The Medicare Tango

I went to my UCLA doctor for my annual physical, and the receptionist asked me, is your insurance the same? I said no, my former employer decided to switch from United Healthcare to Aetna. By the way, I just heard Aetna is being bought by CVS, the drugstore.

Receptionist: I wouldn’t know anything about that.

Me: It could be a good thing. Maybe now we’ll get a break on drug costs.

Receptionist: I wouldn’t count on it.

They asked me for my new ID card and made a copy.

Me: Is Dr. Brown here today?

Receptionist: No, he has moved on. You will be seeing Dr. Jones.

Me: This is my fourth doctor in four years.

Receptionist:  Exciting, isn’t it? Although, technically, Dr. Jones is only a resident.

Me: So, he isn’t a doctor yet?

Receptionist: Almost!

Me:  Is my annual physical covered with my new Aetna Medicare Advantage insurance?

Receptionist: Yes, it is.

Me: What is included?

Receptionist: For free, with no co-pay?  Medicare requires we talk to you for 45 minutes, or we don’t get paid.

What if I have something wrong with me or he wants to do some tests?

Receptionist: If you want to bring up any medical problems, it will cost you extra.

Me: What do we talk about for 45 minutes?

Receptionist: Anything you want, as long as it’s not about your health.

Me:  Blood Test?

Extra.

Me:  Immunizations?

Extra.

Me:  Urine test?

Half off if you bring your own cup.

So I sign a form promising not to mention anything to the doctor about my current health.

After discussing books, movies, theater, and how expensive medical school had become, the doctor ordered blood tests, a couple of shots, shingles, and pneumonia, and because I have high cholesterol and my father died of a stroke at 58, a CT coronary calcification screening.

Doctor: Be sure and get your shots at your pharmacy. If you get it at the doctor’s office, there is a charge.

Me: So, I should go to the grocery store pharmacy to get my shots for free? Not here at the doctor’s office?

Doctor: And they give you 10% off your groceries!

Me: You think this CT coronary calcification screening is necessary.

Doctor: Absolutely! You don’t want to have a stroke like your father.

Me: Does my Aetna Medicare Insurance cover this test?

Doctor: I have no idea.

I call the UCLA imaging department to schedule my CT screening. Can you tell me if Aetna covers this procedure and what it will cost me?

We can’t tell you that until you schedule the test. After you do, we will call you and tell you if your insurance covers it.

So, I schedule the scan. I wait for two days and then call them back.

Me: You never called me.

What for?

Me: I scheduled my screening, as you requested.

A pause, then a voice says, ah, yes, I see it is scheduled for Friday.

Me: So, does Aetna cover the test?

I don’t know. You will have to talk to Aetna. Here is the procedure code and our ID number.

I call Aetna and give them the code. Am I covered?

You are! And there is only a small co-pay…no wait; you haven’t paid anything toward your annual $700 deductible, so it will be full price, around $150.

Me: Well, that’s not terrible. Let’s go ahead; my almost doctor says it’s important.

The day before the scan, UCLA calls. “Uh, Aetna hasn’t approved the procedure yet.”

Me: Why not?

You didn’t get preapproved.

Me: Did I need to be preapproved?

Of course, this is an investigative technically advanced test.

Me: It’s a CT scan. You must do them all the time.

Exactly.

Me: Was I supposed to get the preapproval?

No, your doctor was.

Me: Did he?

Apparently not.

Me: What should I do now?

Call your insurance company. Sometimes if the patient calls, you can get them to approve the test faster.

I call Aetna.

It’s on hold. Didn’t you know you need to be preapproved first?

Me: No. Why didn’t your representative at Aetna tell me that when I called three days ago.

She should have.

Me: What do I have to do to get preapproved?

Call Evercore.

Me: Who is that?

They are the ones who do the preapprovals.

Me: Aetna doesn’t do their own approvals?

Not where you live.

I call Evercore. A recorded voice says, “What is your case number?”  I don’t know. Representative! “What is your case number?”  I don’t know. Representative! “What is your case number?”  I don’t know. ARRRGHH!!!

I call back Aetna and tell them I can’t reach Evercore. They need a case number before the automated voice can proceed.

Aetna: What’s a case number? Never mind, let me try. Please hold. Minutes pass. The rep comes back. I can’t reach them either, and your doctor won’t call me back. Now everyone is closed.

Me: I’m not closed. The test is tomorrow.

We should wait until morning and try again. You really should have called sooner. It normally takes 2-3 days to get a preapproval.

Me: I DID!

Oh, yeah. Here it is in the record. Weird!

An hour later, the UCLA imaging department calls.  Did you get a preapproval?

Me:  No. Aetna/Evercore couldn’t get my doctor to call them back, and they say preapprovals require three days to process. They only received an email from you yesterday.

Why didn’t you request it sooner?

Me: ARRRGHH!!! I wasn’t supposed to. Plus, neither the doctor’s office nor Aetna ever said they needed preapproval for this test.

Well, don’t worry about it, even if it is preapproved, after you get the test, and we submit the claim, it will be denied.

Me: What?

It happens all the time. A patient has the test done, we submit it, they deny it, and then the patient has to pay the full price $410.

Me: Even if the test is preapproved?

Yes

Me: What do you suggest?

Forget insurance. Take the self-pay option, and we can discount it to $275.

Me: This sounds like a scam.

(Pregnant pause) What do you want to do?

Me: Cancel the test, die of a stroke, then come back and haunt all of you forever.

(PS: I never got the scan. I wish I could tell you that this story is made up. Some of it is, but not much, and the names have been changed to protect the guilty.)

 

 

 

 

 

 

 

 

 

 

Fountain of Youth Discovered…

I’ve done it. I’ve discovered the fountain of youth. I have succeeded where Ponce de Leon failed.The fountain is in southern California. But, there are no sacred waters to drink; no special potions to swallow. All you have to do is move here.

Don’t believe me? Ask anybody out here who is not a native. When did you arrive in Los Angeles? They will likely say…”Oh, I haven’t been here that long. I think it was around 1989.”  And you will say, “Dude, that was 26 years ago.” And they will say, “But I look and feel the same as the day I arrived.”

There are several reasons I think L.A. is the fountain of youth: everybody exercises, lots of sunshine, emphasis on healthy eating habits, nobody smokes cigarettes, or lays in the sun, plastic surgery, liposuction, and the number one reason…no seasons.

That’s right, you may celebrate your birthday every year, but without any seasons, there is no sense of time passing. No changing of the leaves on a palm tree. No cancelled school days from snow. No cold winter’s nights in front of a fire. No spring awakening with plants and grass sprouting from the ground, Every day is the same!

I’ll use myself as an example. I moved here in 2008 and took this picture. Here is a picture I posted in 2015. Exactly the same!  

So if you want to live forever and never change, come to L.A. or San Diego. Give me a call, I can recommend some nice neighborhoods.

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Richard Allan Jones is the author of the comic/adventure novel, “DRAFTED” and the soon to be released thriller, “Identity Check.”

Ten Signs That You Are Getting Older

I’m getting older. Yes, I know we are all getting older, but at some point (40s – 50s) you realize you are on the downhill side of life. Not only is your age telling you this, but I have observed there are also definitive clues that you are approaching the end of the conscious part of the journey. In this blog, I have attempted to capture the ten most telling signs that you are about to add “senior” in front of the word “citizen.”

1.  Your Body Is Changing

Your hair starts to thin, turn grey or white, or falls out completely. This is especially traumatic for guys who believe their hair is the sexiest part of their appearance, and a dead-giveaway to age. Look how important hair was to Elvis or the Beatles. Nobody real believes bald is beautiful, unless it’s on an eagle. The hair that once grew on your head now sprouts from your ears and nose. Parts of your body stop working; and what does work, hurts. Your six-pack turns into a keg. Your skin begins to resemble the prunes you eat to keep your digestive system working.

2.  Your Sex Life Disappears

Remember when you were a teenager? Your hormones ran rampant all the time. All guys had to do to get a boner was just look at their hand. That’s gone now, but with age comes wisdom. I’ve discovered all pleasure is based on pressure & release, so a good BM is just as satisfying as sex, plus you don’t have to shave or brush your teeth.  Having the same partner for years can also kill the sex drive. I suggested role-playing to my wife to spice things up, but she got mad when I showed her the photo of the model/actress selected to play her part.

3.  People Address you Differently

Suddenly you are no longer called Bob, but Mister, or even worse, Pops or Old Timer.  Women get up to offer you their seat on the bus or subway. Restaurants give you a senior discount without asking. People talk louder when they speak to you. Children offer to help you across the street. Friends begin each sentence with, “Do you remember when…”

4.  Your Junk Mail is Different

No longer do you get pitches to go cliff dive in Mexico, climb Kilimanjaro, or earn $$ giving blood, so you can pay the rent. First sign of getting older is an invitation to join AARP, The Association of Retired People. You throw the first few letters away, mentally denying you are old enough to be eligible. After awhile, you start looking at the benefits, like this new dating service they offer. Check this out:

a) Lifetime supply of Viagra to the first 30 men to sign up (not much financial risk here considering the average member’s age).

b) Money back guarantee if your partner dies before the end of the first date.

c) Discounts on hearing aids, ambulances, bridgework, and coffins.

5.  Senior Discounts Abound

Not only AARP wants to offer you discounts. I can get 20% off my bill at Denny’s. But if I’m already worried about dying early, why would I want to eat at Denny’s? I appreciate the savings, but why don’t they offer discounts on stuff I really want to buy…like big screen TVs, medical marijuana, or hookers?

6.  Start Receiving Offers to Pre-pay Your Funeral

Really?  Why would I want to do this?  If I give you my money now, will I get a better plot?  Maybe one with a view?  They say the logic behind the concept is to eliminate details at the moment your loved ones are consumed with grief. Are you kidding? My kids will be out hitting the bars, celebrating finally getting their hands on the rest of my money. Besides, I want to be cremated. Of course, they offer a package for that as well. Do I get my money back if I die in a fire?

7.  Your Drug Use Doubles

No, not the fun stuff. You take a pill to get to sleep, a pill to wake up, a pill to get excited, and a pill to calm down. Did you ever read the label on these pills? One line describes the benefit, and ten lines are dedicated to the side-effects. “This drug may cause a severe rash, brain damage, loss of appetite and irritability.” That’s nothing…I had those reactions from my ex-wife. The warnings continue…”patient may develop a third nipple, desire to watch Dancing With The Stars; possibly an uncontrollable urge to commit a senseless crime or spend three straight hours playing whack a mole on the Santa Monica Pier.”

8. Financial Advisers Suddenly Find You Fascinating

On a weekly basis, unknown “experts” invite you to a 3:30pm dinner to tell you how to invest your money. When you ask them how they made their money, they respond, “By inviting old people to dinner, and then slowly depleting their nest eggs.”

9. Become Obsessed with Death

Like Woody Allen, you think about death a lot, maybe make a movie on the subject. You turn to the obituaries first in the newspaper to see if any of your friends, or yourself, are listed there. “In memorandum” is your favorite part of the Oscars. You tend to wear a lot of black clothing. You wander through cemeteries admiring the craftsmanship on the carved headstones.

10.  Return to Religion

Maybe you never left, but as you get older you start paying attention. I’m not sure there is a heaven, but why chance it. I know there is a hell, because I spent a week in Cleveland once. If you aren’t sure which one to pick, try the Catholics. A priest can absolve you of any past indiscretions, and at least give you a shot at the Pearly Gates. Besides, what other spiritual leader gets to wear a three-foot hat to work everyday.

Well, that’s all the time I have (for now, not permanently)…

Rich Allan is the author of the comedy/adventure novel, “Drafted,” and a new political thriller, “Party Favors,” coming to a Kindle near you soon.