Category Archives: ObamaCare

Finding the Faults and Repairing the Unaffordable Care Act

Paying for It

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When I got the bill for my July Obamacare premium, I shrugged it off.

See, I had changed from a Blue Cross Standard Gold Obamacare plan to a Blue Cross Medicare plan as of July 1 and I figured that was just a bill that got mailed the day they got the cancellation.

When I got the bill for my August Obamacare premium on July 5, I shouldn’t have shrugged it off.

When I got the bill for my September Obamacare premium dated August 5 in today’s mail, I couldn’t shrug it off.

Note from your doctor explaining why you were tardyTwo months bill from Vermont Health ExchangeAnd it turns out I wasn’t alone. The Burlington Free Press reported yesterday that billing problems plague Vermont Health Connect, the state-managed Health Exchange that issues and bills for Obamacare policies.

“Terry Libby has received incorrect bills from Vermont Health Connect since last winter when she first signed up for a Blue Cross insurance plan using the state’s new online website.

“Each month she has paid what she owed, called the state’s helpline to report she was being charged double, and received assurance the problem would be corrected.

“A month later, another incorrect bill would arrive.

“A week ago, however, she received a shock — a bill for $4,662.32.”

Four thousand, six hundred sixty-two dollars.

Jeezum. They’ve billed me only $497.06 no $994.12 no $1,491.18. So far. For.A.Policy.I.Do.Not.Have. I feel like such a piker. I’m sure I’ll catch up.

I’m more than a little nervous about screwing with my Medicare policy. Blue Cross carried over my same policy number when I changed from Obamacare to Medicare.

I called VHicks (the correct pronunciation of VHX, the Vermont Health Exchange, according to my Blue Cross rep) to question the bill they sent me. See, I had gone over this very issue in depth when I bought the Medicare policy. Blue Cross said they would cancel me out of the Obamacare plan when they opened the Medicare plan. All part of the service.

The VHicks rep said it wasn’t up to Blue Cross to cancel the policy. He said he’d try to process the cancellation retroactively but no guarantees.

Retroactively?

I called Blue Cross.

“No worries,” that rep told me. “Your Obamacare plan ended June 30 and your MediGap started July 1.” She also said no way VHX had any way whatsoever to cancel my Medigap policy.

I hate this.

“The government is so not trustable about things like this,” Liz Arden said.

“Not so trustable? Can you spell C-H-A-R-L-I-E   F-O-X-T-R-O-T?” Rufus asked only somewhat rhetorically.

“There is no way on God’s green Earth we should be putting up with this level of …. well, it ain’t mediocrity, because that would be far superior to what we are getting.

“You can quote Rufus on that.”

There ya go.

“You don’t want people to get health care!” Annabelle Proctor screeched the last time I wrote. Ms. Proctor holds an undergraduate degree in dance from Bennington College and a graduate degree in Social Justice from Planet Marlboro, Vermont’s two most liberal and free-thinking schools.

My other Liberal friends all seem to echo that.

Nothing could be further from the truth.

I want my doc and yours to do better doctoring than they do today.

I want every citizen to have access to whatever doctor or other healer they want.

I want every visitor to be able to pay Fee for Service to whatever doctor or other healer they want.

I want the cost (not just my bill) to be less than a Moon shot.

Just like it was in 1976 when five days in Cabarrus County Memorial Hospital cost me $254 after a racing accident. That’s less than a hammer, a toilet seat, or a week’s worth of Starbuck$.

And I certainly don’t want the folks who brought us $436 hammers, $640 toilet seats, and $7,600 coffee makers to flush my policy when it gives me a heart attack.

Yep, we’re paying for it now.

 

Know the Code, Part II

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I wrote about my regular annual physical and bloodletting last week.

The family has been concerned about a little bump on my chest although the doc calls it a sebaceous cyst and says not to worry about it. I do worry at it some since it sits right about where I like to scratch.

Regular readers will remember that I am pugnaciously parsimonious (Rufus says that is spelled “c-h-e-a-p   b-a-h-s-t-i-d”) so I also fretted over how much that office surgery might cost.

Benign skin lesions include sebaceous (epidermoid) cysts and a bunch of other big words. Medicare apparently considers removal of benign skin lesions as medically necessary, and not cosmetic, when any of the following is met and is clearly documented in the medical record, operative report, or pathology report:

intense itching, burning, irritation, pain, tenderness, chronic, recurrent or persistent bleeding, physical evidence of inflammation (e.g., purulence, oozing, edema, erythema, etc.)

Do not watch this:

The surgical director of Aurora Clinics shows how to remove an epidermoid or sebaceous cyst.

Really, REALLY do not watch this:

A Do-It-Yourself sebaceous cyst removal. This is one BFF “showing off her skills” with a single edged razor at home on her friend. Do not try this at home.

“Of course I watched them, plus another DIY where they squirt the creamy sebaceous fluid out all over the camera and wall,” Liz Arden told me. “I was eating breakfast at the time — oatmeal. Mmmmm.”

Dermatologists may also use laser treatments to remove sebaceous cysts.

The doc said all my blood tests were good. He made an appointment with a local surgeon to have the cyst removed and gave me a bottle for, well, you know.

I put off the procedure until next month. My Gold Obamacare wants me to meet the deductible and pay a 20% co-pay on diagnostic tests including the x-ray and blood work as well as the outpatient surgery. Medicare has a small deductible and the same 20% co-pay, but the plan I bought pays those.

The catch, of course, is that Medicare has to approve all the procedures.

I rescheduled the appointment with the surgeon. Actually, I rescheduled three appointments with the surgeon.

He plans to do the procedure in the hospital. With a little local anesthetic. Which means I wonder why I have to see him in the office before and again after, let alone go to the hospital and incur those charges. Other than to churn the bill.

I Googled and found very little about the pre- and post-procedures for removing small cysts. Apparently it’s not complex enough to require much of either.

NIH reports that “Excision of sebaceous [or] epidermoid cysts is a common surgical [office] procedure performed by family physicians.”

This is the same surgeon who called me in for an office visit specifically for my preventive colonoscopy last year. He charged extra for that and, of course, all Blue Cross could do was shrug.

I told one of my clients, a local judge, the story. He was aghast. He also has a lot of experience with the local health care providers. He suggested a dermatology practice with a resort-like name in Winooski, about half an hour from here. “They’ll bring you in to their office, swab it, and zip-zip, you’re done,” he said. “They’re good.”

I’ll call them this week.

Still, I’ll bet that original surgeon Knows All the Codes and how much he can bill on each.

 

Know the Code

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I had my regular annual physical and anal probing last week but I had to make an earlier visit to the doc’s office that they might let some blood.

Regular readers might be aware that I am pugnaciously parsimonious (Rufus says that is spelled “c-h-e-a-p   b-a-h-s-t-i-d”) so I was curious about how much the tests cost and whether or not my Obamacare Gold policy would cover them.

Drawing Blood for a TestObamacare covers preventive care.

I called my insurer, Blue Cross.

“Blood tests aren’t preventive care, even if they are done as part of a preventive care visit,” the rep said. Unless they are coded as preventive care and they fit the government guidelines. And the test is done on Wednesday after 5 p.m. or any time Saturday morning. With a blue-topped test tube. Not the red one.

That means I could need to make my deductible before they would pay 80% of the cost of the two or three hundred bucks worth of tests. Amount I’ve spent toward my deductible this year: $0.

My Blue Cross rep was very knowledgeable about my concerns. I couldn’t tell him exactly what tests the doctor wanted, so he volunteered to call their office to find out.

The doc’s office has no idea what codes they use; they order the tests from the lab in English. Or Latin. Or maybe Abenaki. They sent the Blue Cross guy to “billing.” Billing has no idea what codes they use; they simply invoice Blue Cross for the needle stick.

Ah hah. The LAB codes the analysis but they won’t know what codes they will use until the doc’s office sends in the request. In some non-accounting language.

The doc’s office did admit that they draw blood for three tests.

Complete Blood Count
▪ White blood cell count.
▪ White blood cell types.
▪ Red blood cell count.
▪ Hematocrit.
▪ Hemoglobin.
▪ Red blood cell indices.
▪ Platelet count.
▪ Mean platelet volume.
Comprehensive Metabolic Panel
▪ Albumin
▪ Alkaline phosphatase
▪ ALT (alanine aminotransferase)
▪ AST (aspartate aminotransferase)
▪ BUN (blood urea nitrogen)
▪ Calcium
▪ Chloride
▪ CO2
▪ Creatinine
▪ Glucose test
▪ Potassium test
▪ Sodium
▪ Total bilirubin
▪ Total protein
Lipids Panel

The Complete Blood Count is diagnostic, not preventive, and not covered under ObamaCare. Ditto the Comprehensive Metabolic Panel, except when it is. Both plus Lipids, a PSA (Prostate-Specific Antigen), and even the Shingles vaccine could be covered if you code them correctly.

The hospital did tell me a not-covered Complete Blood Count costs about $29 and the Comprehensive Metabolic Panel, $35. The Lipid panel is $46. A PSA test costs between $60 and $80. I don’t get one anymore because the doc says my anal probe is always “fine.” And because it is known to be diagnostically flawed. The shingles shot cost between $200 and $250 alone.

There is a catchall code V70.0 that identifies many of the tests as “preventive.” I just had to remind the doc’s office to use it.

But wait. There’s more!

I should not have to manage this.
As she was filling and filling and filling the gallon-sized test tubes with my blood, I told my favorite nurse she should have a price list on the wall.

“The corner gas station does it. The grocery store does it. Restaurants do it. Even Walmart does it,” she agreed.

She doesn’t know how to get the prices, though. They are hidden and scattered and seem to change by the time of day and color of my belt buckle.

The doc also thinks providers should post a chart of charges. He doesn’t know how, though.

Everyone seems to agree. No one seems able or willing to do it.

As anti-regulation as I am, I suspect regulation or law
will be the only way to get ‘er done.
 

Diminishing Expectations

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“We’ll insure 30 million Americans who don’t have insurance,” Barack Obama said in 2008.

“We’ll insure 27 million Americans,” Barack Obama said in 2009.

“We’ll insure 15 million Americans by 2013,” Barack Obama said in 2011.

“We’ll insure 7 million Americans by March of next year,” Barack Obama said when he moved the deadline in 2013. Again

“We’ll insure 6 million Americans by March 31,” the White House said in last week.

“We’ll insure 2.8 million Americans by 2016,” the White House will say in July.

According to the U.S. Census Bureau, 48.6 million Americans had no health insurance in 2009, 50% more than Mr. Obama originally promised Obamacare would originally cover. “There are still more people uninsured today than when Obama was elected president,” U.S. Rep. Jack Kingston (R-GA) said recently.

He’s mostly right. 15.4% of Americans were uninsured during the first quarter of 2009. That’s 47.7 million folks. 15.9 percent of Americans are uninsured today. That’s 49.9 million folks.

The Obama administration’s original goal was to enroll 30 million 15 million 7 million^H^H^H 6 million people by the end of the open enrollment period on March 31. Around 20% of those will fail to pay and most of those who do follow through already had had insurance that Mr. Obama cancelled.

That’s today.

Do you have insurance? Today is your last day to sign up.

Do you have insurance today?

45.1 million Americans won’t.

And the hidden gotcha: your premium in 2015 will be significantly higher than those in 2014. Aetna and WellPoint predict that most carriers will raise rates by “double digits.”  So will your taxes.

BREAKING NEWS: healthcare.gov was down again for much of March 31 under the crush of the tens of people trying to sign up at the last minute.

 

How Much Will the Government Give You?

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How Much Will the Government Give YouBlue Cross blew an advertising flier into the Herald yesterday to remind us that the open enrollment deadline is just 28 days away.

Want to know why Obamacare can’t flourish over the long run? Click through to see the slightly crumpled flier. I’ll wait.

“A democracy cannot exist as a permanent form of government. It can only exist until the majority discovers it can vote itself largess out of the public treasury…”

This quote probably originated in Elmer T. Peterson’s 1951 op-ed piece in The Daily Oklahoman. Mr. Peterson had probably read Democracy in America.

“The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”

Alexis-Charles-Henri Clerel de Tocqueville was a French political historian best known for the two-volume Democracy in America and for The Old Regime and the Revolution.

In 2000, the health policy journal Health Affairs found that the United States spends “substantially more on health care” than any other country. The use of health care services in the U.S. is below the Organisation for Economic Co-operation and Development median by most measures. The study also concluded that the 19 next most wealthy countries by GDP each pay less than half what the U.S. does for health care.

The Centers for Medicare and Medicaid Services reports that in 2012 U.S. health care spending increased 3.7% to $2.8 trillion, or $8,915 per person. 3.7% is “slowest growth rate on record.” That sounds like welcome news until you look at the real numbers:
1. The official Cost of Living increase is less than half that.
2. Total annual health care spending at this “slow growth rate” will double in less than 20 years, to $17,830 per person.

HOW MUCH $ WILL THE GOVERNMENT
PAY FOR YOUR HEALTH INSURANCE?

And where does “the government” get the money?

The Congressional Budget office estimates that Federal spending on major health care programs will rise from $2.8 trillion in 2012 to $23.8 trillion in 2038. “A trillion here a trillion there and pretty soon you’re talking real money.”

And where does “the government” get the money?

We can’t blame Blue Cross for this; in fact, we ought to thank them for the reminder.

And where does “the government” get the money?

See, the final vote tally for the Obamacare “reform legislation” was 60 Senators plus 219 Representatives. 34 Demorats in the House joined all Regublicans in both houses in opposition. Want to see who would bribe the public with the public’s money? Here’s the blacklist.

Mr. Peterson concluded:

“After that, the majority always votes for the candidate promising the most benefits with the result the democracy collapses because of the loose fiscal policy ensuing, always to be followed by a dictatorship, then a monarchy.“

Horse thievery used to was a hanging offense.

Steven Brill wrote in Time Magazine, “Put simply, with Obamacare we’ve changed the rules related to who pays for what, but we haven’t done much to change the prices we pay.”