Tuesday, May 5, 2009

Just say "no" to Obama's healthcare reform

Part of care-giving is that you will become an insurance "expert." You certainly should not be intimidated by the medical provider's billing department and insurance companies. I have come to believe that medical care providers typically hire high school drop outs or prisoners on work release.

As Obama rants on about "health care reform," I wonder what life would look like in a Medicare for all system. No. We cannot let it happen.

At the risk of just plain embarrassing medical providers that I like (and whom I rely on to save my dad's life), I will resist the temptation to name names. The facts are funny/disturbing enough!

The last two charges that made it past Medicare, private and insurance and to my dad as a bill:

1. Apria (okay, I named this place because they are just plain deceptive and have been the subject of fraud cases by Medicare throughout the country) charged my dad for a piece of durable medical equipment (DME) that dad neither received nor needed. I contacted Apria and explained the error. They argued with me! What?

So, the next step is that I have to send a formal request to Apria to provide us with the paperwork that supports the charge. I did that.

Apria sends me back a fax that was allegedly signed by a doctor that dad saw once 3 months prior to the DME order. Frankly the signature did not look like that of the physician. Moreover, the physician allegedly diagnosed a condition dad did not have.

Bottom line -- dad never received the DME.

I get this notice from Medicare stating that Apria made a clerical error and they would repay Medicare.

I contacted the doctor's office and offered to fax the bogus DME order to them. I would have thought that someone - the doctor's office or Medicare or someone other than just me - would be concerned about this. Nope.

2. One of dad's doctors sent a claim to Medicare and private insurance for an event that never happened. The medical facility was paid by Medicare and the private insurance company.

I contacted the doctor's office and confirmed that this was an error. But of course, the doctor has no control over the billing. The medical facility has a separate entity that bills. Significance? The doctors have zero control over the people that bill. The doctor cannot hire, fire, discipline. Significance? The billing department employees are not accountable to the doctors.

The doctor's office asked me to fax the Medicare EOB and that would be forwarded to the billing department so that they could "figure it out."

I am still waiting for that billing department to cooperate with BCBS-IL for claims dated 2005.

Since I am busy caring for my dad, I really do not have time for the billing department to "figure it out." I decided to resolve the issue by contacting Medicare myself. I explained the facts to Medicare and I will just let Medicare "figure it out." Significance? This becomes a fraud investigation. I made it plainly clear to Medicare that the error was with the billing department -- not the doctor.

Most ill elderly patients just let the Medicare errors ride. I mean who cares right? The patient isn't paying . . . Medicare and insurance is paying. Who cares? I do. It is waste, fraud and just plain wrong.

How on Earth can we even contemplate (with a straight face) extending the concept of Medicare to everyone? Who benefits? Not the doctors. Not the patients. The beneficiaries are those who are part of the single-payer industry -

1. Medco CEO David Snow, Jr.
2. Medco BOD member and now a member of the insider WH health care reform team, Nancy Ann DeParle
3. Tom Daschle and his medical lobbyist wife

As a care-giver you should keep in mind that Medicare purposefully saves money on the front end of the claims process by paying quick and asking very few questions. This is a prime environment for fraud (i.e. Apria) and laziness/incompetence (i.e. sloppy medical care provider billing where the billing department employees are not accountable to the physicians.)

Watch the medical bills - even though there are many!

Contact your elected representatives. Advocate for an end to the nonsense that the Medicare-type system be extended to the rest of us. Daschle, David Snow, Nancy Ann DeParle, Medco are all trying very desperately to create a single payer (Medco) system for us all. No.

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