SOLTuesday: Why I Hate Insurance

Back in March I had my annual mammogram. It included a sonogram since I’d had some pinchy feelings in my breasts and they are dense, so easier for mammos to miss things.

A few weeks ago I got a bill for the sonogram, which was unusual. I called the radiology center (only had to wait on hold for four minutes) and was told that Medicare had started routinely rejecting these as not medically necessary, and that I should have my doctor send Medicare a letter explaining the medical necessity, and the center would follow up. Today I called center’s customer service again (only had to wait on hold for five minutes), of course got a different representative, so I had to explain the situation twice. This representative said she would pass on the information.

 

Is traditional Medicare thinking it will save money by following the private insurance companies’ practice of rejecting claims in the hope that we will give up fighting the rejection?

Later I ran into a neighbor who said her method of fighting the insurance rejection was to try to get the name of the doctor who works for the insurance company who made the “not medically necessary” judgment and get her doctor to call that doctor. Would that really work?

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It’s Slice of Life Tuesday over at Two Writing Teachers. Check out this encouraging and enthusiastic writing community and their slices of life every Tuesday. And add one of your own.

 

SOL1: What I Learned About Medical Insurance Today

            I’m 76, using Medicare. My new doctor wants me to get another pneumonia vaccine even though I had one with my old doctor some years ago.

            I went to my usual independent pharmacy today to see if I could get it there. The pharmacist said that the cost would be $279. She said that my Part D insurance doesn’t cover that vaccine, and this pharmacy doesn’t have a contract that covers the vaccine under Part B. However, I could try going to a chain pharmacy and see if their contract under Part B would cover it.

            This is the first time I’ve had any problem with coverage. Why should it make a difference what pharmacy I get the vaccine at? Why do the chains have a contract with Medicare Part B for coverage for this vaccine, but not this independent pharmacy?

            My pharmacy has the best customer service. They call if I’ve forgotten to get refills for my regular medications. They keep track of when prescriptions expire and will call my doctor to get new ones. My local chain pharmacy has never done any of this.

            What about yours? Do you have an independent pharmacy near you? Does your local chain pharmacy provide good service?

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I’m participating in the 12th annual Slice of Life Challenge over at Two Writing Teachers. This is day 1 of the 31-day challenge.  It’s not too late to make space for daily writing in a community that is encouraging, enthusiastic, and eager to read what you have to slice about.  Join in!

33 Days

My boss is on vacation, I'm doing his job and mine, and the new staff person, the hopefully-to-be-my-replacement, worked today. He seems to be doing okay, at least the questions he's been asking are good and reasonable ones. I haven't checked his work to see whether he missed anything egregious, but the editors whose work he read will doubtless give me feedback. I'm still feeling half in/half out. I need to remember how to do everything so I can fill in the replacement, yet I'm finding myself not caring about details that used to concern me.

Meanwhile, I had to make a phone call about my father's life insurance and only learned a crucial piece of information by using the old journalist's interview technique of asking, "Is there anything you want to tell me that I didn't ask about?" What I learned added an additional step to the process, but simplified another step. I still need to get in touch with my retirement account person and one of my father's accounts, and make some informational phone calls about Medigap and Part D. Retiring is such hard work!

Countdown...

In six weeks, I will leave the full-time workforce and no longer have to go to an office. Right this minute, that feels really good. But there are so many steps that still need to taken:
1. Sign up for Medicare Part B: two forms that need to be filled out
2. Sign up for a medigap policy and Part D  prescription coverage by December 7
3. Make sure my replacement at work will really work out (the first choice didn't at all)
4. Get used to using my to-do list again (I lost track of it the past few years)

There's more, but isn't this enough?