Hey Mr. President, Tally Me My Health Plan (repost, but yeah)

Reposted from July 11. Because yall seem to enjoy this one (& only this one). 😉

Health care. It affects you even if you think you are the healthiest little creature in the whole widely world, because even those of you in high school will be working soon, & will be paying into a system that could collapse in on itself like a giant achey souffle full of boomers.

First I have to say I am terrified that my stupid blog may be the only source of non-popstar-death related news or commentary in the world for a while, so I am sorry I have not paid it more attention for you. The amount of press this nonsense has been given is not worth even an ounce of commentary, so I.

[That was me, dramatically cutting myself off at slightly less an ounce. Did you catch that? You probably did. You are much smarter than I am.]

Anyhow, today Rick was suggesting that in order to prop up Medicaid (whoo boy, more on that later), the rich, who do not like paying taxes (because, you know, the poor line up for it, it’s more fun than fire eating all nude strippers at Disneyland), should be asked to “make a donation” of a million dollars or more to Medicaid every year, & hence have their taxes reduced in that fashion.

I said, “Dude, that’s a tax.”

“No it’s not,” he said. “It’s a donation.”

“Dude. A forced or even suggested donation is a tax.”

“Oh. Well, can they be asked to consider donating…”

“Ok, let me explain the free market economy to you from the rich person’s standpoint. Hi, I am Richy Wigglebottom McHumphries the Third. I have a million dollars. It’s my money. I want to donate it to the charity I choose. I, Richy Wigglebottom McHumphries the Third, happen to want to save abandoned long haired teacup Pomeranians. I like them better than I like little children of races that are not my race. So I am not donating that money to Medicaid.”

“Races that are not my race?”


“Teacup Pomeranians?”


“Did that just come off the top of your head?” Rick asked, laughing.

“Of course it did,” I said, serious as all hell, “Because this shit is always at the top of my head. I am always thinking about this conundrum when I am at work,”

How DO we get everybody to want to pay for other people’s healthcare? Other nations seem to enjoy doing this, enjoy reaping the benefits of it, and don’t really bitch about all that much, These nations are all very cold, populated by hot blonde people, and their dearest ambition in life appears to be getting to the next coffee-oriented mixer. So that might have something to do with it.

People from these freezing cold countries ask me, “Kay-lee, how come in Amereeka, nobody wants to buy me an Einsterzenden Neubauten CD?” Ok, so that’s just one guy. His name was Jan (pronounced Yahn) and he was from Norway, & he called me a fascist because I would not spend every dime of my babysitting money on his CD collection & M&M addiction. But he is a perfect example of how people in America, including English people like me in America, are not into subsidizing everybody else’s wants & needs.

In cold countries, it’s hard to survive. Those people have Viking survival genes where sharing is caring & huddling around the fire (or in the nekkid hot tub) and hacking up a reindeer & roasting it over a spit (nekkid) and forcing guests to drink unholy quantities of coffee (nekkid or otherwise) is extremely important in order to live in those ridiculously cold ass countries. It is now hardwired into their genes to fork over 70% of their money to pay for everyone ever.

Now let’s look at America, a people that, a little over 200 years ago, were being oppressed by a king who had syphillis. There was a lot of unfair taxing, and now American people are predisposed to hating all tax ever for any reason whatsoever. I actually worked with a woman who said to me, and I quote, “I am at the tail end of the boomer generation. I better get my damned social security money & I better get full Medicare benefits,”

I responded, as any sane person would, “Well, barring a plague that only strikes people born between 1945 & 1960, they’re going to have to raise taxes to make all of you happy.”

“Raise taxes?!” shouted the sun spotted, gap toothed, rural Nevadan. “Raise taxes on ME?! I’ll bet them Demmy-crats would like that, them fat cats in Washington.” Because I swear to you, all rural Nevadans talk like Grandpa Simpson.

I said to her, “Wait, you want your benefits, but you don’t want the government to get the money to give you your benefits?”

“Well, they can’t take it from ME!”

And that, right there, folks from other countries, is the problem. Americans are so vehemently opposed to taxes, even the kind that pay for stuff we actually do badly need in this country, that they fail to apply logic to the situation. Tax everybody but me & my kind. Tax Mexico. Tax them fat cats. Um, there’s more of you, moron, than there are fat cats, and the fat cats have better lawyers who find all the loopholes. Lots of morons, so let’s just tax the morons. Well, nobody thinks they’re the moron, do they?

Sigh. So first, you are dealing with a populace that doesn’t want to pay for squat. Living in America, I can kinda see their point. In Nevada especially, paying taxes does not necessarily mean that the canyon that has developed in your street will ever been repaired, nor that literate people will teach at your kid’s school, nor that Medicaid claims will be paid. In fact, it seems to us in the health care industry that Nevadans pay tax specifically so the state can hire people who spend all day denying Medicaid claims for weirder & more frustating reasons.

So Americans don’t necessarily get a lot of bang for their buck. Californians, who are suffering so violently from this economy, are actually getting gigantic state sponsored funeral processions for PRIVATE CITIZENS (ok, just the one) with their tax dollars, so they have every right to be extremely confused as to why they are paying over 10% in sales tax. And MediCal (California Medicaid) fucking blows. I can say this from vast experience with the program. I live ten minutes from California, so we get a lot of MediCal patients. I am happy to explain why MediCal is the 3 Stooges of Health Care if you are willing to read a rant.

How can I put this? When The Governator was running for office, I wrote him a letter. I said I was not an American citizen & couldn’t vote, but I would urge everybody I know with my various powers of persuasion to vote for him if he would just reform MediCal. It is a gigantic money wasting behemoth of nonsense that virtually guarantees no doctor wants to take Cali state aid patients, meaning these people can’t see anybody. What good is free heatlh care if nobody participates? Why don’t we want to participate?

1. The phone books every month. It’s not as bad as it was before Governator took office, but once a month, MediCal sends what is basically a yellow pages to every single MediCal provider. They have a website, but they send the paper updates. That are as thick as a phone book. Is this to prop up the federal economy with postage payments? Is this because the California Department of Healthcare hates trees & wishes upon the world a nice crusty carbon monoxide death?

2. Failure to comply with MANDATORY FEDERAL MODERNIZATION & STANDARDIZATION ACTS. Believe it or not, the federal government has actually done a lot in the past few years to make federal health programs like Medicare & Tricare faster, cheaper, and better. And it’s WORKING. Even reluctant doctors’ offices that bitched & moaned about the upgrades we all needed to make to our systems are now realising that it is actually better in the long run. But MediCal, while paying lipservice to the MMA by adopting NPIs (but still having their own weird PINs, rendering the convenience of NPIs useless), still makes up and enforces their own modifiers. WHY? TO WHAT END? There is no REASON for it except to delay payment, but in the meantime they are wasting even more money mailing out denials, and asking providers to submit appeals ON SPECIAL FORMS THEY PRINT AND MAIL YOU TO…with carbons! Like you can’t do this shit online with Medicare & print as many copies as you need!

Some of you are confused. Medicare is a federal program. Medicaid is a federally FUNDED program, but it is state run. Each state has its own Medicaid guidelines & sometimes calls it a different name. California Medicaid is called MediCal. Nevada has TWO. Southern Nevada calls their Medicaid program SAMI. We’re just good old Medicaid in Northern Nevada.

MMA = Medicare Modernization Act, which dragged Medicare kicking & screaming out of IRS land & into high speed internet wonderfulness. NPI = National Practitioner Identifier. Before NPI, all the Medicaids in the country, Medicare, & all the private insurances all had separate provider IDs. There was no good reason for this except that everyone in the insurance business is a prick. True fact, cannot be disputed. So the federal government actually had the ganas to say, “You know what, this is stupid. Let’s give each doctor in the United States one 10 digit number that works for everything. The doctor must update the NPI database with new info any time it changes, & that will be that.” Well, in theory. NPI is my friend, I love it. I adopted NPI immediately. I was actually the NPI touchstone in town because other offices in town were calling me to ask how to get one & how to use it (which was silly because the website takes you through the whole process easily, but I like to help so whatever).

MediCal has adopted the NPI, but that’s it. And then there’s the stupid PINs, which,again, since they are MediCal specific, renders NPI’s purpose impotent with that program.

Part of MMA was to make sure everybody in the insurance industry was using the same modifiers on codes. For example, if you have an office visit with me (99214) and we do a study on you on the same day, because during the visit it seems like a good idea (93880), we get to add a 25 to the visit so that your insurance knows the visit is separately payable from your carotid ultrasound. It is billed out as 99214-25 & 93880. We are telling your insurance company “Mrs. X came in with headaches & intermittent left sided weakness. After taking a history & physical, we thought she might have some carotid stenosis. Our tech was available, so we had him do a carotid study & we found that she has 80% & needs to be managed to prevent a stroke. You will pay us for both services, please.”

A normal insurance company says, “Ok. That makes sense. Here’s 25% of what you billed. Muahahaha! There’s nothing you can do about it! Muahahahah!”

MediCal says, “Oh no, here is your claim back. 25 is not a valid modifier in the Holy Sovereign Dimension of California. It is not even a number here. In California Medicaid World, it goes 23, 24, BoomBoomPow, 26, 27. Also you need to add ZA and &!# to your carotid study, whatever that is. We’ve never heard of a carotid & we are pretty sure you are making that up. Also people don’t have strokes. You stroke the kitty cat. You do not HAVE a stroke.”

Commence ME having a stroke.

3. DId I mention MediCal’s thing where they have their own appeal forms? They come as a pad. They also have special prior authorization forms but lie about when you need to use them. They also tell you need them after the fact even when they told you that you didn’t need them before. Also, if you want to call their appeals department, you are told they don’t have phones. I shit you not. I actually asked them one time, “What happens if there is a fire? How do they get the fire department to come?” The rep said, ‘Well, they can call out, but they can’t get calls in.” I asked, “What if their child is sick at school, & the school needs to contact the parent, working, I imagine, in your appeals department?” The rep sighed. “We are not allowed to give out the number.” Ah HAH. Fuck me.

4. When you get a denial, it says things like this. “Service is not payable because it is a duplicate of an identical service paid on XX XX XXXX.” It actually says XX XX XXXX. I am not using that as an example. There is no DATE there to take the place of the XX XX XXXX. It’s just XX XX XXXX. Or, you get something like, “Please resubmit claim with an RTD.” This is will be after the NINTH FUCKING TIME YOU’VE SENT THE CLAIM BACK IN WITH AN RTD. Or, you will get this inexplicable charmer: “Claim denied. This provider is not qualified to provide Charpentier services.” WHAT THE FUCK IS A CHARPENTIER SERVICE?!!! And when you call them, WHEN YOU CALL *THEIR* FUCKING CUSTOMER LINE… THEY DON’T FUCKING KNOW!!!!!!

5. Next year, when you DO get a payment, for the 47562 laparascopic cholecystectomy you billed out, that was $2030.00, you get $327.00.


Nevada Medicaid, unfortunately, is going the way of MediCal in this economy. They are pulling the “we don’t recognize that modifier” bullshit & also denying claims but not actually saying why they’re denying them. They don’t even come up with something as creative as a Charpentier service. They just say “Claim denied because: ” and then there’s no “because”.

So Dear Rick, how the fuck do you expect to get rich people to donate $1,000,000 for THAT?! Really?

So Dear Obama, if we’re gonna do a public option, please make Medicare available to anybody who wants it. Medicare only has 2% overhead, opposed to 30% for some private health plans. Medicare patients can see any doctor they like as much as they like for any reason they like. They do not need pre-auths. They do not need permission. They do not have to tell the government what they’re doing (that’s MediCAID, not MediCARE). The only thing Medicare doesn’t cover is cosmetic procedures. And really, duh. Medicare also does not cover drugs well, but I have a solution for that. Get rid of Medicare HMOs. They drain patients dry. They are horrible. They are run by the same assholes that are clobbering you and me with deductibles & copays. Imagine having nice, sensible, nobody-tells-me-what-to-do

Medicare except this time, instead of the patient paying 20% of allowed, add a bigger deductible, and co-pays, oh, and prior authorizations, and have the HMO tell the doctor & the patient that they can’t do a whole hell of a lot.

Stop subsidizing Medicare HMOs. They cripple Medicare. Just abolish them. Completely. Please.

DO NOT put a limit on how much treatment a patient can get, Mr. Biden. You are not a doctor! Medicare does not put a limit on the treatment a patient can get. Medicare has a program for people with end stage renal disease called, you guessed it, the ESRD program. For 31 months, Medicare is secondary to your employer’s insurance, but after the 31 months when you are too sick to work much, Medicare kicks in as primary. People with ESRD sometimes have surgery EVERY MONTH because their dialysis fistulas occlude, they bleed, the caths get infected, whatever. If you limit how often ESRD patients can see their surgeon, you will straight up kill them. It’s that simple.

So those of you Republicanny types that are bitching about one payer healthcare (which the President has NOT endorsed), simmer. Those of you thinking Medicare will be like the government telling you what to do, you are clueless. Medicare is THE most free form plan in America, period. It pays for shit, but doctors sometimes don’t mind because they know they don’t have to argue with a bunch of suits to get a procedure done on a patient. Medicare will deny anything they consider as medically unnecessary AFTER the fact, and NOT ding the patient. It’s true!

So those of you Democratty types that are bitching there’s no one payer healthcare, trust me, that’s ok. Competition IS good, & I have seen shitty HMOs fall apart because employers stop using them & go with better plans. The better plans are like Medicare but pay even better if allowing slightly less freedom of choice. In this economy, however, employers are sticking with shitty plans if they’re cheap, which kinda blows, so @HaemishM ‘s idea about all of us buying our own insurance is a good one.

So Christ. Lemme tell ya. Health coverage has to be more affordable because everybody deserves to be healthy. Everybody. If Americans don’t want to pay for it because they have this knack of dumping things into the ocean when they have to pay too much for it, fine. I don’t want my doctors to get dumped in Tahoe, with the manatees & the Lochness Monsteresses. But that means private plans have to be regulated, which means more government, or maybe less government, but smarter & more direct. Because right now, many private plans are getting away with murder, literallly, because their members are dying from lack of treatment. I won’t name names in writing. Gimme a call if you want me to tell who NOT to send a cheque to every month. And there are some you should avoid like…like a Norwegian who insists you buy him dodgy industrial music on a nigh hourly basis.


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