Live-Blogging (sorta…) from Bureaucracy Hell

So…I’ve lost my Social Security card and my Medicare card was stolen. Getting these back, as you can imagine, entails an unholy amount of hassle. Which do you suppose would entail less pain?

  • Call Social Security on its 800 number; jump through a thousand robotic hoops, and wait and wait and wait and wait and wait… Finally reach a person who has no clue what she’s doing. (As you might guess: been there, done that!)
  • Drive in person to the Social Security office in Scottsdale, the bureaucracy’s nearest brick-&-mortar venue. Take a number and wait and wait and wait and wait and wait… Sometime today (maybe) get to speak with a human who knows how to solve the problem.
  • Go to the Social Security Website, create a “My Social Security” account (or, if I stupidly did this some time in the past, find it and figure out how to break into it), dork around and screw around and dork around and screw around and dork around and screw around and dork around and screw around and dork around and screw around and dork around and screw around and MAYBE get the new cards ordered. Or not.

Any of those involves time-sucking frustration of the first order.

Experience shows that physically going to a Social Security office is less time-consuming (despite the drive time), less frustrating, and less outright enraging than either of the other two options. So early this afternoon, after finishing the minimum amount of work needed to make progress on the client’s huge project, I climbed in the car and started driving.

Arrived at the SS office right at 1:44 in the afternoon. They close at 4 p.m.. That left two hours and 15 minutes, sooo…there was at least a shot of getting to speak to a functionary before they threw us all out.

Drew “Welcome to Social Security” coupon number Z140. Sat and waited for them to call that number

Z135.

Z132.

Z134.

Z168.

Z136

Z143….

And on. And on. And fuckin’ ON.

Meanwhile, I’d learned that to get a new Social Security card I had to apply at this office. But to get a new Medicare card, I had to go around the corner and stand in ANOTHER line to beg for that.

Finally, after about half an hour or 45 minutes of this futility, I think oh fukkit and get up and leave.

I walk around the corner to see if maybe I could at least get the Medicare card with a slightly more reasonable wait. Pass through the security guard — this one a lot more hostile than the guy in the Social Security office. Yeah: a WHOLE lot more hostile. Help a couple of terrorists in their early nineties figure out how to use the punch-a-button nuisance to generate a ticket to wait. Generate my own. Sit down.

Many fewer victims here. I figure out that actually there are only about five people ahead of me. Take a seat and…well, yeah. About ten or twelve minutes later, my number is called.

I claim that both my cards were “lost.” If you define “thieving” as a variety of “losing,” that’s probably accurate. Why do I resist admitting that the Medicare card was stolen? Because the gummint’s web page says you have to file a police report before asking for a replacement. And THAT will cause still more trouble and headaches that I DO. NOT. NEED.

To my astonishment, the doughty bureaucrat behind the desk asks me a series of rote questions, goes CLICKETY CLICKETY CLICKETY on his keyboard, and announces blithely, “The Medicare card should arrive in two weeks; the Social Security card will take about three months to show up.”

uhhhhh…HUH!

“But…,” say I, “they said I have to go to two different offices and apply for each one separately.”

“I just ordered them both.”

Oh. My. GOD! You beautiful, spectacular ebony saint of a man! Can I take you out to Ruth’s Chris Steak House and buy you a T-bone? How about an orange soufflé swimming in heavy cream for dessert? A bottle of Domaine Loubejac Pinot Noir to go with?

Stop by the Fry’s on the way home to stock up on veggies and miscellaneous junk. Stumble in the house, bolt down a box of sushi and a couple bottles of beer.

Having finished the day’s ration of the client’s index before heading off for the Adventure in American Bureaucracy, I now sit down to write this post, and….

In comes this fine message from DropBox:

Hi Victoria,

We really appreciate taking the time to write in.

For security reasons could you please confirm the restoration?

Just to summarize, we are going to undo the following event link in order to remove the selective sync conflicts from your account:

https://www.dropbox.com/event_details/87657979/123465432/713437281

I just want to confirm that you want these events reverted in their entirety, and there are no other actions you’d like me to take on your account at this time.

Once you’ve written me back to confirm that’s the case, I’ll pass this along to our Restorations team to perform the requested operation on your account. If there are other things you’d like done, please write back with additional event links or a description of the circumstances surrounding your situation.

I look forward to hearing back from you!

HOLY SHIT!!!!

I have not asked Dropbox to do anything in the past week. The last I looked — about three hours ago — all is well. I do not know what this means, but “remove” or “revert” sounds a whole lot like DELETE stuff. Random fuckin’ stuff.

This causes a complete, total, exhausted-old-lady can’t-stand-another-minute-of-bullshit-hassle MELT-DOWN!

I have NO idea what this worthy is talking about, but I can NOT afford to have some good soul delete the project that I’ve spent the last gawdAWFUL number of torturous, tedious, brain-banging, mind-numbing hours on!!!!!!! GAAAAAHHHHHHHHH!

E-mail back, also having no idea whether a reply will reach a human being, DO NOT CHANGE ANYTHING DO NOT DELETE ANYTHING and frantically start copying key folders to the iMac’s desktop, not knowing whether the machine has anything like enough memory to hold that much data.

Meanwhile… The MacBook, the one whose repairs absorbed some six hours of driving time, days of down time, and hour after hour of fuckup-recovery time, is NOT fixed. Last night it started shutting down again. Same story: PLINK, out of the blue. Reboot, find there’s plenty of power on the battery, data has been lost, pages have disappeared, fuckups have been fucked up. Last night I call Apple’s 24-hour service and reach a tech in Australia. Explain that this saga is beginning to wear on me. She says with AppleCare I have two or three in-house visits coming. She tries to set this up but because of course Apple has gone to bed in this country, she can’t get through. Gives me a phone number to call.

Reach one of Apple’s accelerated AppleCare dudes here. He says well, that would be true if we were in Australia, but it doesn’t apply in the US. I complain about the interminable drive to Scottsdale, now that the bastards have closed down the central Phoenix store. He says they have a deal where they will send me a shipping box and cover the cost of FedExing it to the repair dudes and FedExing it back to me.

Well. That’s better than a hit on the head, anyway. Best of all would be if you could FIX the damn thing.

Finish copying stuff to the iMac’s desktop, including all The Copyeditor’s Desk’s present and past client data.

By now it’s getting dark.

Take the dog for a doggy walk. She lunges onto a neighbor’s lawn to have a good grass-wallow and then launches into one of the worst episodes of reverse-sneezing she’s ever had. If you’ve never seen a dog doing the reverse-sneeze thing: it’s much like a kind of seizure. Even if you know the dog will get over it, the dog doesn’t know that. And the dog tends to panic. Now Ruby is wheezing and gasping for air and shaking all over her little body in terror.

Whenever she gets to the point where she can more or less breathe again, I have to pick her up and carry her the quarter-mile back to the house. Jolly fun.

Day from Hell…

Medicare: Watch Your Back

Of interest: When you hit Medicare age, you will be shuttled into what looks like a single-payer system. But bear in mind: it’s NOT a single-payer system. It’s really a two- or three-payer system.

SDXB’s lifelong friend is dying of prostate cancer, a condition he’s been struggling with for several years. Recently he told SDXB that the costs he’s racked up will pauperize his widow. At one point, a hospital demanded they disgorge $9,000 up front, before he could be admitted for treatment.

That may be because he doesn’t have so-called “Medigap” insurance: a supplemental policy that picks up the costs Medicare won’t cover. Possibly, too, his prescription drugs have dropped him into the so-called “doughnut hole,” in which the victim of a serious illness has to cover Rx costs out of pocket after they hit $3,300 and until they reach an astronomically high ceiling.

Traditional Medicare, the safest option because it allows you to choose the doctors you will go to rather than limiting you to an HMO’s network, covers only 80% of most bills. A stay in a hospital can rack up tens or even hundreds of thousands of dollars in medical bills.

In the US, costs for treating major ailments vary by region. Rescuing you from a heart attack, for example, can cost as much as $92,000. Folks…20 percent of $92,000 is $18,400! Not many of us happen to have that laying around the house. And acute costs may be just the beginning. Treatment for most conditions of old age goes on and on and interminably on.

If you select traditional Medicare (Part A comes with the 65+ territory; the optional Part B covers doctor’s visits and outpatient experiences), you will also need to buy a couple of other policies if you want to be fully covered. These include a Medicare supplement policy (often called “Medigap”), which picks up the 20% that Medicare doesn’t cover, and a Part D policy to (partially) cover prescription drugs. These are supplied by private insurance companies, not by the government program called Medicare.

So now we have not one payer, not two payers, but three payers.

Yes. You can opt out of buying Part B, a Medigap policy, and/or Part D. But you do so at your extreme peril.

So, those who elect “traditional” Medicare so as to preserve their right to see a doctor of their own choice and who wish to be fully covered will end up with three-provider coverage: the U.S. government, a large corporation selling Medicare supplements, and another large corporation selling prescription drug coverage.

An alternative is to buy a Medicare Advantage plan, which is your basic HMO or PPO designed to collect your Medicare benefits in exchange for rationing your care. Medicare Advantage insurers usually sweeten the deal with dental and optometry benefits, which make those plans look more attractive to the unwary. Some, but not all, Advantage plans also include coverage for prescription drugs.

Does a Medicare Advantage plan keep costs down? Maybe; maybe not. Depends on the plan and the circumstances. In 2015, for example, almost half of these plans imposed limits on prescription drug coverage above $5,000.  For a victim of prostate cancer — just as an example — an androgen receptor inhibitor can cost $8,862.

AARP tells us that by law, “all [Medicare Advantage] plans…have annual limits on out-of-pocket costs.” What is this limit? Unclear. Says the redoubtable lobbying group and insurance provider for the aged:

Additional out-of-pocket expenses associated with Medicare Advantage plans depend on a variety of factors, including

• If the plan covers part of or all of your Part B monthly premium
• How much you pay for each service or health visit (copayment and/or coinsurance)
• Whether the plan has a yearly deductible that you must meet before it provides coverage
• What types of services you require and how often you require them
• Whether you join a plan with additional benefits such as vision, dental, or prescription drug coverage
• How much the plan’s maximum out-of-pocket limit is for medical services
• Whether you receive care from in-network health care providers

Some plans charge yearly deductibles. Some do not. Some plans charge copays for some benefits and services, and all Medicare Advantage plans are allowed to set their own coinsurance percentages and terms. In other words: good luck with that!

Only about 82 percent of Advantage plans cover Rx drugs. For some plans, your monthly premium may exceed the amount you’d pay for part D. Original Medicare has no out-of-pocket maximum. Unless you have Medigap coverage, you’ll keep paying for some part of as you use them. Medicare Advantage plans, by law, have an out-of-pocket maximum of no more than $6,700 per year. Once you hit that limit, the plan pays for all covered expenses.

And by the way, if you’re in a Medicare Advantage Plan that includes drug coverage, you must accept its terms for prescription drug coverage. Dare to join a Medicare prescription drug plan, and you’ll be expelled from your Medicare Advantage Plan and returned to traditional Medicare.

So how is SDXB’s buddy going broke despite a federal plan designed to protect the elderly from exactly that? Evidently he has traditional Medicare without a Medigap policy, or else he has a Medicare Advantage plan that doesn’t cover drugs and he failed to get a Medicare Part D (prescription drugs) plan.

The whole program is tricky, complicated, and loaded with land mines. You have to study it carefully and understand exactly what you’re doing — no small order! — to protect yourself from impoverishment should you face a medical problem that doesn’t carry you away quickly.

Medicare Bills: OMG!

Anybody who thinks Medicare is some sort of a bargain and that all us old folks are sucking off the public teat either doesn’t know what he’s talking about or is just batshit crazy.

Just paid my annual Medigap premium: it rose by $277! That was after the Part D, which covers nothing because I don’t take any meds, went up by $60 a year. Part D is provided by a private insurer, but Medicare recipients are required to subscribe to it on pain of a penalty that amounts to a heavy, recurring fine. Part B also rose this year, but Social Security rises to cover Part B increases even in years when there’s no COLA increase (we’re now in the second year with no Social Security COLA, because after all there’s no inflation. :roll:).

Not anticipating such a large jack-up, I failed to self-escrow enough to cover the increase, so I had to raid my regular savings to pay the bill. Another two months with no clothes! Guess I’ll be wearing black Costco jeans all summer. Damn!

Medicare now costs some 15 times what I was paying for similar coverage at the Great Desert University. And of course it doesn’t cover everything. The Mayo keeps sending me incomprehensible bills, and the various Medicare providers keep sending me incomprehensible statements. Piles of paper are swelling my file folders, and I have no idea what any of it means…it’s just impossible to parse it out.

What this means is that I have no idea what I need to pay my doctors out of pocket. And that means I can’t really ever get out of debt to them, because I don’t know what to pay. Even if I could afford to do so, I can’t pay the full amount of each statement and then pocket the amounts coming in from Medicare/Medigap, because the clinic’s bills don’t reflect all the pending charges; if I spend the Medicare checks on groceries, I won’t have anything to cover the new little surprises that keep coming in the mail.

Complicating matters, Medicare will not pay the Mayo directly, advertisements to the contrary notwithstanding. The Part B coverage is supposed to direct-deposit payments to the Mayo, but for some reason because it’s the Mayo they won’t do that. Hell, no! Instead, they dribble out checks to me by snail-mail, which I have to deposit and then disburse to the Mayo myself.

Needless to say, the potential for snafu is huge. There’s always the chance that some check will be lost in the mail or in the piles of paper in my house—because a blizzard of trash paper is always coming in from these insurance companies, it’s easy to lose an envelope with an actual check in it.

Mercifully, I can now scan checks and deposit them electronically. It’s almost as much of a nuisance as physically driving to the credit union, because my scanner is excruciatingly slow. And of course, it draws so much memory or power or whatever it’s doing, I can’t do anything else on my computer while I’m waiting for it to plod through the process. The CU’s system won’t accept color scans, but my scanner defaults to color. Sometimes even when I set it to scan greyscale, it defaults right back to color. So then I have to do the whole scan over again. One time it took over half an hour just to scan in one check so the system would take it—I could have traipsed to the credit union on the way home from campus in that time!

Dealing with this bureaucratic BS is a difficult nuisance now, while I have most of my marbles. I can’t even begin to imagine how the elderly frail cope with this tsunami of confusing, complicated, demanding crapola. If you don’t have someone in your life to help out with it, you’re SOL. And you can be sure you’re getting ripped off seven ways from Sunday.

There’s just no excuse for America’s healthcare system.

Best Guide to the Medicare Maze

If you or someone you’re close to is about to walk into the labyrinth that is Medicare, take a look at the December issue of Consumer Reports, now on the newstands. This month CR is running the best, clearest guide to Medicare I’ve seen to date.

Medicare’s rules are astonishingly complicated and booby-trapped with land mines. The government and a vast slew of vendors send you hundreds and hundreds of pages of information and sales pitches. As well-intentioned as most government writers are, the copy they pour out is verbose, involved, sometimes contradictory, and often impossible to figure out.

CR has boiled the entire mess down into two pages of do’s and don’ts. Their article explains why you should get signed up for Medicare before you turn 65, how Medicare Part B works and what will happen to you if you fail to sign  up in a timely way, how to avoid being screwed out of Medigap coverage—and why you really need it—and what the advantages and disadvantages are of Medicare and Medigap.

It’s crystal clear, easy to understand, and mercifully brief. This thing should be offprinted and sent to everyone who’s coming eligible for Medicare.

Hmh. I’d forgotten how much I enjoyed Consumer Reports before I let the subscription lapse. Now that I’m feeling flush again (sort of…), maybe I’ll re-up. It’s a useful resource for the frugalist and the wily consumer. If you’d like to subscribe, you can click here to subscribe online at the same rate the magazine is offering on its blow-in cards. Come to think of it, those of us who are running monetized PF blogs ought to be able to write off the cost as a business expense.

🙂

Gotta love those insurance companies…

Wellcare, the outfit I selected (among dozens) to handle my Medicare Part D insurance—that’s prescription drug coverage—just sent me a package to plow through: TWO HUNDRED AND TWENTY-FIVE PAGES of dense, incomprehensible copy to try to figure out!

The booklet you’re supposed to start with, which explains annual changes to the plan, is twelve pages long. Apparently every single year you have to study all this garbage, try to decide if you can live with the changes they’ve come up with, and, if you can’t, try to find another insurance company whose terms you can live with, if any such thing exists.

This year they’re raising the prescription drug coverage from $19.70 to $23.80, or $285.60 a year.

That doesn’t sound like much, except for the fact that you don’t get much for your $285.60 a year. The yearly deductible is $310, so in fact before this thing starts to pay for prescriptions, you pay $595.60 out of pocket. Then it only covers $2,840 until you reach the “doughnut hole.” When your prescriptions have racked up a $2,840 bill (easy to do if you have cancer, diabetes, MS, Parkinson’s, or any of the numerous other ailments of old age), then you’re screwed. You then have to cough up $4,550 for your meds, at which point you reach what Congress in its wisdom has decided is the “Catastrophic Coverage” stage. Then you pay $2.50 for the drugs the company approves, $6.30 for brand-name drugs (many drugs do not come in generic form, you know), or 5 percent of the total cost. Again: Five percent of cancer drugs could add up to one whopping bill.

So really, you’re paying almost $600 for what amounts to only $2,840 worth of coverage. For the cost, it’s very chintzy.

All these plans are about the same: they’re required to provide approximately the same coverage with about the same terms. So, buying a more expensive plan won’t help you, except insofar as some plans apparently are a little more or a little less generous about what types and brands of drugs they’ll cover.

To figure out whether anyone else is offering a comparable drug plan for a lesser price, I’ll have to get a ten- or fifteen-page list from the state SHIP department, plow through that, negotiate telephone punch-a-button mazes to order up information from several insurance companies, and then plow through thirty- to forty-page piles of paper from each of those. Like I have time to do that, and like I could understand what any of that verbiage means, anyway.

Medicare Part D coverage is highly restrictive. To keep you from understanding exactly how restrictive it is, insurance companies have set up a complicated four-tier system involving generic, “preferred generic,” “preferred brand,” and “nonpreferred brand” drugs. It is so baroque as to be incomprehensible. According to the booklet my company sent, some drugs, apparently chosen arbritrarily, can cost you nothing if you order them from WellCare’s pharmacy. Once you start ponying up cash or daring to do business with the nearest drugstore, though, the least you will pay is $36. Yes: per prescription.

Some generics and “preferred brand” drugs can cost you $123 per prescription! Then you get to the Tier 3 “generic and nonpreferred brand drugs,” where you’ll pay $282 per prescription!

Think of that: $282 for a bottle of pills.

To further confuse matters, they move drugs from tier to tier. This year, we’re told, “Some drugs will be in a lower cost-sharing tier; others will be in a higher cost-sharing tier.” So, if you have a chronic disease, chances are you’ll have to change drugs once a year as the companies jack up the cost by moving them up a tier or two.

Evidently they’re supposed to give you some sort of discount on drugs once you tumble into the doughnut hole, but that’s not evident in the 12 pages of daunting gobbledygook in the summary booklet. It says here that the new healthcare legislation, which our Republican friends are campaigning to get rid of, “continues to close the coverage gap, or ‘doughnut hole,’ by reducing the percentage of cost-sharing for beneficiaries in the gap. Effective January 1, 2011, drug manufacturers will provide a 50 percent discount on brand-name drugs and the government will provide a 7 percent discount on generic drugs for those who fall into the coverage gap (Sec. 1101, HR 4872). This is in addition to a $250 rebate, effective in 2010, for beneficiaries who reach the coverage gap.”

All very nice, but it doesn’t change the fact that the doughnut hole amounts to $4,550 and that if you get seriously ill, which all of us will unless we drop dead of a heart attack or are killed instantly in a car wreck, you’re going to be out the cost of your premiums plus the cost of your deductible plus the vast out-of-pocket costs of the doughnut hole. For my modestly priced plan, that would amount to $5,146, not counting the costs of copays ranging from $12 to $235 per prescription.

What we have here is one real good reason why I don’t want to go to the doctor for my bellyache. Don’t know what I’d be getting into…and if it’s anything that requires a lot of drugs, well…

After a month and a half of general misery, I’m pretty sure that whatever is ailing me is probably serious. If it weren’t, it would have passed by now. But with Social Security confiscating an entire month’s benefit—$1,275 gross, $975 net—after my having struggled through a whole summer without enough income to cover my expenses, I’m flat broke. I simply do not have money to pay for doctors and drugs.

What this partnership with despotic private insurance companies actually insures is that seniors will delay going to doctors as long as they can. That actually pushes up costs, because by the time you get to the doctor whatever is ailing you will have reached an advanced stage, which will cost more to treat.

Some puppies are pleased that we lazy, greedy old bustards who oughta get a job won’t see a cost of living increase from Social Security in 2011, for the second year in a row. WellCare’s premium is the smallest part of my Medicare bill. If it’s gone up $4, you can be sure the much more expensive Medigap policy will go up even more. I’m already ponying up $90 a month (God only knows what it’ll be in 2011) to another private plan to cover the many lacunae in the government plans (Part A and Part B), and Part B itself, costs $111 a month for rather skimpy coverage.

With Part D, you have the option of taking a chance that you won’t get sick and won’t need a lot of drugs before you croak over. There’s no law that says you have to buy Part D coverage. (If you think the game doesn’t play out in favor of the table at Vegas, then by all means take this bet!)  But if you don’t get it at the first opportunity when it’s offered to you, then the cost goes way, way up: effectively, you’re punished for not buying insurance from private corporations until you think you’re actually likely to need it.

Nor is there any law that says you have to buy Part B. But you’d be a fool if you didn’t, unless you’re already so poor as to qualify for Medicaid. Part A is roughly the equivalent of major medical. It doesn’t cover much.

So far it appears the Medigap coverage works pretty well, though I haven’t used it except for the useless follow-up care for the torn rotor cuff, which I can’t afford to have repaired because I can’t afford to take a semester off my part-time job. So to date, I’ve paid $90 a month for air. Presumably next year the cost of air will even higher.

For $111 a month plus all the Medicare taxes I’ve paid and still pay on every dime I scrape together, Medicare should cover everything—without forcing beneficiaries to open their wallets wide to the rapacious insurance industry.

Balancing the Budget on the Backs of the Vulnerable…Again!

What is it about Americans and American politicians that we think it’s OK to let the rich and the corporations get by with low or no taxes and then cover the deficit on the backs of the most vulnerable people in our society?

Our government, much reviled by the right for its new “progressive” leadership, is going to cut Medicare reimbursements to doctors by 21 percent!

Medicare reimbursements already don’t cover a doctor’s cost of doing business. Many doctors here won’t see patients who are on Medicare, and many more won’t take on new Medicare patients. The Mayo, where my doctor moved after “managed care” by HMOs first started making physicians’ lives miserable, will (for the time being) keep seeing you if were a regular patient before you were switched to Medicare, but it will not accept new Medicare recipients. One branch of the Mayo here in the Valley, a practice on the west side, fired all its Medicare patients and now sees no one who doesn’t have private insurance.

I expect that will be the way the main Mayo Clinic will go, too. Even though the present cut may (or may not) be temporary, the message is clear: expect a permanent version in the near future.

{sigh} The level of medical care here in Arizona leaves a lot to be desired. No doubt there are horror stories in every state in the union, but I’ll bet in many states not every single resident has a story to tell. In Arizona, unless you’re lucky enough and stubborn enough to stay away from doctors and hospitals, you’ve got a war story. The Mayo is one of only three hospitals (the last I looked) that has a top rating in national rankings of clinical care and safety.

So, when you find a decent doctor, you want to hang on to that doctor. The last thing you want is to be bounced from doctor to doctor, or to be forced to see someone whose competence you mistrust or who is too overworked to spend more than five minutes speaking with you.

It’s not “Cadillac care” to have a doctor whose skills are competent and who has fifteen or twenty minutes (or more, preferably) to listen to a patient and arrive at a thoughtful diagnosis.

This vicious slash in Medicare is going to put a lot of elderly people out on the street and yes, bouncing from doctor to doctor. If they can even find a doctor. It will push most of us into low-quality clinics or to hungry young practitioners without the experience and wisdom one needs to see in a doctor. I’m still fairly young—only just eligible for Medicare—and I’m too old to go through that. Imagine the suffering and just plain bad medical care this will inflict on people who are too frail to fight the system!

Inexcusable.