Smoke and mirrors

One of this week’s outings was for the purpose of having a bone-density scan that I’d been persuaded would be a good idea.

It isn’t something I worry about and I avoid breaking bones without having to be told. I’ve reached the age where I think tests are no longer necessary and in any case the way things are going I shall soon not be able to afford them.

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A letter arrived from Medicare. Such communications make me want to rip my hair out.

This particular letter concerns the denial of payment for anesthesia applied during a treatment two years ago. The doctor’s office has not attempted to bill me, but whether they will eventually, I have no idea and in the meantime I have had many more similar treatments, which leaves me wondering how much I may one day have to come up with.

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Trying to understand medical insurance does my head in.

Faced with retiring, I had to select a plan which would, as I understood it, pay for that portion of fees not covered by Medicare. It turned out that this was not at all what I took it to mean.

Fortunately, I found someone to guide me in selecting a plan because there are literally dozens and each has its own variety of choices. Good luck figuring them out.

At the end of each year you have a chance to change your coverage and you get bombarded with advertisements for improved plans that you should consider, but I hold on to what I have, fearful of making matters worse, not better.

And somehow in the process losing coverage altogether.

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The plan I have has so far been widely accepted with no co-payments, but I have no confidence that it will remain so and the premiums are escalating toward being unaffordable.

If the statements I get are to be believed, it seems to me I should abandon my secondary insurance. Here’s why:

For simplicity, I’ll round the numbers:

One treatment was billed for $4,000

Medicare approved $56 (yes $56) but paid $44.

Secondary insurance did not pay $3,956 which surely is the difference?

No, they paid $12 which is the difference between the $56 that was approved and the $44 that Medicare actually paid.

A few $12 charges would be more affordable than the $355 per month I pay to this company.

(In addition to the $203 I pay to Medicare)

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There is something else going on, otherwise doctors would be out of business.

It was suggested to me that the huge shortfall in payments is offset as a tax write-off and maybe this is the case, but there is also something called alternative revenue streams.

Such as: Capitation…

Under capitation, a doctor, medical group, hospital or integrated health system receives a certain flat fee every month for taking care of an individual enrolled in a managed health care plan, regardless of the cost of that individual’s care.

Thus, if I was to cancel my secondary insurance, I would end up being charged a great deal more than $12, but medical fees are fiction, which I discovered when dealing with my uninsured father’s cancer treatments.

Smoke and mirrors.

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Not wishing to live constantly in fear of losing medical coverage, I’ve decided to be pragmatic.

So many things I worried myself sick about never came to be, so I’ve given it up.

Worrying. It serves no purpose.

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The bone density scan indicates osteoporosis and my height has diminished. In the past 6 years I have shrunk another 3/4 of an inch. No surprises.

Almost everyone shrinks. What I did not expect was having my jaw shrink. No doubt this is what accounts for older people having crooked teeth.

The changed configuration of my jaw caused me to constantly bite my tongue in my sleep. If you’ve ever done it, you will know it’s painful and I got quite fed-up with it, so I agreed finally to get a custom-made brace. I’d tried one in the past and found it too uncomfortable to sleep with but the new one is hardly noticeable.

Now I don’t grind my teeth or bite my tongue.

Things to be grateful for!

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Arriving back from Glens Falls on Thursday afternoon, we came upon a solitary juvenile deer scratching in the snow under crab-apple trees down the road. She wasn’t worried as we passed beside her, only looking up when we stopped to take her picture.

We urged her to come up the road for a snack but she did not follow.

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