Physical Rehab, Reinvent, Retrench-Insanity

January 20, 2012 at 8:17 PM (Uncategorized) (, , , , , , , , , , , )

My legs are not wrapped.  This vital process will not happen the way I was told.

Because of my cerebral palsy, I cannot wrap and unwrap by myself.  there may be a way to figure part of the unwrapping, which I will work on tomorrow, but the wrapping is flat out impossible.

I was told my aftercare until I graduate to compression socks would be covered under Medicare part A.  That someone would come to the house and unwrap my legs, help me clean them (not entire bathing, simply my ankles and feet. Rewrap my legs since they would be certified to do it. )

Now, the home health care agency will not wrap my legs (its a non-skilled service)

There is no way to send someone certified to wrap that would be covered under Medicare part A

I’m supposed to be set up with an outpatient clinic instead, that Medicare may not cover, even under part B.   I advised of the transportation problem making the cost of that prohibitive, they said then I’d have to be in a rehab place or an SNF [ even tho medicare wouldn’t cover a return—-] until I graduated to compression socks, or live with someone who could transport me.  I won’t go into details here, but living with my parents would be, um…problematic and risk my mental health.  I don’t mean that snarkily or as satire.  It’s a real issue.

I am not leaving my home.  I worked too hard to get here.

I AM NOT LEAVING MY HOME!  Not over a 45 minute process.  I AM NOT LEAVING my home.

So, it’s be institutionalized or lose all the progress and leave myself at risk for congestive heart failure, or come up with a way to be transported to these lymphadema clinics every day, pay for that, and pay for either 20% or 100 % of those costs.  Even having Medicaid waiver fixed would not necessarily solve this problem.

I’m contacting the patient ombudsman for Medicaid in my state, to get the transportation set up, at least.  I’m also contacting my church.

But that has to wait til Monday, and the damn legs have already begun to ‘reinflate,’ because all the home care folk can manage is a simple ace bandage.

And yes, I’ll be dumb enough to stay at risk to stay in my home.

There’s such a thing as quality of life and I will not surrender it to bureaucratic forces that cannot speak to each other or bend to necessity.

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Off your meds…

June 21, 2011 at 11:21 AM (Uncategorized) (, , , , )

That offensive little phrase is now going to have consequences attached to it that could rival the bad credit score…since FICO is the one that’s doing it…

Medication adherence.
Non-compliant. These are some new health insurance/pharma buzzwords…

Via my friend in the health insurance fight nyceve.
Fico is the thing that presently calculates your financial score….and now it will get your prescription information and rate you.

Because if you don’t take your medications…you’ll have a ‘non-compliant’ label attached to you.

Will employers be able to see this stuff when they run a standard credit check (almost universal for full time job applicants now. )

Know what meds you are on and guess what you’ve got?

Non compliance? Someone not having enough *money* to pay for their meds? Doesn’t matter. Still non compliant….

OK. looks like HIPPA just got a piece chipped out of it….

One more way to screw people.

This disgusts me.

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A private insurer does something right.

July 9, 2010 at 6:58 PM (Uncategorized) (, , )

Get me a fainting couch, few but loyal readers, because I am stunned, dizzy, and very discombobulated.

(Also I did promise to publicize this, so here goes.)

An old friend advised that their COBRA health insurance had lapsed for no reason.  The company was handling the premiums via automatic debit, and stopped doing so.  Of course the policy lapsed, leaving my friend holding the bag for a possible monthly out of pocket prescription bill of $2700

It is being reinstated.

(It will take 7-10 business days to take effect so he’ll still have to pay 950 this month…but…


Whomever worked with him at the insurer and the insurer’s decision maker in this instant should get a raise and /or eventually supervise.

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First they went after “Health”

June 27, 2010 at 11:09 AM (Uncategorized) (, , )

Now “Safety” of data given to a health insurer is in question in California.

Anthem raised rates by 39% in California to provide the bestest in computer security, evidently.

From the Orange County Register via Big Orange…it appears private data was available for five months on the web due to a breach of Anthem Blue Cross’s website that was not noticed.

Oh, yeah, private industry is the best protector of health info.  Sure.

And I have a bridge in Brooklyn I’d like to sell you.

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A nuts and bolts diagram: What Single Payer will

June 22, 2009 at 4:41 PM (Uncategorized) (, , )


Non-reimbursed indigent care for citizens. = Major bucks.

The big players in the Healthcare Industry:

Anthem Kaiser United Cigna Aetna

Each have four or five Cost Avoidance Mini Bureacracies, where employees toil every day to say either “No,” or “We’re going to reduce this.” I’d imagine the smaller players do as well.

Other Party Liability Aka Coordination of Benefits Aka Subrogation.

What that means in English is that the doc or hospital billed the person’s health insurance and more than likely got reimbursed, but…Another insurance company is the primary carrier and the correct place of payment. (Private insurance carried by a parent or spouse…Worker’s Compensation injuries…Auto accidents covered by auto insurance.  Lawsuit or liability of a person or corporation.) Legitimate, but there will be many many fewer of these kind of knotty snafus in a single payer system.

Fraud…great idea in theory, and they should continue. But insufficiently documented rescission of coverage should be given up immediately. Conversely, legitimate fraud should continue to be pursued aggressively.

Duplicate Payment Recovery: Legitimate.  If they’ve paid two times for the *same* exact line item from the same exact provider on the same exact day…(Not just rejecting related services ) that[s overbilling and private and public insurers should get that back.)

Denials of appeals.  Correct documentation of appealed procedures vary by carrier and that nuttiness would again, greatly reduce under a single payor system. Also, I doubt there will be ‘quotas to say no’ under single payer.

Now, multiply the cost to run these departments by five. Salaries and benefits of these employees. Five of each of these, instead of just one…. In addition  The cost to providers of service waiting out delays that are ultimately resolved by a payout would be reduced dramatically

Under a single payer system there would be one set of cost avoidance bureaucracies, not five.

The fraud department *alone* under single payer would probably be large enough to absorb most of the former employees of the private cost avoidance departments, and would save the US more money due to their experience than just increasing single payer’s fraud unit by new  federal employees that may not have experience tracking abuse or fraud down.

Other party liability would lose much of it’s “Other health insurance policy responsible” delays and costs in productivity as would Duplicate payment recovery.

Businesses wouldn’t have to pay for US worker’s healthcare.  (I know the unions are peeved about that….but sorry…that’s a huge cost savings. Can’t the unions offer primo dental and vision still? )

More medical and behavioral health coverage means, ultimately less medical costs and less homelessness.

50 million more insured people.  That would up reimbursments to hospitals and doctors.  They’d actually get paid *more* not less due to the reduction in indigent health care costs, and the fact that *some* of those presently without insurance are healthy and wouldn’t drive costs into the system immediately.  More people insured means more $$$ going to providers under the present system by aggregate, even if individual patient’s bring less $$ in.

The need for medical billers and claims processors would skyrocket, creating jobs that could easily be ‘moved into’ by former employees of private carriers (not to mention help the economy)

Our present system of economic rationing would be drastically reduced.

There it is.  Why it hasn’t been disseminated to the Senate and agreed upon is beyond me.

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