Category Archives: Obamacare

Reminder: Thou Shall Not Kill

I hurt my knee.  It hurts like hell in certain positions, like a scalpel being inserted point-first into the patella.   If I sit too long and try to stand, or even just straighten my leg, scalpel into patella time.   I am trying a knee brace, not bending the leg when I sit, but it’s not always possible to avoid the searing pain of trying to straighten my once sturdy leg. 

Finally went to the doctor, who sat on my foot and pushed and pulled my knee from different angles.  The only thing that hurt was the direct pressure on the patella when I tried to straighten the leg.  The doctor told me to go have an x-ray, which would then allow my insurance to pay for an MRI if the sports medicine practitioner needed to do an MRI.   

I called my current insurance company, Healthfirst.  I declined the robot’s kind offer to take their customer satisfaction survey for the “service you are about to receive” by pressing two.  It was only a few moments before Jackie was on the line, very pleasant, bright, sympathetic.    She tried to walk me through the website, which was buggy today on my end.  It displayed completely differently for her than it did for me.  The search function did not seem to be working correctly on my end.

She found me a nearby x-ray place, then a sports medicine doctor, both of whom took my specific Healthfirst insurance plan.   Then an opthamologist, so I can get a prescription for new glasses, then a gastroenterologist for my overdue colonoscopy.  We truly had a great chat while all this was going on.   At the end of ninety minutes of customer service I thanked her, we had a last laugh and parted as great friends. I began to make the calls.

The nearby x-ray place does not have an x-ray machine, it turns out.  They do several other forms of diagnostics, have a lot of sophisticated equipment, but no x-ray.   The receptionist there gave me the name of another nearby x-ray place, and the phone number.   It was a fax line, I learned when that eerie squawking began.  

I called the sports medicine doctor, figuring they might have an x-ray machine on site, save me a few steps.   The doctor, it turns out, does not accept my particular Healthfirst plan.  A first time visit would cost between $320 and $640, if insurance paid nothing.   I asked the receptionist what determined whether the visit was $320, $435, $508 or $639.99.   She had no idea.

You walk into a restaurant.  There are no prices on the menu.  When you ask the waiter how much the BLT is he tells you not to worry about it, the sandwich is delicious.  In three months you’ll get the bill in the mail.   The EOB from the third party that deals with the restaurant informs you that the BLT is billed at $640, but since you have insurance the negotiated price is only $120.  Your copay is $50.  You made out like a fucking bandit.  

We can’t tell you what it will cost until the provider sends us the bill and the billing codes.    That is the standard line and it is perfectly legal under the Patient Protection and Affordable Care Act.  You see, until the provider tells us the exact price, nobody can predict anything.   That’s clear, easy to understand.  How is anybody to possibly know that this hospital charges $44,000 for a bag of chemicals they will infuse into your body?   No possible way anybody could possibly know that, prior to the procedure, the submission of the billing codes, and the calculation of the EOB.  Jackie confirmed as much when I asked if the $44,000 bag of Rituxan that may be in my immediate future is covered under my current plan.  There is simply no way to know in advance.  

The first appointment with this sports medicine doctor who will charge between $320 and $640 is a month from now.    Your aching knee is nobody’s fucking problem but your own.  You should have made this appointment weeks ago, you’d be almost in line to see the doctor by now.

I struck out with the other doctors’ answering machines.  Call during business hours, the first one advised me, between 9 a.m. and 5 p.m.   I noted to myself, with familiar bitterness, that it was 4:30.  Same deal with the next doctor’s machine, only by then it was 4:35.   Well, it was 75 degrees out, Sekhnet reminded me.

Soon she was done trying to cheer me up.  As I laid the merciless details on she was finally struck dumb, began crying because this shit is so frustrating when it happens to somebody you love.   It is worth noting, of course, that if the law allows an insurance company to list a thousand doctors as participating, and only a handful actually are, there is no harm and no foul.  The piece of shit, er, customer, merely has to keep making calls to different offices further and further from their home.  Eventually they will find a doctor somewhere who accepts their insurance.  No fraud where the law says there’s no fraud.  Patient Protection Act and shit.  Hey Barack, Arbeit Macht Frei.

I asked Jackie about getting evidence from Healthfirst that my recent invoice had been returned to Healthfirst by my local post office as undeliverable.  I told her the story, another short chapter in the million chapter book they are constantly updating.  That book is called How We Fuck You To Death You Fucking Piece of Shit.  The main device is never allowing the true facts to interrupt the dominant narrative.  If you can’t produce irrefutable proof, and you are not incredibly dogged, we can fuck you with impunity, fuckface.

Jackie wished she could help, by giving me the evidence that the local post office is now returning rent checks to me and insurance invoices to my health insurance company.   That could only be done by Finance.  There was no way for her to directly contact Finance.  Nobody was allowed to know who Finance is or what they do, but she dutifully made a complaint to them, asked them to send me some proof that they had received the last bill sent to me back marked “undeliverable”.   She gave me the complaint number, said I can follow up in a few days if Finance doesn’t contact me.  Finance unfortunately has no direct extension, so I’d have to get lucky when I try to follow up.

“This is exactly how they kill us, Jackie, those powerfully legally created psychopaths who make all the rules to best serve themselves. You have to admire the seamless perfection of it.”  I then described my request to see a mental health professional, as I imagined it would go.   It did not go well.  Jackie found it hilarious. When I hung up the phone I noticed I was foaming at the mouth.

I was seated on my aching hind legs, head thrown back, howling as loud and plaintively as I can.  I am doing that right now, as I type.   Easier than you’d imagine, really. 

Letter to Alvin Bragg (draft one)

Alvin Bragg, we learned recently, is the New York State Executive Deputy Attorney General for Social Justice.   This is the person, I discovered, thanks to a friend who alertly picked up a news release during a press conference with the Attorney General,  to whom my October 2017 letter to the A.G.  should have been addressed.   I’ve been writing “Alvin Bragg” periodically in my notebook, going back a few months, intending to write a futile cover letter to him.  Figured I’d give it a shot here, on a slow day.  I’ll have to strike just the right tone.

Dear Mr. Executive Deputy Attorney General:

(if that is your fucking name)

Enclosed please find my correspondence with your office.   I naively sent the Attorney General a letter recommending actions the state should take to protect the rights of low income health insurance consumers.   Mr. Schneiderman never saw that letter, a letter that should have been addressed to you, I learned from the organizational tree in one of the A.G.’s press releases.

My letter details some of the systemic abuses of the private insurance health system, and the lack of any state oversight available to consumers, outside of a desk in your office, and proposes actions that your office could advocate for.  It was not a consumer complaint seeking redress of a particular grievance, though it was treated as one by your office.    

Enclosed are the two responses I had from your office’s Health Care Bureau.   Neither one is responsive to the letter I wrote, except that the second one attempts to be helpful by suggesting I’m a consumer, like many, who is unaware of the powers of the Health Care Bureau in the A.G.’s office.

My October letter, and this one, fall into the category of “in a more just world letters like this wouldn’t have to be written at all”.  My letter to the A.G. was in part a cry of anguish from somebody with a limited income stuck in a bureaucratic quagmire with limited options for getting treatment for an eventually fatal disease.   The PPACA, as anyone who is subject to it quickly learns, is a very flawed solution to the vast institutional problem of providing affordable health care to millions while preserving the profits of private insurance companies and private health care providers.    

I am well aware that people with a limited income have only so much right to be heard on even the most vexing institutional injustices: like the three to six month lag between a medical procedure and Explanation of Benefits,  with the inevitable multiple bills and collection notices that accrue in that time frame.  Or that past EOBs, even with the assistance of a diligent attorney from the Community Service Society, and all required legal documents signed, were never provided at all by the insurance company.  “The law, in its majestic equality, forbids rich and poor alike from begging, sleeping under bridges and stealing a loaf of bread.”

Ah, listen, Alvin, I don’t know what I really hope to accomplish with this note to you.  What outcome am I hoping for?  A paragraph apologizing for the poor response from your overworked consumer help desk, sympathizing with the situation I describe in my letter, assuring me that the activist A.G. of New York is doing everything in his power to address some of the institutional vexations set out in my long letter.  Strength to your arm, friend, dictating that paragraph to your secretary.

My best to you and your staff,
Eliot

Procedure Codes

I suppose one way providers can fight back while being paid 20% of their billed rate for services is by skillfully working the procedure codes.  I may be wrong, but I suspect this may be the case.   The thought never occurred to me until yesterday when I got the approval from Healthfirst for the minor surgical procedure I had two weeks ago.

I had diagnosed the tiny cancer cell on my nose myself.  I had only felt that intermittent slightly stabbing pain twice before.   Each other time it had been a basal cell on my nose.   The growth was so tiny that neither the dermatologist nor the surgeon she sent me to could actually see it.   I pointed to a spot on the bridge of my nose under which the basal cell, its visible part about the size of a pinprick (if the pin is very sharp), was slowly growing.  The surgeon told me that since we’d caught it so early there would be no need for a skin graft, just a couple of tiny stitches that would leave no scar.

The surgery was painful, due, according to the red haired surgeon, to the skin sensitivity of people with red or reddish hair (my beard, before turning white, was red).  It turns out the surgeon had made a slit the length of my nose, dug out the basal cell from underneath, and left a line of large black stitches about the size of an eyebrow, from my left tear duct to the top of my left nostril.   When I first changed the bandage I had a bit of a shock at the size of the incision to remove something smaller than the period at the end of this sentence.  Sekhnet, of course, had a theory about why the long cut was the right thing to do.

Tomorrow I go to get the stitches out.  Yesterday I received approval from Healthfirst for the procedure, which they informed me would be good between the two dates indicated (first date about four weeks ago, the second date rapidly approaching).   They approved five separate procedures:

17311  MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS

17312  MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYL)  

13152  REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM  [1.02362″ TO 2.95276″ –ED]

14060  ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS  [3.93701″]  

14061   ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS-ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS NOSE EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM  [3.93701 SQ INCHES TO 11.811 SQ INCHES– ED.]  

Could all be on the up and up, I suppose.  Until they start digging they don’t know if that tiny tumor will be less than an inch across or the size of 30% of my face.  Fair enough.  The rest of that stuff, I’m not sure about.  Maybe it explains why the incision came so close to my left tear duct, where the stitches start.   Maybe I am just so bitter about corporate medicine, and so aware of the psychopathic nature of the corporation, that I just suspect the worst from these “persons”.  As for the humans– I think about the surgeon’s failure to provide me with pain medication after a surgery she acknowledged was painful for me, as it would be for her,  But why be judgmental?

Still, you know, it makes sense, from the point of view of the provider, being squeezed and nickeled and dimed on their bills by powerful insurance companies, to bill for every possible procedure.  The eyelid adjacent stuff may be very lucrative, for all I know.  Who am I, who has never run a successful business, never been an entrepreneur, never had to answer to a room full of very wealthy, pissed off shareholders, to opine about anyone’s business practices?  

Hopefully there will be little pain tomorrow when I get the stitches out, that I won’t find it necessary to ask the surgeon any pointed questions, and that, true to her word, the long line of stitches will leave no scar.   Otherwise I’ll get me an eyepatch, and a parrot, and limp down the street cursing their salty, scurvy wives and unwashed ill-reputed mothers.   Arrrgh.

 

 

 

 

 

Explanation of Benefits

You’ve got to love the in-your-face shamelessness of the American profit motive.  Check this one out, for your health, which is a lucrative commodity in our exceptional  economy, even as many continue to die every day for failure to sufficiently monetize their own self-worth.  I believe the numbers in this story will blow your mind.

American medical treatment, famously expensive, is generally paid for through private insurance companies or government insurance schemes like the Veteran’s Administration, Medicare and Medicaid.   It would be foolish for an American to seek any kind of major health treatment without insurance, it’s a recipe for lifelong debt and/or bankruptcy.   With insurance, pay enough every month, and on time, and you’re pretty much covered, much of the time.  Like a good patriarchal neighbor, the insurance company will step in and negotiate for you.

After any medical service the insurance company sends you a chart called the Explanation of Benefits, or EOB.  The EOB tells you, for the first time, what the medical facility charged you for treatment.   The next column informs you what the insurance company agreed to pay, the rate negotiated between the insurance company and the ‘provider’ (or ‘doctor’ to us old fashioned folks).  The next column tells you what the insurance company actually paid of this negotiated rate and the amount of that rate applied to the deductible, or MOOP, if applicable, and then what you owe. 

As I’ve noted here before, under the Patient Protection Act the doctor or medical facility cannot tell you the price of treatment until everyone gets their EOB.  The insurance company cannot tell you the price prior to treatment, because, until they get the bill from the provider, they don’t prepare the EOB.  Go to the restaurant, order what you want from a menu without prices, or the specials (waiter can’t tell you the prices), and we’ll bill you for the entire amount a month or two from now, no problem.  If you pay monthly meal insurance premiums, we’ll make sure the restaurant doesn’t gouge you too badly.   This way everyone makes money!   

When I went for my first infusion of rituximab (or rituxan) I learned something cool.   I was presented with a contract to sign before I was sent upstairs for treatment.  The last section claimed, on my behalf, that I’d been informed of the price of the rituxan treatment I was about to get and that I agreed to pay the full price if insurance refused to pay any part of my bill.  I returned to the woman behind the desk, pointed to the language and asked her what the price was.   She told me, in a friendly way, that she had no idea, that they’d tell me upstairs.

Here’s the cool thing I learned.  I circled the bullshit language about being informed of the price and crossed out the signature line, with the full approval of the woman behind the desk.  She smiled, nodded, photocopied the contract and handed me my copy.  I went upstairs for treatment.  They also had no idea what the price of the treatment was.   We’d all heard it’s very expensive, that’s all we knew.

Six weeks after the first infusion I got the EOB.  For some weird reason I owe $33.54.  A couple of five dollar charges, a twenty, and some change.  The total bill for the first of two treatments was $44,129.58 — putting the total for the two infusions at over $88,000.   The loose change I owe is the full negotiated price for the injection of methylpredinosone/sodium succinate, billed at $14.38.   For some reason insurance won’t pay the negotiated $3.54 for that shit, you know.  Why would they?  Fuck that shit — you pay it.

Here’s the thing, though.  The full retail sticker price for the infusion of rituxan turned out to be $33,730.20.   Guess what the insurance company paid?  It might be fun to guess, so I’ll hide the Amount Covered by Plan in this footnote, if you’d like to play at home [1].  It gets better, somehow.  The chemotherapy administration, intravenous infusion, was billed at $6,910.  Play along with us at home, won’t you?  The amount I am responsible for is at footnote 2.  Take your wildest guess what part of that I owe. [2]

Everyone will tell me, correctly, that I’m lucky to have insurance, fortunate that I paid last month’s premium on time, didn’t get bounced off insurance before they could pick up all but $33 of the more than $40,000 I was billed.   This time it was a damned good deal.

The larger question, of course, is what the fuck?  What is a fair and reasonable price for the medical treatment I received?  Is that question really unanswerable?   Is the total mystery of the price really necessary so that everyone makes maximum profit?  I don’t get it.  The provider was satisfied to get less than 20% of what they billed as full payment for the expensive, possibly life-saving treatment they provided?  Pennies on the dollar, as President Trump likes to say about paying to settle something like the fraud case against him for Trump U (“Hey, Trump YOOOO, assbite!”).   

They sued then candidate Trump for $40,000,00 and, through the art of the deal, he paid a mere $25,000,000, or pennies on the dollar (a mere 62 pennies on the dollar), to make the problem vanish forever.  But one would have to agree, my insurance company did a much, much better, and a far more artful, deal for themselves, and for me (see footnotes).

Look, I get that corporate capitalism is an amoral predator with only one aim– to make money by the bushel, cut any possible corner to make more profit, and have a team of top notch attorneys poised to fight regulators and liability for any expensive harm the entity causes, any fraud it commits, pay as little as possible for any deaths it causes.   It’s all understandable.  The business of America is business, as America’s wealthiest often say.   

The greediest and richest are indisputably entitled to unlimited acquisition, to as many luxury homes, private planes and yachts as they like, while the takers, well, they get what we grudgingly give the fucking parasites.  In America every parasite has a cell phone and a refrigerator, and a TV, and they’re all still bitching, and taking drugs, and having children out of wedlock.  While the children of billionaires will soon no longer have to worry about being taxed so much as a penny on every dollar of the unimaginable fortunes they will inherit. 

Of course, the children of the super-rich deserve every inherited nickel for being natural aristocrats in the land of the free and the home of the new landed gentry.  That blessed top 0.2% (two tenths of the wealthiest one percent, that is), the children of our most successful money acquirers and hoarders (“job creators”), is finally on the threshold of liberation from that scourge of the children of the super-rich, the hated Death Tax.  If you’re born poor, well, suck it.   If the choice is five or ten ‘to die for’ homes for me —  and I really need just one or two more, got my heart set on a sweet little pied a terre in Paris — and zero homes for you and your parasite children — is it really a choice?

I’m not going to change any hearts and minds here among the handful who stumble on these words.  All I can hope to do (while noting my own monstrous ingratitude for the great medical deal I just got) is set the outrageousness of this set up out as clearly as I can.  What the fucking fuck?   Is this really the best Americans deserve?  In our exceptional nation, the likes of which the world has never known?   God shed his grace on thee, motherfucker, and if you don’t believe it, curl up and die somewhere for all the rest of us fucking care.  Have a nice day!  Have a blessed day!

 

[1] $7,475.70 of the $33,730.20 billed, every red cent paid by Healthfirst.   22%, baby!

[2]  $5.  Healthfirst ain’t paying jack for that one, but they got  me a pretty sweet deal, I have to say.  Knocked the price down from $6,910 — to five bucks.  I’ll take it, I guess.  Talk about pennies on the dollar… 0.0007 pennies per dollar!!!   Suck on that, Don, you fucking loser.

Note to Eric

As predictable as it is SAD!

Dear Eric:

Please excuse the liberty, colleague, I’m responding to the November 6 letter from one of your Division of Social Justice assistants, Jennifer Lonergan, who incorrectly stated that I had addressed my letter of October 12 to “Eric Schneiderman”.   

I voted for you in each of your State Senate elections and for A.G.  I share many of your political views, including the belief that a primary role of government is protecting citizens from the predations of the powerful.  I applaud the proactive stances you take on many important issues.  I don’t blame you personally for the inadequate response to my long and detailed letter, though it reflects poorly on the office that acts in your name.

Ms. Lonergan begins her point by point refutation of my painfully researched assertion that the New York State regulatory help scheme for low income health insurance consumers is a cul du sac by demonstrating active listening, the dismissiveness of her tone in restating the obvious probably inadvertent:

It appears that it is difficult for health care consumers, such as yourself, to ascertain where to turn for help regarding various health care issues, and further, that you received misinformation from various entities tasked with assisting consumers with health care issues.

Ms. Lonergan, although perhaps not fully grasping the blood pressure elevating vexation that unregulated health insurance causes low income New Yorkers,  did an impressive amount of cutting and pasting in assembling a letter full of potentially helpful sources that could possibly solve some pressing healthcare-related consumer problems within only a few months.  According to her, the help desk in your office is more than a match for most of the vexing, unregulated consumer abuses detailed in my letter.   

Her response to this paragraph was noteworthy:

Essential Plan members do not have a right to file complaint appeal (sic).  If they need assistance filing a grievance or appeal, they may also contact the state independent consumer assistance program at:  Community Health Advocates, 105 E. 22nd Street, NY NY 10010 or 888-614-5400 or email at cha@cssny.org

source:  Anthem’s National Contact Center Document under NY market tab for “Essential” plan updated as of 12-14-16 at 7:56 a.m.

She informed me, presumably based on research unavailable to a consumer like myself, that the health insurance representative had been mistaken when he pretended to read corporate policy from his customer service manual.  This leaves me marveling at the rep’s inventiveness and eidetic memory,  “reading” me the identical made up wording several times, so that I could transcribe it accurately.  Adding that it was printed in red, and providing an invented source, were truly brilliant, if diabolically misleading, touches.

Ms. Lonergan also corrected my slipshod use of the legal term “fraud”; she was good enough to point out that I had not established an essential element, since doctors I’d been referred to by the insurance company who had refused me treatment had not actually taken payment from me.  I guess, arguably, the premiums I pay every month to the corporation that referred me to these doctors are beside the point for purposes of a claim of fraud.

I greatly prefer the letter from Mr. Bockstein (attached), which, while clearly sent to me in error, at least spelled my name right and did not dismiss the health-threatening concerns I’d taken pains to detail carefully for your office’s consideration, practices I offered as illustrations of the desperate need for the policy changes I suggested.  I subsequently had Mr. Bockstein’s kind assurance that my original letter was under consideration by an advocate named Jennifer Lonergan who would be getting back to me.  No point beating a dead cul du sac here.

I suppose the most honest letter I could have received in reply to mine would also have been the most depressing: low income healthcare consumers get whatever care they get, and whatever version of due process goes along with it.  And though they may address a letter to a champion fighting institutional injustice, with the power to advocate changes to grossly inadequate protections under the law, they can expect, at best, a letter like Ms. Lonergan’s.

Have a great day,
Eliot “Widaeu”

20171105_000124

For reference, the corrected file number on my original letter is 1370738.  Presumably my letter is also preserved under that file number.

This One I Truly Don’t Get, Obama

Happy Thanksgiving, first of all.

I had the usual holiday bot response from the New York State of Health Marketplace this morning at 8 a.m.   An important message in my inbox, the email advised me, which, of course, could be any message whatsoever.  Last Christmas, on the day, that important message told me, in error, that I would not be receiving the subsidy because my income, well within the range for the subsidy, well — no subsidy.   That only took five months to fix.  The year before I think it was New Year’s Day, I was informed that my health insurance was cancelled and could not be restored until March 1st, but only if I uploaded a series of demanded documents within seven days.   

The emails tell you to log on immediately to see the important message.  Presumably this is done for your privacy.  If they sent you an email saying: congratulations, your enrollment for 2018 is complete, see message in your inbox for details, anybody hacking into your email could see that you were eligible for insurance coverage in 2018.  It’s confidential, of course, and your confidentiality is very important to us, so please go to your inbox for this important message.

Your NYSOH inbox shows all these messages marked Template, with various random, inscrutable template numbers.   Even in your private inbox there is no indication of what these various messages may say, only the dates they were sent to you.   You must download these form letters, in PDF format, to read them.  OK, this is a witless bureaucracy and presumably they can save money by having a tireless, unpaid bot send you a generic email each time NYSOH communicates with you, and also, by putting Template 099 next to each message in your inbox, instead of labeling them; enrollment, immediate action required, seven day notice, health insurance in jeopardy, what have you.

Here is the part that truly confounds me.   It has nothing to do with Trump defunding Obamacare advertising, or Republican sabotage of a law they despise that happens to allow more low income people to have health insurance, or the current, most excellent president’s fanatical zeal to overturn everything his slippery, lying Kenyan-born secret Muslim predecessor managed to enact.  It has nothing to do with the flawed design of the cleverly named Patient Protection and Affordable Care Act.  It is just a puzzle, and I have no idea what is at work, outside of plain, simple human stupidity and bureaucratic rigidity.  I literally have no clue, outside of the usual shabby consideration given to people affected by any government program that serves those who are in any kind of financial need.

On October 24th I had an email from NYSOH, the only one I had since July.  In July the important notice, Template 077, told me what I already knew.  It turned out to be a condensed electronic version of the mediator’s decision that I had been entitled to a subsidy all along, and that it was restored, retroactive to the first premium payment of 2017.     Bear in mind that this October 24th notice, which I read the other day, was the only notice I will receive about deadlines for re-enrolling to be eligible for health insurance in 2018.   Page two (of ten — one blank, four related to registering to vote, in many languages) reads:   

 

Screen Shot 2017-11-23 at 11.19.58 AM.png

Dig this.  Not only are the IF categories forgetting one important IF– if you want health insurance for 2018 you will have a thirty day window to get it, but there is something far worse.  (OK, I have to admit, in fairness to these sloppy assholes, that page one informs me that “ACTION IS REQUIRED by December 15” so that an appropriate — or inappropriate– decision can be made on my health insurance coverage for 2018).  

Here’s the mystifying thing.  This October 24 form letter is the only notice you anyone on Obamacare will get regarding your health insurance for 2018.  On October 24 you get an important notice telling you that beginning on November 16 you will have thirty days during which to purchase your 2018 insurance plan.   Mark your calendar carefully, asshole.  Note: we changed the arbitrary deadline this year, it no longer extends to New Year’s eve.

Leave aside all the other institutional problems with a health plan that is based on private insurance companies selling you insurance.  Forget the rabid profit-crazed foxes left in charge of the henhouse.  Forget all of the gripes about the problems of the original PPACA, unaddressed by a Congress full of twitchy fundraisers, half of them fanatically focused on repeal of the popular law.

I live in New York State.  This state was one of the original adopters of the PPACA.  When it came into law the state abolished its own program for low income New Yorkers.   New York State was all-in from the beginning.   It’s not like the state is in the hands of people that have any motive to sabotage the law or deny anybody coverage.     That is the case in many states, who refused to participate fully because they opposed the conservative health insurance compromise on principle, because it was sponsored by a post-racial president.  (Post-racial, wink wink, you get what I’m sayin’?)

Does anyone have any idea what the logic, if any, of this single important notice given three weeks before the short holiday season window opens for buying the following year’s health insurance could be?  Outside of another random example of exceptional American human idiocy?

I suppose I could ask Donna Frescatore, the director of NYSOH, a political appointee who doesn’t allow reps at NYSOH to divulge her name (why should she?) — but that would seem churlish, don’t you think?

The World is Easy Enough — when you handle it right …

Mr. Bockstein was most pleasant during our less than ten minute conversation just now (most of it on hold, granted, while he looked under the file number on the letter he mistakenly sent me).   He soon told me to forget about that letter, it had been sent to me in error.

The initial wait to speak to him was less than 40 seconds, which is great.  The wait when he looked up his erroneous letter to me, after I explained I’d received it in error and read him the reference number he’d assigned, was less than five minutes, again, quite reasonable.  The letter under reference number 1369393, it turns out, was not responsive to my complaint.  OK, mistakes happen. 

“Obviously it was meant to go to somebody else,” I said when he confirmed that his letter about my complaint against two entities I’d never heard of had been sent to me by mistake, “my concern is that I wrote a long and very detailed policy-related letter to the Attorney General and I’m not sure why I was getting a response from your subdivision of his office.”   

“Do you remember what it was about?” he asked me.  “Because I’m not finding…” 

“My letter was, the cover letter was two pages and there were about twenty pages of attachments. I was proposing legislation to remedy some terrible  oversight problems with healthcare and the administration of the PPACA in New York State, and my letter…”   

“Hold on, hold on,” he said, still trying to make sense of why he couldn’t find any trace of my complaint in his system.  Then he confirmed the spelling of my name and asked me to hold.  This time he remained on the line as I waited.  He was breathing in an exasperated manner because his computer was apparently buggering him while I held.   He let out one long, loud, exasperated exhalation, then continued to breathe more or less normally as I waited for him to find my name.   He let out another exaggerated breath and said imploringly “come on, computer, will you please?”   It was nice to be speaking to a human being, I thought idly to myself.   

“OK,” I finally said, “so actually, my question is how can that letter be placed in the hands of an assistant that reads policy and proposed legislation-related letters for the A.G.?”   

“Well, that would have to go to… hang on a minute…. did you file a complaint?”   

“No, I never filed a complaint with your bureau.” 

“You didn’t file a complaint about Healthfirst and the Marketplace?” 

“No, the letter discussed Healthfirst, and the Marketplace, and a number of other things.  It also discussed Blue Cross/Blue Shield and some systemic problems… basically it was a description of the cul du sac of consumer help that anyone who has any problem with health insurance finds himself in in New York State and it was proposing several ways to…”   

Mr. Bockstein, whose computer had apparently just released its uninvited, amorous, two-handed grip on his waist interrupted to give me the good news.  “Your complaint was assigned to one of our advocates.  Her name is Jennifer Lonergan and she will be responding to you based on your complaint.  As for that other one,  just ignore it.” 

“Well, I mean, I can certainly ignore it,” I agreed, “but I, you know, I was hoping it was not the end of a letter I spent a lot of time writing.”   

“No, no-no, no, no,” assured Mr. Bockstein at once, “your complaint has been assigned to an advocate, it’s being reviewed and the advocate will respond to you.”   

I confirmed the spelling of the advocate’s name, he gave me my correct file number and I thanked him very much. 

“OK,” he said affably enough. 

My recording ends with a long exhalation by me, a moment after I pressed disconnect to end the call with Mr. Bockstein. 

 

 

No Reason to feel like a Chump, Chump

My bad, really, in not beginning that letter to the NYS Attorney General’s office with an unmissable disclaimer:  THIS IS NOT A BILLING COMPLAINT.

No wonder that a healthcare-related letter, complaining of the lack of any sort of government agency to resolve health insurance-related problems NYS patients have in New York State, would be dropped promptly on to the Healthcare billing dispute desk of the A.G.’s office.   My letter, foolishly, began:

Dear Mr. Attorney General:

I am appealing to you for assistance, on behalf of many thousands of New Yorkers caught in a sometimes life-threatening situation regarding their healthcare.  As described more fully below, citizens of our state have no government agency that intervenes in cases where patients are mistreated by the corporations we buy health insurance from.   This is true even in cases of apparent fraud.  

An idiotic idealism had me send it, for myself and on behalf of other people many Americans believe are lucky to have any health insurance at all– and who are in danger of losing the shit care they currently have.  I am not a campaign donor, or an Ivy League classmate of anyone close to the A.G., why would I expect my letter to reach such an important man?   If I was a wealthy, connected person, what would possess me to write such a letter in the first place?  Not being one, what did I fucking expect?   Perhaps anything but the mistaken response I received:

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But still.  And although the letter is non-responsive to anything in my letter, it is easily enough straightened out.  I could do it in couple of lines:

Dear Mr. Bockstein:

Thank you for your prompt reply to my long letter to the Attorney General, though it was clearly sent to me in error.   My correspondence did not involve a billing dispute (though one section contained examples of a couple), and I never heard of St. Joseph’s Physicians or Oneida Healthcare, let alone had a billing dispute with either of them.   Please transfer my letter, and the attachments, to the assistant for Mr. Schneiderman who reviews policy-related correspondence.  Or let me know to whom I should address a new copy, to avoid a similar fate to copy number two.

Thank you, and have a blessed day.

No need to point out the obvious irony to the overworked Mr. Bockstein — that his idiotic ‘response’ to my letter is yet another stunning example of the administrative cul du sac I described in my letter as so infuriating and soul crushing to aggrieved low income patients of New York who have no government agency protecting them from the predations of the health insurance companies they are mandated to purchase healthcare through.

Or that bureaucratic responses such as his are particularly dangerous to patients being treated for serious major organ disease and already suffering treatment-related extreme high blood pressure.   When your blood pressure is dangerously close to hypertensive crisis range, a letter like that, though polite, is the last fucking poison you need.  Although it is good for me to keep in mind that the preventable death of an American who is not at least middle class is, as the law styles it, a trifle, truly.  Nothing personal.

I rest my case, Mr. Bockstein.  I’d make an idle threat to rest it in a venomous letter to the editor of the Grey Skank, but we all know how silly that would be to threaten.  Theoretically, a tart letter to the editor quoting the AG’s response would momentarily embarrass your boss, who appears to be one of the few good guys, and who is tirelessly making a good name for himself with clear future ambitions.   On the other hand, a short description of the callous, or at best, inept, functioning of his progressive office would only serve to provide more ammunition to the powerful and well-funded forces of reaction bent on returning this country to its former greatness.

I am left idly threatening to unearth my Louisville slugger, Joe Pepitone model.  And fiercely pointing out that I can be up in Albany in the time it takes Mr. Bockstein to crank out a few dozen of these fine letters, man of peace and reason though I always aspire to be.  At the same time urging Mr. Bockstein, for purely legal reasons, not to construe this as any kind of physical threat– I mutter it mildly and abstractly, for expressive purposes only, through a haze of monoclonal antibody side effects.  Though, even in my asthenic state, I recognize that, truly, the many vexations of Americans with a low income, even the most theoretically easily preventable vexations, are strictly their own affair and attributable only to their poor choices in life.

You Can’t Make This Shit Up…

Which doesn’t mean, of course, it doesn’t make you want to smash the responsible parties in the face with a baseball bat, just once.   As a man who tries to practice Ahimsa, non-harm to fellow creatures, the feelings this can produce are complicated.

Many things are complicated, granted.  Our exceptional country, we can stipulate, has a sometimes spotty history for doing the right thing.  We know liberals are always banging on about the extermination of the native people, slavery, atomic bombs dropped on Japanese civilians after back-channel surrender talks were in the works, segregation,  a century of lynching, the “pre-emptive” invasion and destruction of Iraq, torture, drones, imprisonment of more than a million Americans for arbitrary crimes that harm nobody, a powerful, wealthy gun lobby that makes sure tens of thousands of Americans are free to kill tens of thousands of other Americans every year, blah blah blah– as if liberals never do anything wrong.   

Our world’s most expensive health care system, its expense inflated by fabulously paid private insurance middleman as much as by high tech medical interventions and Big Pharma, vital industries which are sometimes judgmentally called ‘predatory’, allows tens of thousands of Americans to die every year over money issues, even under Obamacare.   Oh, and intergenerational poverty and racism, and not paying women as much as men and not fixing that.  OK, we’re not perfect, but we’re always trying to form a more perfect union.   

Once in a while someone who thinks they’re smart tries, in the face of odds that say, overwhelmingly ‘shut the fuck up, anonymous, powerless asshole’, to write a cogent letter to someone in power who might be moved enough to address at least one systemic, institutional injustice.   I was one such person recently, and I exerted myself mightily over many months, to craft a letter that was readable and proposed solutions to the institutional problems it detailed.  I sent it to our activist, progressive,  not publicity-shy NYS Attorney General.   You can read the final version of my letter here, and the attachments to it here. 

To my relief, I got a prompt response, from the Attorney General’s Division of Social Justice, no less.  Here it is.  You truly can’t make this shit up.

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Of course, it would seem churlish of me to note that I’ve never heard of St. Joseph’s Physicians/Oneida Healthcare, nor, to my knowledge ever had a billing dispute with either one.   

Hopefully I can remain calm and relatively civil tomorrow when I call this steaming pile of distracted dung, Health Care Bureau Intake Specialist Alexander Bockstein, and inform him that my letter reached his desk in error, as his did mine.   I will need to strike just the right tone to get my letter into the hands of someone who will thank me for it in a manner a bit more on point, indicating they may even have read a paragraph or two of it.  You know what I’m saying?

You sound a bit… insane, sir

I am scheduled to have the first of two five hour infusions of a drug called Rituximab on Friday.  This drug is usually used for lymphoma patients, as far as I can tell, after a visit to the manufacturer’s website.  Nephrologists have recently found Rituximab is often helpful in curing the kidney disease I have, membranous nephropathy.  I am resigned to being hooked up to a slow dripping bag of this miracle drug, which seems to have a fraction of the side-effects of the steroid-based chemo regime I was being pressured into a few months back.   My current nephrologist recommended three vaccines before I start, as the Rituximab will suppress my immune system.  

I had a flu shot, and a pneumonia shot.  I’ve spent the last ten days or so trying to get the third — an immunization against shingles.  From everything I’ve heard, shingles is something to be avoided.    I am prone to skin troubles, I am over sixty, I have an auto-immune disease, had chicken pox:  I am a good candidate for this potential side effect of the immunosuppressive regime.  

My primary care doctor, for whatever bureaucratic reason, could not order the pneumonia and shingles vaccines.  He gave me a prescription to fill.  The pneumonia vaccine was easy to find, the shingles vaccine, not easy.  I have been to seven pharmacies so far.  My local pharmacy, for whatever reason, could not order the vaccine.  Two chain pharmacies had the vaccine, RiteAid ordered and quickly procured it, and DuaneReade had it in stock, but they do not accept my insurance.    

It costs about $300, if I wanted to plunk down my credit card.   Four pharmacies that accept my insurance, CVS branches, did not have the shingles vaccine. The CVS closest to my apartment has been waiting months for it to come in. The pharmacist at the last place, the one that had the vaccine, but doesn’t accept my health insurance, suggested I call Healthfirst, the corporate gatekeeper of my health care.

It was not a terrible suggestion, but past experience whispers now that I should not have made the call.   For one thing, the inviolable policies of corporations are not something mere mortals can question, let alone contest. For another, there is the psychological angle — I cannot separate the practices of one homicidal legally-created psychopath from those of another homicidal legally-created psychopath, and I hate them all.  

“Homicidal” sounds so judgmental, I know, but do the math.  I live in the USA, where tens of thousands die every year for lack of affordable access to adequate health care.  It’s a cost of doing business here in the Land of the Free and the Home of the Bankrupted by Cancer.  We don’t bat an eye about the annual preventable deaths, more than tenfold the death toll of September 11, 2001, every year.  We have reality TV, social media, a big American Dream, evil people to hate– so people die here, like the tens of thousands of Americans who died of oxycodone and heroin overdoses last year, what’s your point?  Your little problem?  Fuck you, asshole.  Get a better life, make enough money to buy whatever you want, including good health care, and shut the fuck up about ‘injustice’, boner breath.

In fairness, and we should always strive to be fair, insurance companies do not make money paying out claims, the profit is in paying out as little as possible.   In a nation that was not insane, stoned beyond reason on “free market” kool-aid, it would not be a patient’s problem to figure out how to get a needed inoculation paid for by the insurance company he pays a premium to every month.  

My trouble is that I can’t separate the frustration and the indignity from the injustice any more.  I get angry, though I control my language, and I cannot help but remind the helpless representative, reduced to meaningless apologies, that she works for a corporation, something we pretend is a “person”, but is the kind of person incapable of conscience, empathy or anything but naked self-interest.   This does not sit well with some of the reps.   They are not being paid enough to listen to this kind of shit from someone who is angry that he has to keep calling a murderous psychopath for help with healthcare.  Murderous psychopaths do not give a fuck, what kind of idiot does not know that?  What kind of moron tries to argue with representatives of an artificial “person” who is also, by definition, a murderous psychopath?

By the end of yesterday’s marathon 40 minute chat with an excessively polite woman named Ilene, the obstacles escalated considerably.  Not only, did she inform me, (after two long holds for consults on how to deal with an insane raging asshole, and a sickeningly articulate one), would Healthfirst not pay for a shingles vaccine administered in a pharmacy, assuming I could even find the drug anywhere, the shot must be given by your doctor, in his office, after he receives pre-authorization from Healthfirst.   

As for how long that pre-authorization might take, nobody has any idea. Could be fast, could be very slow.  Ilene, after all, is on the membership side of Healthfirst’s corporate brain.  Pre-authorizations come from the provider side.  These two sides have no way to communicate with each other.  I have experienced this before.  It was a kind of last straw yesterday.  I remarked that it was handy, for an artificial “person” without conscience,  to have a divided corporate brain that could not communicate between the halves in order to answer a simple question.  Before I could utter a stream of horrible curses nobody would be able to unhear, I thanked Ilene in an acid tone and wished her a good day.

The pharmacist in Sekhnetville, who has ordered the vaccine, assured me that they give shots to Healthcare customers all the time, that it should be no problem, once the vaccine comes in, to shoot me up right there.  In hindsight, I suspect that Ilene, being a polite and hardworking girl, probably from the mid-west, had found a way to tell an insane asshole to go fucking fuck himself, in the politest, most vicious possible terms.

The latest call to the pharmacist in Sekhnetville, who promised the vaccine would be in today, revealed that… oops, the manufacturer does not seem to be currently shipping the vaccine.   It appears to be on back order.  Could be weeks, or even months.  So, sorry.   Have a very nice day.  Unexplained is why RiteAid was able to procure the drug within a couple of days, or why the shot was available at DuaneReade.

Looks like I’d better reach for my credit card and just have the fucking shot at one of the “out-of-plan” pharmacies that currently have the shit.

USA! USA!!!!  Nice work, Barack, rocking that big, lucrative corporate boat as gently as possible while making some small, long-overdue improvements for more folks who couldn’t previously afford health care.  Good luck with your book sales and paid speaking tours, my man.