially reduced rate compared to what Blue Cross/Blue Shield pays and my care providers are cheated by the government for services rendered.
Because Medicare is the first or primary payer, BC/BS becomes the secondary payer, and they only pay the co-payment. Suddenly, everything becomes clear. TriCare never pays for anything and TriCare is an earned benefit of my husband’s, a Vietnam-era vet. (Yes, I’ve mentioned he’s a Vietnam-era vet twice.) These vets received no respect, ever. Now, the government elects to stomp on them again. They didn’t have a choice about Vietnam and they don’t have a choice about Medicare.
My number one reason for hating Medicare and all it represents is that with me, the federal government has taken away my freedom of choice.
My second reason for not wanting Medicare is that their convoluted rules nearly killed me. Computers cannot care for people. Only trained healthcare professionals can determine what is best for a patient.
I had what is normally a routine surgery in October, 2012, for which the normal hospital stay is three days. Unfortunately, my surgery turned into an experience that was anything but normal. The procedure which should have lasted ninety minutes took six hours.
On a Saturday, the third morning after my surgery, my surgeon entered my room for the fourth time that day. I like and respect my doctor but I wasn’t used to his dropping by my room so frequently, plus there was a major home university football game that day. It was a given that he had box seats.
Something wasn’t right but I wasn’t sure what.
I’d frequently discussed with my doctors the wrongs the United States Congress had brought on Medicare and the individuals it’s supposed to protect. My surgeon and I had engaged in some of the same discussions.
As it happened, on that Saturday morning, the Medicare computer only read my admitting diagnosis from the hospital electronic data file. There was no over-ride mechanism in place for Medicare and no phone number to call. Medicare said I had to go home.
If Blue Cross/Blue Shield (BS/BS) were still my primary payer, they would have granted an additional twelve days, and possibly more. Unfortunately, Blue Cross/Blue Shield could no longer over-ride a Medicare decision wherein computers talk to computers. BC/BS has licensed medical staff wherein hospital medical staff can explain the need for additional days.
- The Medicare computer didn’t care I’d lost almost half of my total blood volume during surgery and my body didn’t want to make more.
- The Medicare computer didn’t care that my blood pressure hovered at 70 for forty-eight hours after surgery. (I’m normally at 102 with no deviation.)
- The Medicare computer didn’t care that I’m diabetic and my blood sugar crashed to 52 during surgery (normal range is 90-110), and it was over thirty-six hours before it was up to 75. My blood sugar read 80 when I was released to home with no dietary instructions. (Thankfully, I knew what to do).
- It was another week before we knew I had also acquired a hospital-grade infection—but I’m sure the Medicare computer wouldn’t have cared about that either. Medicare did have to pay for the numerous doctor appointments that resulted because of the numerous co-morbidities. It took seven weeks and six rounds of different antibiotics before the infection was crushed.
If my husband hadn’t been at my side 24/7, I’m not sure how I would have survived those first awful weeks I was home. I questioned myself over and over, why wasn’t I getting better? Feeling bad didn’t begin to explain how I felt. Others had told me they’d had the same surgery and were up and about in two to three weeks.
I understand Medicare is all important to a large population of the United States, but not to me. I planned differently. That doesn’t make me special. I gave up a lot in order to have health coverage and now the United States Government, the very entity I worked for, takes away my freedom of choice.
I watched the television program ‘Need To Know’ on PBS. (pbs.org/needtoknow) They are doing an informative series on Medicare and other healthcare concerns in the United States. The first installment is about hospitals being penalized for Medicare patients returning for readmission within thirty days of discharge. The percentage is high. One in five Medicare patients returns to the hospital within thirty days of their admission. I was a prime candidate for return, but it was Medicare that forced me home in the first place.
I wish I had an answer for the healthcare crisis that confronts each of us, but I don’t. For me, the only acceptable choice is one I’m allowed to make myself. The United States Government and the Medicare computer don’t have a clue.
Physicians and disease would not have been the cause of my death during those dark days of October, November, and even early December when I was asking why. I’ve now had three specialists tell me Medicare would have been the direct cause of my death, but then I already knew that. I wasn’t healthy enough to be discharged to a skilled nursing facility where Medicare would have had to pay so Medicare discharged me directly to home.
What do you think? Does healthcare and your choice or lack thereof scare you?
Sheri Lawrence de Grom 
I hate medicare too. So many clinics like mayo and emergency clinics don’t take it. I want a substitute. I want my insurance back. Medicare is not free and it is a terrible insurance Medicare go away
I finally found your article after trying various searches in Google and scrolling through multiple pages of search results. I was medically retired out of the active duty Army due to physics injuries sustained during an IED blast. The only mental injury I sustained, according to a psychologist on post, was generalized anxiety disorder. I received 40% disability from the board, and was retired out. One of the benefits promised to me was Tricare prime. Not the greatest insurance, but head and heels above Medicare of which I was soon to find out.
The VA upped my rating to 60% almost immediately. But I struggled for years mentally, and was wondering if something more was wrong with me. I went to college using Voc rehab, and then in 2011, I started a job at a prestigious accounting firm. Not even 5 months into employment I get sacked. They wouldn’t give me a straight answer as to why, only telling me my performance wasn’t up to par, even when all of my reviews were excellent. One of the partners of the firm helped me get a new job with a good corporation, and my pay even jumped about $11,000 dollars. Every time I was offered company insurance, I turned it down because Tricare prime was way cheaper, about $38/month including my wife. Well a breaking point finally came for me mentally, and I started having outbursts at work. I went and saw a specialist psychologist who worked at a Ptsd trauma recovery center. He diagnosed me with Ptsd after giving me a 3 hour exam. After 6 years of being out of the Army, I finally knew what was wrong with me. I was diagnosed in the summer, and around fall, my work allowed me to take a few months off of work to go through an inpatient program for Ptsd at the VA.
After the program was completed, they realized that my Ptsd was worse than they originally thought. So bad that the VA gave me 100% for my Ptsd alone, and ignored all my other conditions for a rating decision. They still recognized I was physically injured still, but once one condition is 100%, the other injuries don’t count for a rating, as they wont pay anymore than 100%. My psychiatrist sent a letter to my work recommending that I don’t return, and that my condition probably wouldn’t get better in the near future. I was subsequently terminated from my company.
So not being able to work, I filed for social security disability, and was immediately accepted. A little over two years later, I get a letter saying I was eligible for part A and B Medicare. I denied part b because I had Tricare Prime. A month later I got a nasty gram from Tricare saying they found out I was eligible for Medicare part b, and that my Tricare prime would be cancelled for myself but not my wife. A few months later, and many hours on the phone I was able to rectify the situation. I had no choice, I had to accept Medicare part b and would have Tricare for life as a wraparound and my wife would stay on prime.
So now I’m paying around $110 for myself when I only paid $19 for myself on Tricare. So my monthly cost shot up almost 6xs, and now I had worse insurance. So who’s logic looks at this situation and thinks it is right. This disabled veteran can’t work anymore because of his disabilities. He is now on a fixed income making less than what he was making working. So let’s jack up his health insurance cost by 600% and give him worse quality insurance!
Case in point, I had to go to the emergency room for a condition that I have, that may or may not be service related. I ended up staying in the hospital for a few days, and then was released. Under Tricare prime, the most I would’ve had to pay out of pocket would’ve been $30. I get a bill from the hospital for $1200! I wait to see if Tricare for life will pick up the tab, and they didn’t. I got an envelope from Medicare explaining that I was responsible for $1200 because they didn’t think I needed to stay the last day I did, so they refused to pay it. Funny, since I was begging the doc everyday to let me go home. But I guess Medicare has an MD, so I get screwed out of what little money I have. What’s even worse, is even if I wanted to go to a hospital on post, I’m last priority now, even lower than when I was on Tricare. This is such garbage, and the only recourse I have I writing my congressman and senator, which I’m sure will make something happen immediately? Yeah right.
So it looks like I’m out $1200 of what little money o have to pay for a hospital visit because my insurance is worse than what I was promised, even though I pay more. I just can’t deal with this garbage anymore.
James, Please excuse my lateness in responding to your reply to my post. I will say I’m delighted to hear from you and wish I had a bit more information. If you are comfortable sharing your contact information you may contact me at sdegrom@conwaycorp.net. I request that you read my bio and my disclaimer. That way you’ll know a bit about my background.
I hear you and your anger loud and clear. My husband [currently in a civilian hospital] and I have fought many battles with insurance and Medicare. None of the battles have been pretty.
It’s none of my business but I’m curious how the medical board broke down your disability. If they originally gave you 40% and part of it was physical but they recognized the generalized anxiety, then you actually came out ahead on how your board listed your disabilities. I’m not saying disabilities are good because that’s not the case. But, it’s always better to have them broken down into various categories.
May I suggest you never downplay generalized anxiety. I’ve seen it stop the most professional of individuals in their tracks while they have panic attacks. Sweat will be coming out of every part of their skin, they’ll shake like a frightened animal, feel sick and many other symptoms.
I totally agree with you there’s little to brag about when it comes to Tricare Prime and that’s what led me to enroll in Federal Blue Cross/Blue Shield as a Federal Employee. I knew Prime would never cover the medical needs of our family once my husband retired from the military. Never once have I regretted my decision although the cost is outrageous.
I have heard but haven’t read or even researched that a service member can be more than 100% disabled. I attended a workshop presented by an attorney and it was my understanding from what he said was the service members receiving 100% for PTSD or other mental condition plus a physical condition such as TBI then the percentages were added together and the disability was paid accordingly. I have nothing to back me up on this but if I were you I’d check with 3 sources and I would do it in this order: #1) Your local Veteran’s Service Officer – each county has one and they are a ton of information and genuinely nice guys. #2) The American Legion – Their office will generally be at a VA but they are nice to work with and are good about providing information. They will make an appointment time for you (at least ours does). #3) Disabled American Veterans – I had a great advisor with a regional director and then his duties took him away from the office almost full time. The person assigned my husband’s case was worthless in that she gave me information that was wrong and I spent 3 months preparing a claim file wherein we did not qualify. Needless to say, this made me angry and I decided not to do further business with them.
Unfortunately no one automatically tells you that you must enroll in Part B Medicare. One of the largest advocacy projects I’m currently working on is doing away with that requirement. In our case, we have full coverage with Blue Cross and Blue Shield and Tri-Care for Life picks up the deductible. Now that we have to pay for Medicare Part B, Tricare only pays for the deductible on our prescriptions. Medicare and BC/BS covers everything else. BC/BS covers all pharmacy except when there’s a deductible. The only thing Part A pays for is hospitalizations.
On the subject of hospitalizations, it sounds to me like you need to read my blog on ‘Shifting The Cost of Emergency Room Care To You.’ You’ll find it at https://sheridegrom.wordpress.com/2014/08/06/shifting-the-cost-of-e
I have another blog on the subject coming up in a couple weeks or so. My new blog address is https://sheridegrom.com. You might be interested in some of my veteran blogs and other blogs regarding Medicare.
Regarding that bill you received from the hospital: you wanted to go home and the doctor didn’t discharge you. You have an arguable case. Additionally, the hospital’s utilization review department/nurse (depending on how large the hospital) is responsible for getting approval from your insurance company (in this case Medicare) for EVERY DAY you are a patient in the hospital. They are to get the approval before midnight of the day you stay. In the industry the language we use is: “if the day isn’t certed then we don’t pay.” IT’S ALWAYS THE HOSPITAL’S RESPONSIBILITY. No one else can do it.
With your being 100% disabled why don’t you have 1st priority at your VA hospital or do you simply elect not to use the facility. We use civilian facilities because I have the BC/BS. My civilian career with the military moved me frequently and I knew my husband would need the medical care and I wanted to know we’d have access to quality care wherever we were whenever we needed it. I also didn’t want to have to jump through hoops to get that care.
I never had to hunt for a doctor before Medicare. It seems crazy to me. Now 6 of our doctors have retired early as a result of Medicare’s bulging administrative requirements and low reimbursement.
Hang in there. I’d love to hear from you. If enough of us stick together on this issue, just maybe we can help ourselves.
And, James, Thank you for reading with me.
Sheri
sdegrom@conwaycorp.net
What I would like to know is who in congress we can call and annoy and hopefully (but I doubt it) change this crap that if you have Tricare you must take medicare.
Hello Robbyn – Thanks for stopping by. Our only recourse is to continually stay in touch with our Senators and Congressional Representatives. Hold them accountable for what they do along with what they don’t do. Make sure they know your name and what you stand for. I continue to use the telephone to call their offices but I’ve found letter writing to cause more accountability.
I detest Medicare and having to be on it. I’m 70 and started it only last May after my husband retired. We were fortunate to have had excellent insurance through his work. Now, after a mind-boggling search through supplement plans and part D plans that I might be able to afford, I am on an advantage plan that is not great. Thank you for the article. It was just so nice to read that I am not alone in hating Medicare and believing it is not as great as my parents used to say it was.
ElvisAnne, I’m delighted to see you here. Not just because we both hate Medicare but because you are articulate and can/could become an advocate regarding all of the terrible things happening to individuals shoved into Medicare when that’s the last place they want to be. Our legislative bodies certainly aren’t rushing to sign up for coverage under Medicare and they have no real connection to what’s going on within the agency.
I’ll be writing more about Medicare and the mess it’s in during 2015. I’d love to have you follow and that way I’d hopefully receive your input. The input I receive from fellow bloggers is some of the most important information I receive.
I have 2 other Medicare blogs you may be interested in: Medicare Part D Has Me Worried @ http://sheridegrom..wordpress.com/2014/07/10/medicare-part-d-has-me-worried. The 2nd one is Medicare and The Death Squad-Authors Opinion. Where Have The Doctors Gone? This one was published in Medical 2014.
Thank you for you interest ElvisAnne and I look forward to seeing you around the blog. Sheri
This is what I like best about you Sheri, you don’t quibble or mince words. Medicare I Hate you just about says it all!
Cindy – I still feel the same way about Medicare as I did when I wrote this post. Our country needed Medicare when it was adopted in 1965 and the doctors were paid appropriately and patients provided the care they needed. Now we have bureaucrats dictating to physicians what they can and cannot do for a patient.
Amazing! Its genuinely remarkable post, I have
got much clear idea on the topic of from this post.
Medicare is a sad way to ‘practice’ medicine. We’ve paid in for years and were still afraid and contined to pay the monthly premiums for our Blue Cross/Blue Shield and now it is the second payer. That to me is the crime in this situation.
Reblogged this on lost creek publishing.
Thank you for reblogging this post. I sincerely appreciate it.
As a German I have problems understanding the American health care system. We have had universal health care since 1874, and we never have to ask our health insurance if they cover this or that treatment or surgery. They just do. I read in a magazine about immigration to other countries that if I wanted to live in the US and wanted the same healthcare benefits that I have in Germany, at my age I would have to pay 4000 Dollars a month. I couldn’t believe it. As a freelance journalist in Germany I pay only 100 Euro a months now – even if I would see 5 specialists a day. And no, we do not have long waiting times, as many Americans think. The US and South Africa are the only countries in the world with such a strange health care system. I hope that one day you’ll have one like ours.
Cornelia – Hello and thanks for stopping in for comment. I didn’t have a problem with health care until the government stepped in. I don’t want socialized medicine and was doing just fine getting the health care I wanted and when I wanted it before the government interfered. I lived in Germany for 6 years and did not have problems receiving health care at that time either. The problem with our system is for individuals that have private health care insurance that takes care of all their needs and then are forced into the government system (Medicare). Medicare is good for many individuals that don’t have other health insurance but for those of us that do have health insurance, we don’t need it and for most individuals in the situation that I fall into, we don’t want the government’s program.
Patty – I’ve been researching the Tricare situation. I don’t have enough information for a blog. On Nov. 9, 2012 Military Advantage posted an article by Terry Howell (unfortunately I don’t have the link or I’d send it to you) and he reported, “Defense officials are expected to soon announce that military retirees and their dependents that live more than 40 miles from a military treatment facility or BRAC (base closure) site will lose access to Tricare Prime as early as next April.” He went on to say, “This move could force as many as 171,000 retirees to shift to Tricare Standard, which would mean an increase in out-of-pocket costs — especially those with special needs dependents or other chronic health issues.” If you have coverage through Tom’s insurance, you should never have to pay a deductible to Tricare if Tom is regular retired military. The fact that you have a primary payer takes the majority payment off Tricare and they pay the deductible of your regular insurance. Your regular insurance should always be billed ahead of Tricare.
You said what has been our minds for the past few years. DH had to keep his insurance with the state when he retired because of me, I am a bit younger than him and need the health insurance, we also have tricare. We are paying for his state benefits at a considerable lower rate than if I would have kept it for myself. The problem will be when he turns 65 – forced to take medicare part A – now he will have three insurances because we cannot afford to drop his state benefit because of me. Then it gets better as he will also be forced to take the medicare part B to keep the tricare – now he has 4 medical insurances. The medical center has enough trouble with two insurances. Medicare and CHAMPUS (the old military insurance) fought for years after my mother died who would pay her cost first…it has always been that the military is secondary. Now what is screwed up with this system? We do not want medicare either but are forced into it. Why should we be forced into it…it is our choice to continue to keep what we have which we like a lot better. Why should we pay for more medical insurance we can’t afford while we are covered adequately? Here we are over insured while others are uninsured? I think it is disgusting that the government doesn’t have a better plan. We have lost our freedoms years ago, and I have been saying for years I am glad my father did not live to see what has happened. phew I feel better now!!! 🙂
Patty – I hear you loud and clear. The whole thing tied into the requirement of taking Medicare Part A, the part that covers hospital care, the individual doesn’t pay extra for. However, as you stated, you don’t want it and we don’t either. Part A is what almost killed me. Medicare Part B is the portion we are required to pay for and of course we don’t want it and don’t need it. Like you, for years I’d explain to physician’s billing offices that they had to bill our BC/BS first and Tricare 2nd. Often they would tell me that because my husband was retired military, that his care had to go to Tricare. Of course, when the explanation of benefits came back as zero pay and noted as the patient has other insurance, the doctor’s office would often act as though it was our fault. Sometimes I wanted to climb across the desk and choke someone. In the near future (hopefully before hand and arm surgery) I’d like to get a letter off to my state senator, representative, the prez, and several committee chairs and of course I can’t forget John Boehner.
If you need a signature let me know!! 🙂 They just don’t get it. I heard our tri care payments are going up, I did not realized we were paying for them, I assumed it would be our deductibles going up or are they going to start charging us?
Hubs and I both on Medicare and yes I hate it and it is getting worse by the day !!
Len – Is there something specific you’ve encounter with Medicare I haven’t mentioned and that’s a problem for you and your husband? I learned today that Medicare is ‘supposed’ to pay for one pair of diabetic shoes a year. The physician assistant wrote up the paperwork for my husband and said if everything wasn’t filled out exactly the way Medicare wanted, they wouldn’t pay. So, we’ll see how everything works out regarding the shoes. That’s an item we haven’t tangled with before.
Thanks for stopping by.
Oh don’t get me started!!! Ok I will anyway as beirfly as I can. When I was granted disability in 2008 medicare back dated my part A (hosp) to 2005 because they did that my primary through hubs work (Signa) said they wanted reimbursed for all they had paid out on my behalf…Drs. hospitals, labs everyone returned to Cigna what they had payed then Medicare refused to pay any of it as Cigna ws primary was their excuse consequently we ended up paying back out of pocket nearly a qqhalf million in charges and that was after negotiating to cents on the dollar. I could go on but that is the worst and why to this day I am broke.
It was Cigna’s responsibility to subrogate for third-party payment against Medicare. It wasn’t your responsibility to repay the money. You received the care legally because you didn’t have Medicare at the time you received the care. If Cigna wants their money back, they are responsible for going to the source they want it from. (In this instance that would be Medicare). I AM NOT AN ATTORNEY AND CANNOT PROVIDE LEGAL ADVISE. But every action I’ve seen on cases such as this, federal courts have always made the individual insurance companies and Medicare fight it out and not put the patient in the middle of the problem.
I fought for years as I made payments to afraid of not receiving the service I needed. Just this year we ended up filing bankruptcy on the balance of the medical bills which was just over 50 thousand when all ws said and done. Sure hurt my pride but did not know where else to turn now our credit is shot and we have nothing set aside for emergencies. so we step out in faith that all will be well.
I’m so sorry to hear that. I understand the pain that must have cost you for something that was not your fault. You were not responsible. Your insurance carrier was legally responsible for filing against Medicare for repayment. Of course insurance companies know it’s nearly impossible to get anything out of Medicare so they turn the table on their beneficiaries and make them the victim.
As for the diabetes thing… yes they do pay for one pair of shoes, what I don’t understand is even through supplement insurance we pay we can’t get the supplies paid for. They will pay for insulin but no the needles to inject it…
There must be a supplemental insurance that will pay for the additional supplies you need. Does your supplemental insurance cover test strips and that type of thing? Our needles, test strips, lancets, even the meters are paid for by BC/BS. This is just plain crazy they won’t pay for the needles.
We have Humana as a supplement and no matter which plan they aren’t paying and this year they took away the free pap/mammo/dental and eye benefits so now another budget item for those insurance supplements, congress can get a raise but we get cut benefits. Land of the Free ha!
I’d do a double check on the preventative exams such as the pap and mamo. Under Obamacare they are ‘supposed’ to be covered and with no co-payment. Insurance is also supposed to cover preventive exams for prostate and colon cancer at 100%. Humana has been a stickler in the past with excluding certain benefits and practicing under an exclusion umbrella but it’s my understanding they can no longer deny benefits that are included in the federal coverage law for all citizens. I’d check with a local provider before I went without the care. We do have to have additional coverage for dental. It has never been covered under any of our traditional plans. The mere fact that diabetes is involved, that guarantees one eye exam per year to check for degenerative disease.
I too hate Medicare! I can not even get Medicare to get my name corrected!They shortened my name, and now they act like they are some kind of God. and I have to accept the fact they my name was shortened. I even contacted my Congressman’s office, and still the name is the same,. I was told my name is too long. Wel, the card has enough room on it for my name. They don’t want to be bothered is the problrem. I used to program computers,, and I even offered to program their computers so my name would fit!! I would prefer to be able to buy my own insurance from whomever I WANT. We send people to the moon why can’t we just give everybody a voucher to buy their own insurance?
Vernalea – I hear you loud and clear. The administrative staff of Medicare doesn’t care about the individuals they are paid to communicate with. I use the word communicate loosely as I’m not sure many of them know how to read or write. Have you ever tried to talk with anyone on the telephone! My father used to call The Department of Agriculture the last great plantation as they didn’t have a clue as to what was really going on in the world of agriculture and the same can be said for Medicare. Medicare hasn’t a clue as to what is going on in the world of medicine and the client base they serve.
Any ideas how to get my name corrected?
Vernalea – As long as your claims are adjudicated correctly, Medicare probably won’t change your name. Tom’s and my last name has never been correct on any government form and we’ve come to accept it as part of having a unique name. Some battles simply aren’t worth fighting. With Medicare, I’d wait for something really big to come along before I pulled out the big guns.
You can’t see me, but I am SO nodding my head! My Dad was a veteran and a retired federal employee who kept his BC/BS. In August his doctor checked him out, stem to stern, and proclaimed him in good condition for a 91 year old man. In September Dad fell. In October, he died. Medicare killed him. Dad had every complication you can imagine, but on a certain day of his stay, the hospital had to send him down the road to skilled nursing and rehab. Every day something new was happening – blood clots, heart failure, diarrhea, you name it. But every day, they’d drag this poor sick old man out of bed and take him to rehab, so Medicare would continue to pay for his stay. I bought into the fantasy that the rehab was making him better, because I adored my father and wanted him to get better, but with the clear understanding of hindsight, I can see that rather than treating my dad, they were just going through the motions to get paid. There’s something very wrong with this picture. Maybe Dad would have died anyway, but the farce played out in skilled nursing was a sad way for a dignified man like my father to spend his last days and that’s something you can’t explain to a computer.
Jane – I so understand where you’re coming from. The exact same thing happened to my father. My dad was my best friend and not a day goes by that I don’t miss him and wish I could have a do-over with his medical care. While my father was a rancher and not a federal employee, he rode high in the saddle until he was in his 90’s. He was my John Wayne and he never complained the 15 days the so-called physical therapy was used for skilled nursing to get paid. I hope we are wiser with our medical care and my advocacy campaign has begun. Our country is so deeply in debt, I’m attacking the issue of why have medicare pay for individuals like my self and your father that have adequate insurance to cover their needs.
I was in the room with my dad at the nursing facility when the staff psychologist came by to dot her i’s and cross her T’s. She went down her form asking about alcohol usage and church membership. She asked if he’d felt hopeless or depressed in the last few weeks, in exactly the same tone as she’d asked about his appetite and hobbies. Believe me when I say I’d been hopeless and depressed during the weeks of his illness, so I wondered what his answer would be. He chuckled a bit and said, “Well, I’ve had a pretty rough time of it lately.” Only then did she realize that she was actually talking to a human being rather than a case number. She couldn’t get out of the room fast enough.
Yes, healthcare does need to be re-vamped, but we don’t need another program or more regulations. We need more medical professionals devoting their time to taking care of people. As I sat with my dad every day I got so frustrated by the nurses who were more interested in plugging my dad’s numbers into the computer than they were in actually caring for him. The monumental task of documenting everything they did to protect themselves from getting sued, preempted the time they could have spent practicing medicine.
I vividly remembered one afternoon after a shift change an aide was waltzing up and down the hall with her little rolling computer explaining to everyone that she couldn’t do anything because the computer was down. She obviously didn’t realize that she didn’t need a computer to rearrange pillows, comb hair, give sips of water and talk to patients about their needs. I was with my dad from early morning to late at night, trying to keep him comfortable and at ease, but when I would walk down the hall I would see room after room after room of pitiful people who never had a visitor. They didn’t need their temperature taken and input into the computer, they needed a kind voice and some hope.
I don’t blame the nurses, doctors and aides though. They have a job to do like anyone else and when I got a real moment with any of them, they hated the computer demands as much as I do. I blame a system that by necessity has to document everything or be faced with a lawsuit or no reimbursement for their efforts.
I agree, we don’t need another system. But, I want freedom of choice. I don’t want Medicare, that’s the bottom line for me. Don’t make me go there.
One of the best nights I had in the hospital occurred when a young nurse came in and asked, “What may I do for you?” It was in the wee hours of the morning and I couldn’t sleep (probably a combination of pain and my mind spinning around). It was a beautiful hospital. All private rooms. Patients could order from a room service menu whenever they wanted their meals, and many other services we’re generally not accustomed to in a modern hospital. But, back to this wonderful young nurse. She asked if I wanted something for pain and I told her no – I was tired of pain medication and I already had a morphine drip going. I didn’t want anything else.
She had the insight to pull a chair beside my bed and we chatted until I fell asleep. We talked about the small farm she lived on, but only after I’d told her I’d grown up on a cattle ranch. We talked about education and how hard we had both worked for ours and how important we both thought advanced studies for women were. All in all – she didn’t enter a single computer code the entire time she was with me. She straightened my bed (when’s the last time you saw an RN do that). What did happen was that I slept through the remainder of the night and I’m convinced it’s because I knew a real human being cared enough about me to check on me regularly.
The times I blame caregivers is when they don’t allow time for patients and/or family members to ask questions. I’ve ferreted out my husband’s caregivers and they know I’ll follow them to the end of the earth to get my answers. Now, I recognize, I must have a medical advocate that will do the same for me. I’ve never had to have one before. I’m teaching my husband.
I’ve taken my husband out of hospitals several times against medical advise because he wasn’t getting appropriate care. Of course, that was when BC/BS said, “Sure, we agree with you. Do what you need to do. We’ll certify the new admission at the hospital you’re going to.” And, people wonder why I hate Medicare. There’s not a computer in the world that can give you that type of service.
Hi Sheri,
I work in the medical field doing billing. Medicare is every provider’s worst nightmare. From the red tape to the denied claims to the ridiculous fees they pay…it’s terrible.
Good for you for speaking out and educating the public about how it works. (or doesn’t)
Denise – You are so right about Medicare being every provider’s worst nightmare. With the new rate structure, we’re seeing physicians allowing themselves to be bought out by large hospitals. Physician groups still stay in their same location but now actually belong to the hospital as a clinic of the hospital. This way, the doctors are paid the same as if the patient were at the hospital. I actually think this is a great idea on the part of the doctors. The docs have tried for years to get Congress on board with them and Congress has refused. What the doctors are doing is not illegal and I applaud them for this move. The primary change for the doctors is their clinics now have to meet all JACO guidelines but this isn’t hard once you get everything set up correctly. Providers of care have to do something or they are going to lose 40% of their revenue from Medicare this year. Who can stay in business with revenue cut so sharply. Congress gave themselves a pay-raise but not anyone else.
Sheri, that was a shocking post to read. I’m so sorry you had to live through that terrible experience … perhaps I should reword that … I am happy you lived but sorry for the traumatic journey through which you suffered. I absolutely agree that everyone with military service as well as their family should be assured of automatic lifetime health coverage.
Patricia – Thanks so much for stopping in. My main complaint, now that I can be up and around is my government is taking away my freedom of choice. Why should I have to pay for Medicare when I don’t want it in the first place. My husband and I already have 100% coverage with BC/BS and Tricare. By the federal government forcing us to purchase Medicare, we lose the benefit of BC/BS and our freedom of choice.
Oh my God, Sheri, I am horrified after reading your post. I had no idea. And I totally agree that you should have a say in your healthcare and you shouldn’t be forced to have Medicare coverage EVER. What the hell kind of “free” society are we supposedly living in? Geez. I am speechless.
Patti – Exactly, we are supposedly a country about freedom of choice. At first I wasn’t going to do the post and then I decided to go ahead and do it because I knew their were youngsters like yourself out there that read my posts and I wanted you to know what Medicare was up to. I know Medicare is so important for thousands of people, but the other thing I took away from my recent experience is that if I hadn’t had Tom at home – I could have died. Medicare is sending patients home when they are not well. I’m beginning to wonder if we are rationing care, the same as some other countries. It doesn’t exactly leave me with a warm fuzzy feeling.
Health care, especially after I retire from an employer that pays for my coverage, has me terrified.
I’m trying to save up all the insulin-pumping supplies I can, because I suspec thatt by the time I qualify for Medicare they’ll insist I give 120 shots per week with one disposable syringe.
But of course, if that makes my diabetes control worse they won’t pay for it. No idea what the answer is, though…drat!
Laurie – Any chance your employer offers continuing benefits after retirement but at a higher premium? I pay 3/4 of the BC/BS premium just to hold on to it. If I ever let it go, I’ll never get it back. I know a lot of individuals that are stock piling inventory for different conditions. Until the present Medicare Part D is amended, changes are, you’ll face a time when you’ll be paying out of pocket for a lot of things you don’t pay for now. My BC/BS pays 100% for all diabetic supplies (under the preventive medicine clause). Our healthcare coverage was 100% for everything and it was the best of any we’d had anywhere in the world until Medicare wanted into our business! There’s something so wrong with this picture. If Medicare hadn’t forced us into their playground, we’d still have everything the way it was.
You make some great points, Sheri. First, I am fortunate to currently be covered under my husband’s insurance, despite my loss of job. As you know, I lost my job back in July. I WAS terrified about what that would mean as our insurance coverage was through me (my premiums were significantly lower through my prior employer). Fortunately, at my prompting, my husband called his benefits department and found that even though it wasn’t an open enrollment period, we could choose to enroll, effective immediately. (Apparently, my loss of job was what they considered a “life change” equal to marriage, adoption and other incidents)
As for Medicare and how it applies to military retirees and their beneficiaries? Honestly, I think you guys deserve the free coverage while those elected into office should have to pay the premiums that you guys are currently required to pay. Simply put, your sacrifice on behalf of your country is greater than the bureaucrats that push paper and rarely put themselves in harm’s way.
Great post!
Kitt – Thanks for stopping in. Yes, the fact that you lost your job and your husband’s job offers a ‘family benefit package’ requires them to add you on to his policy or to bring both of you into the fold although it’s not open season for enrollment. There’s a federal law covering that particular benefit. I always had to keep up with all types of insurance regulations when I worked for the government so have continued to keep up with them. I get a real kick of helping my friends when their insurance company doesn’t want to pay for something and the fine print clearly covers the issue, or hospitals overcharge, and on an on.
Oh, yeah…as my prior history left me with a pretty good understanding of insurance and managed care, I’ve also found myself helping friends. I was glad that they didn’t make things difficult or complicated.
Sheri – I had no idea it had come to that for you. I am so sorry. As a Canadian, with a health care system where choice is still possible (my husband was told to stay in hospital several times but wouldn’t) and where I do have options and alternatives, I can’t even imagine what you’ve been going through. I know the American new system is “somewhat” modeled on the Canadian system, but I can assure you, we don’t have any private system overriding a public system or vice versa. Canada has decades of experience with its public health care system. Sounds like the U.S. system is going through growing pains that should have been avoided if they had taken our Lessons Learned. And, for sure, our veterans don’t have to deal with what you did. They are covered. Period. Thank you.
Mary – I still have freedom of choice of where and who provides my care. I knew what was coming because I read the 2,000+ page document of Obamacare before it passed. My issue is with Congress and the fact that they require Tom and I to have Medicare and that it over-rides our Blue Cross/Blue Shield — which I pay the premium on. All would still be okay if we simply didn’t have to enroll in Medicare. Hundreds of thousands of Medicare age individuals cannot afford private health insurance and they rely on Medicare. I’ve made sure that Tom and I were never in that position and we’re still stuck with the process.