May I Vent a Bit Here, Mr. Obamacare?

I’m having a stressful day so far, as I wait for President-Elect Fuckhead’s latest publicity stunt to hit the wires.  I can’t keep it to myself.  Poor Sekhnet was bawling uncontrollably just now at my frustration before I could calm her enough to let her off the phone.   I need to vent, so if you’re not up for it, I understand, click away, click very away.

I went to an accountant who made a few minor errors on my taxes.  The first would have cost me almost $300, the second a little less than $500 in tax liability I apparently didn’t have.   I don’t hold this against her, going forward it won’t happen again, and, fortunately, I avoided both of those costs, as far as I know.   She told me to wait for the IRS to bill me on another matter, and I waited, and they billed me.

I paid this bill to the IRS.   Then two weeks later I received two certified letters from the IRS, threatening me with a levy or garnishment to satisfy the debt to them they claimed I hadn’t paid.  Their threatening certified letters were dated 12/12/16.  The payments to them were made on 12/5/16, confirmed on date of posting and the backs of both cancelled checks.   I wonder what their next letter will say.

But that’s nothing to get upset about, it’s easily resolved.  Just print out the images of checks, front and back, put stamps on their fucking IRS mailer and enclose the proof of payment with their certified mailed notice that they will begin collection efforts against me for a debt already paid.  Or better still, just wait for their next letter.

What I’m upset about is the Obama news conference I made the mistake of listening to just now, in the context of my ongoing horrors with his signature program, Obamacare.  

It’s true he’s killing people with drone-launched missiles in at least seven countries, off of a secret kill list.  Many of these people might be terrorists, no doubt, and hopefully few are innocent children and old women, or innocent men, for that matter.  His successor will have the same top-secret kill-lists presented to him for his approval.  

It’s also true that Obama has reserved, for himself and any future president, the right to kill American citizens without the need for any sort of process at all, with or without charges.   Tidying up afterwards is just book-keeping, most Americans are not paying attention, seriously.   Just pose with Kanye West or Kim Kardashian until the news cycle is over, done.    

I have plenty of beefs with Obama, who I voted for twice, but let me just give you the details of one I know better, and more personally, than anybody else I know.  Most people I know are comfortably middle class and work jobs where their health insurance is not at the mercy of the industry-written compromise called the Patient Protection and Affordable Care Act.  

You are assigned a level of health insurance based on your income as reported on your tax return.  If you don’t file tax, no Obamacare.  Fine, fair enough– the State Health Insurance Marketplace automatically gets all your proof of income statements anyway.  Submit your income numbers, get the level of insurance coverage your income entitles you to.  Choose any participating company to provide your care, at the assigned level, and start paying your premiums.  

I had a diagnosis of a slightly dilated left atrium over the summer.  The left atrium is one of the four chambers of the heart.  I asked my doctor how serious this was and he pantomimed a strong man pose, the healthy atrium muscle flexing, and then a limp armed pose, the same atrium, only flabby and weak.  He promised to refer me to a cardiologist, one who was joining his practice any day.  That was in August.

In September I began having pains in my chest when I did a strenuous bike ride.   I discontinued riding and kept following up to find out about the cardiology referral.  By November 17th I still had no referral and the doctor, returning my late night call about chest pains, agreed it might be best if I went to the E.R. to rule out a possible heart attack.  

Reclining on a bed in the Emergency Room, I learned the medical jargon meaning of “a good story”.  My EKGs had come back fine, my blood work was clear of markers for recent heart events, but as I was taking medication for hypertension, high cholesterol, and was 60– I had three of the five major risk factors and was, thus, “a good story.”  

I smiled, relieved, ready to go home, until the doctor explained that a “good story” was a bad thing, not a good thing.  I was a good story for possible heart disease and they’d better admit me to the hospital to rule out some deadly event that might soon befall me.

More out of shape than I’ve ever been, since I’d done no aerobic exercise in a few months since the chest pains while biking, I did OK on the stress test and was given a clean bill of heart health, cleared for all activities, though I was also diagnosed with an abnormality in one of my ventricles as well.

After payment for my visit to a neprhologist was denied as out-of-network since I had not pre-submitted the referred doctor’s location-specific NPI number and made sure he was in my plan at that location, I called Empire Blue Crucifix to make sure the next specialist I saw was in network.  

Empire gave me the name of a cardiologist and his office address.   I took pains to read back the site-specific NPI number for the provider and send his office the front and back of my insurance card.   I verified the doctor’s NPI number and was told by Maria at his office that we were good to go.   Ten minutes into my interview with the cardiologist’s assistant she was called away.  It annoyed me that she left the room mid-sentence, cutting me off without saying so much as “excuse me”.  

That annoyance would turn out to be a rather trivial.  Ten minutes later I was called back out of the consult room to the front desk.   The cardiologist himself was sitting at reception, very apologetic. He literally couldn’t have been nicer.  He told me that unfortunately the insurance company had informed his office that he was out-of-network.  We spoke for a few minutes, and I thought this was a person I could be good friends with, if circumstances were different.

I mentioned the importance of restraint as a musician and he raised his eyebrows.  “I should write that down: ‘restraint’…” he said, and we went on to talk about a master of that subtle and indispensable art, George Harrison.   The doctor gave me a print-out of all the materials from the hospital visit, with the intimate details and scientific names for my two or three heart irregularities.  We shook hands.  

My right hand, which has regained much of its strength six months after I injured it in a fall, is still stiff.  The P/T I began in November made it feel immediately better.  When I returned for my second appointment I was told that, unfortunately, I was out of network.  

I got a referral from my insurance company, complete with site-specific NPI provider number, for another P/T provider two blocks from the cardiologist.  I walked over with my referral form after my aborted visit to the cardiologist to set up an appointment to resume P/T.

I was surprised that I’d walked into what looked like an Old Age Home.  I checked the address, I was in the right place.   The receptionist was surprised that I was there for outpatient P/T.  She wasn’t aware they offered that.   The director, over the phone, told me they did offer P/T, but only if I checked into the nursing home as an inpatient.

I walked home 0 for 2 on referrals given to me by my insurance company.  I thought of the third notice of a $1,324 medical bill I’d received the day before for a sonogram I’d had months earlier.  I’d had an x-ray of my hand and two sonograms that day.  The x-ray and one sonogram were both covered, the other was not.  $1,324, please.

 After the second notice demanding $1,324 I straightened things out, on October 19th, with the insurance company and the provider, it took less than an hour.  Daniel at the provider told me I’d been billed in error and actually only owed a $25 co-pay.  I told him I’d pay it when they billed me.  Then, six weeks later, I got the third notice to pay $1,324.    

This time, I was told by the insurance company, that I was responsible to have read all of the fine print in my contract and that it was clearly spelled out which body parts were not eligible for coverage.  She was not able to explain the reason for this, but assured me it was the law, all described clearly in the contract.  She then called the provider and confirmed that I owed the entire $1,324.  Daniel had no recollection of having spoken to me, on October 19th or any other day, she said.  

It was a purely futile conversation and there was no supervisor available for me to whine to.  Empire’s position was that it was my responsibility to familiarize myself with the arbitrary and random bodily exclusions from coverage under the specific policy I had under the newly-created Essential Plan.

Tired of making Sekhnet cry, I thought outside the box just now and had a very pleasant twenty-five minute chat with a thoughtful and intelligent man named David at 311, the NYC information hotline.  

David had only one number for complaints about medical insurance, the New York State Department of Financial Services, naturally.   You can reach them Monday to Friday from nine to five at 212-480-6400.   He doesn’t know if they investigate medical insurance fraud, or oversee any agency responsible for assigning and administering health care in New York State, but it was the only thing he could find, though he searched long and hard.   He recommended I contact a local politician for help, they usually know how to do these kinds of things.

He agreed that the new norm of corporate opacity in government is very troubling.  I told him how the New York State Health Marketplace would not divulge contact information for its director, when I was erroneously denied health insurance for two months earlier this year and called many times trying to get the error corrected and have my health insurance reinstated.  

“Sir, we are not required to provide you that information,” one of the New York State of Health representatives told me from their call center in Albany.  

“Why is that?  Are you a private corporation?” I asked.  

She admitted that they are a public agency, but reiterated that  a member of the public is not entitled to know the identity of the director. They have specific instructions not to provide their boss’s contact information.  Their supervisor will not provide that information either, nobody will.   As for an ombudsperson, or someone available to help distressed customers, they are not required to have one under the Patient Protection and Affordable Care Act.  

They have an appeals process for all disputes.  I initiated an appeal and was told I’d hear within two weeks.  I heard nothing, nobody could give me an explanation for the delay.  Two months later my health insurance was back in effect and I began paying my premiums.

Two months after that I had a call from an appeals ‘hearing officer’.  He asked me if I was ready for my appeal over the phone.  I asked him why I’d received no notice of the hearing.  He told me a notice had been sent to me thirty days earlier. He directed me to where I could find it on line.  

There was no notice there.  He saw it on his end, he told me.  I pointed out that if the person who is entitled to notice doesn’t receive any notice it really doesn’t matter if a form was prepared or not.  

He was not the sharpest knife in the drawer, and had a shit job, no doubt,  but he was on point, I’ll say that for him.  No matter what I said he returned to his single question: are you prepared to go forward with your appeal or do you wish to abandon your appeal?

I explained, in vain, as it turned out, that since I had been appealing a denial of benefits for January and February, and it was now May, that we would need a time machine in order to have a meaningful appeal of the wrong I had appealed.  

“Do you want to abandon your appeal or go forward, you have to tell me one thing or the other, sir,” he said.  

I went out on a limb and used a word many people mis-correct as “mute”.  I told him it was academic, since the controversy was now moot — the harm was done and could not be corrected any more due to the passage of time.  He asked his single question again.   I explained the concept of mootness to him.  I might have been explaining it to my own sonogram-exempt body part.

Obama was surrounded by organized, determined, ruthless enemies, no doubt.  He had very wealthy donors in the industry that, in fairness, he had to consider as well as the public his law was designed to protect.   However you slice it, Barack Obama is the Obama of Obamacare, and I hope he will not be too offended if I point out again that he’s a sell-out and a bit of a dick.

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