A letter arrived in my mailbox last week that really brought some reality into my life. It was from CMS, the Medicare company that pays the insurance claims. CMS also sends copies of what it has paid to healthcare providers as well as how much they have forward to the supplemental insurance company.
A purpose of our receiving these notices was to let us know if a claim was approved or not and to let us know just how wonderful Medicare is for us seniors. CMS is hoping, I guess, that if we see any discrepancies, we would report it to them. I've read on other blogs or forums that such reports more often than not go without any CMS action. I do not know if those posts are accurate or not.
Those CMS notices also had explanations of why a claim was denied, why a payment didn't exactly meet the bill, etc. The billing and payment never coincided as Medicare has decided how much it will pay for various procedures. Healthcare providers who accept Medicare must agree to the payment. The notice also contains an explanation of how much of the bill has been forwarded to your supplemental company, if you have one. If not, you could be billed for that balance.
I have been warning for the last two years that the new "Affordable Health Care" law would be disastrous to seniors. We have had several warnings, perhaps the most ominous from then Speaker of the House Pelosi who said the new law had to be passed so Congress could read it to see what was in it.
Now we're beginning to know for sure. First we heard that multi-billions (I heard on Sunday morning that the number was 700-billion) of dollars have been cut from Medicare by the President who warns us that the Republicans would kill Medicare as we know it. Then some of the changes began to come to the surface.
A friend of mine, for example, who is diabetic, had a Medicare approved pump that constantly measured his glucose level and made appropriate adjustments. A few months ago, Medicare no longer paid for his diabetic supplies so he had to switch to the needle route, but the insurance does not cover all his supplies, like the needles.
I have an inserted device called an ICD, a combination Pacemaker and defibrillator for my heart. Another friend was scheduled to get one last January but his doctor told him to move it up to December because after Jan. 1st, the lifesaving device along with the Pacemaker would no longer be covered by Medicare.
I have a younger friend who has parents trying to get into a care facility. She was told that Medicare no longer covers some of the services. Many of us have had our prescriptions changed because of Medicare.
These are just a very few of the hundreds of examples of how Medicare is changing.
One other such change affects me directly now. Sarah Palin warned us this was coming but her statements were poo-poo'd by the government so, of course, many of the multitudes thought she was crazy.
There is a provision that once a senior hits 75 years of age, and I'm there now, claims will be approved or not approved by a "committee." Most cancer treatments, for example, after one reaches that age will be denied. That local committee will examine all other claims, too, to determine if they're medically necessary. At that age, most won't be.
"Aw, come on," you're thinking. "That's just more of those phony scare tactics by people who oppose the health care law." Sorry. They are true. That CMA notice I received earlier for the first time contained, in the exlamation section, a statement that my claims were examined by a local committee to determine if they were acceptable or not.
My health has now been taken away from me and my physician and placed into the hands of some "local committee."
Am I scared? Damned right I am!
Listening to the news shows Sunday morning, I heard how the choosing of Wisconsin's Paul Ryan would destroy Medicare. Ryan will be the Vice Presidential candidate with Republican Mitt Romney. The plan Ryan proposes keeps Medicare for those of us already on it and those approaching it. His changes to save Medicare are only for people under the age of 55.
Check out the cost of your Medicare insurance, especially beginning in 2014.
All I can say is, especially if you are a senior, pay very close attention to the debate over the next several weeks and get all the real information you can get. Right now, I know I'm not ready to "just take a pill."
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