I decided to change my blog plan and discuss the changes in Medicare as the ACA goes into full action. Consider the following letter from a Medicare patient and if you are a senior citizen tremble with fear!
Letter from a senior gentleman in Mesa, Arizona:
Dear Family, Friends, Neighbors and former Classmates,
I just found myself in the middle of a medical situation that made it very clear that “the affordable care act” is neither affordable, nor do they care.
I’ll go back about seven years ago to a fairly radical prostate surgery that I underwent. The Urologist (a personal friend) who performed the surgery was very concerned that it was cancer, though I wasn’t told this until the lab report revealed it was benign. Since that procedure, I have experienced numerous urinary tract infections, UTI’s. Since I had never had a “UTI” prior to the prostate surgery, I assume that it is one of the side effects from surgery, an assumption since confirmed by my Family Doctor.
The weekend of March 8-9, I was experiencing all the symptoms of another bout of UTI. By Monday afternoon the infection had hit with full force. Knowing that all I needed was an antibiotic, I went to an Urgent Care Center in Mesa, AZ., to provide a specimen, a requirement for getting the prescription. After waiting 45 min. to see the Doctor, I started getting very nauseous and lightheaded.
I went to the Receptionist to ask where the bathroom was as I felt that I was going to throw up. I was told that I would have to wait for the Doctor because I would need to leave a specimen and they didn’t want me in the bathroom without first seeing him.
That was when the lights went out, my next awareness was that of finding myself on the floor (in the waiting room) having violent dry heaves, and very confused. At this point, I tried to stand up but couldn’t make it, and they made it very clear they weren’t going to let me get up until the ambulance got there. By the way, when you’re waiting to see the Doctor and you pass out, you get very prompt attention.
Now, “the rest of the story”, and the reason for sending this to so many of you.
I was taken to the nearest hospital, to emergency. Once there, I was transported to an emergency examination room. Once I had removed my clothes and donned one of those lovely hospital gowns, I finally got to see a Doctor. I asked “what is going on” I’m just having a UTI, just get me the proper medication and let me go home. He told me that my symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.
For the next 3 hours I was subjected to several tests, blood draws, EKG’s, and demands for specimens. At about 7:30 the nurse came back to my room to inform me that one of the tests takes 1- 2 days to complete, I asked if they (the results) could be emailed, at which point she informed me that I wouldn’t need them emailed because I wasn’t going anywhere. I started arguing with her but was told, “if you don’t start behaving, I’ll start taking your temperature rectally, at which point I became a perfect gentleman. I did tell her I wanted to see the doctor because I had no intention of staying overnight.
Now, this is what I want each of you to understand, please read these next sentences carefully. The doctor finally came in to inform me that he was going to admit me. I said, “are you admitting me for treatment or for observation?” He told me that I would be admitted for observation. I said Doctor, correct me if I’m wrong, but if you admit me for observation my Medicare will not pay anything, this due to the affordable care act , he said that’s right, it won’t. I then grabbed for my bag of clothing and said, then I’m going home. He said you’re really too sick to be going home, but I understand your position, this health program is going to hit seniors especially hard.
The doctor then left the room and I started getting dressed, I was just getting ready to put my shoes on when another doctor (the closer) came into the room, he saw me dressed and said, “where do you think you are going?” I simply said, “I’m going home, to which he replied, quite vociferously, no you aren’t. I said, “Doc, you and I both know that under the “affordable care act” anyone on Medicare who is admitted to a hospital for observation will be responsible for the bill, Medicare won’t pay a cent”. At which point he nodded in affirmation. I said, “You will either admit me for a specific treatment or you won’t admit me.” Realizing he wasn’t going to win this one, he said he would prepare my release papers.
A few minutes later the discharge nurse came to my room to have me sign the necessary papers, relieving them from any responsibility. I told her I wasn’t trying to be obstinate, but I wasn’t going to be burdened with the full (financial) responsibility for my hospital stay.
After making sure the door was closed, she said, “I don’t blame you at all, I would do the same thing.” She went on to say, “You wouldn’t believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney.” She further said, “The ‘Affordable Care Act’ is going to be a disaster for seniors. Yet, if you are in this country illegally, and have no coverage, you will be covered in full.”
This is not internet hype folks, this is real, I just experienced it personally. Moving right along, this gets worse.
Today I went to a (required) follow up appointment with my Arizona Family Practitioner. Since my white count was pretty high, the follow up was important. During the visit I shared the experience at emergency, and that I had refused to be admitted. His response was “I don’t blame you at all, I would have done the same thing”. He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70.
I told him that I had heard that the affordable care act would no longer pay for cancer treatment for those 76 and older, is that true? His understanding is that it is true.
The more I hear, and experience the Affordable Care Act, the more I’m beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they’ll be.
November is coming folks; we can have an impact on this debacle by letting everyone in Congress know that their responsibility is to the constituents, not the president and not the lobbyists. We need to let them ALL know that they are in office to serve and to look after the BEST INTERESTS of “we the people”, their employers, and not to become self-serving bureaucrats who serve only out of greed. And if they don’t seem to understand this simple logic, we’ll fire them.
On the mend, (signed)
REMEMBER: Demand your hospital admission is for TREATMENT and NOT for OBSERVATION!
Letter from a senior gentleman in Mesa, Arizona:
So, is this a reality?
Consider the article written by Craig Joseph Dan, Medicare Patients are the First Casualty In Emerging Healthcare Revenue Battles. It turns out that how patients are technically admitted to a hospital, and how many “midnights” they stay, both play a critical role in what Medicare wi cover and what the out-of-pocket costs will be. Revenue battles are going to continue to heat up as the government decides how to pay for the care for the underinsured that will be covered by the ACA (Affordable Care Act).
The United States Department of Health and Human Services (DHHS) through the Medicare Modernization Act of 2003, created the Recovery Audit Contractor (RAC). The RAC identifies and recovers improper Medicare payments paid to healthcare providers under fee-for-service Medicare plans. The DHHS made the program permanent for all states by January 1, 2010 under section 302 of the Tax Relief and Health Care Act of 2006.
Dr. Bart Caponi wrote a summary of the RAC issue on te Hospital Leader blog site who offered his assessment. He stated that Medicare patients don’t really know that CMS uses private bounty hunters who are paid on contingency to audit and deny hospital claims. Therefore, hospitals provide the care and then either lose an audit or have to fight through a lengthy appeals process for reimbursement of services. This perceived risk or set of risks has changed the behavior of hospitals, which means, as we have seen in this letter, that patients can get blindsided with big out-of-pocket expenses.
Also, earlier this year, Maryland received a waiver from the Centers of Medicare and Medicaid Services (CMS) to institute a five-year demonstration program known as the all-payor model contract. This program attempts to reduce spending for hospital services by keeping the rate of revenue growth in hospitals from all sources- including private insurance, the government, and employers- to no more than growth in the overall state economy. The goal is to keep costs down by reducing the number of patients admitted the hospitals and encouraging hospitals to work with physicians to maintain their patient’s health. This program, implemented under H.B. 298 permits the Health Services Cost Review Commission to set rate levels and increases, which is the most comprehensive attempt by any state to control health care costs and includes all health care payors and most hospitals, as well as an enforcement mechanism. Interestingly, this commission is represented by a majority of the insurance industry. Lack of bias much???? Now who do you think is affected by these restrictions? Again consider the Medicare patients, especially in regions where the dominant people are the retired Medicare patients.
Beware senior citizens and those of you who will be covered by Medicare insurance in your future.
The ACA or Obamacare will force more consideration of costs and sustainability. Who will pay the cost of a flawed roll out and a flawed health care system?
Also, consider what the future of the ACA will be and what the future of health care will be?
Wake up America!