As anyone who has been reading this column is aware, getting set up in Medicare is a nightmare. Even after you finally make all the necessary decisions, the probability of your experience going sideways is very, very high.
Most of my day has been sent straightening out what can and did happen to me at opening stages of my relationship with the program. Prior to joining the Medicare program, I was insured with a normal employer health care policy. I let that policy go in preference to Medicare. My wife and I have traded one point of contact for ten points of contact to accomplish the same task and we now pay significantly more than we did before we joined the program. This is not because Medicare is such a bad deal, but because of the way politicians and special interests have muddied the health care waters.
Several months ago, I had a pretty normal health problem for which I went to my primary doc. He sent me to a specialist in that particular problem. And now I’m fine… Thank you for asking.
Now, Medicare requires a “Part B” deductible (which is $147 in 2013) before it pays anything toward your expense. Medicare assumes that you are otherwise insured until you assure them elsewise. So… the first question is “To whom does a patient pay the initial $147?” And this is where the waters start to muddy up.
Of course, Medicare decided they it wasn’t liable for my care because I had previously enjoyed other insurance and they kicked back the doctor’s bill to the doctor. The doctor’s representative immediately called me and wanted to know why they hadn’t been paid.
On calling Medicare, we corrected the records error and they told me to instruct the doctor to resend his bill in ten days because that was how long the change in status would take to go through the Medicare system. While all this was going on, a second bill from the primary doctor and two bills from the specialist wended their way up the Medicare pipeline. The second bill from the specialist got to the payment point in the government system after three were rejected because of the original computer data problem.
The initial $147.00 deductible suddenly reared its ugly little head. It turns out that Medicare keeps track, but who I owe the deductible to depends on which doctor submits his bill first. Medicare thinks they know what I owe, but not to whom and until my Medicare supplement decides what they are going to pay, no doctor wants me to pay anything because that screws up their books. Whew!
Confused yet? Medicare and the doctors have now told me to cool my jets and see what ends up dropping out of the system. I will end up paying the $147.00 to someone; we just have to wait to see who.
All this would be comical if the waste added to the system by the horse trading in Congress and on K Street didn’t make the whole situation so serious. This is not an Obama-care problem. It is a special interest problem.
The health care dilemma could be solved by a small group of folks devoted to best solutions for the country on health care rather than the best twist for each of them individually. This begins to explain why American health care costs almost twice as much as that in similar countries yet achieves worse statistical outcomes.