Medicare Summary Notice....

[Smokin Joe]

Okay, I need to pitch a bitch.

I just got a Medicare Summary Notice in the mail.

They graciously informed me that they would not cover the cost of a blood draw and A1C check done on January 16 (yes, January) of this year.

What's more, they graciously informed me that I have until August 26, 2024 to file an appeal if I disagree with their not covering an A1C test by my medical provider, namely the one that formed the basis for my being diagnosed as a Type 2 diabetic.

At the back of this stack of paper, they informed me they were aware that the notice was delayed and blamed it on a "...recent disruption to our external print and mail services..."
(This was from Noridian Healthcare Solutions, a CMS Medicare Administrative Contractor.)

They further informed me that there is an extension of 120 days from the postmark to gather documentation and submit appeals for disputed claims.

Lovely. There is no postmark, it's presort postage paid! (out of Fargo, ND).

Thankfully the bill is small, paid, and done.
 
RECENT? This stuff is virtually ancient history. The statement covers claims processed from January 30 to April 22 2024. If a "recent disruption" in their printing and distribution chain caused this to be late, there are serious other problems as well.

What is the problem? Have their printers been cranking out Kamala ballots or what?

[jafo2010]

The problem with the federal government is that they support at least 28 different healthcare programs, each with its own bureaucratic mountain of six figure pukes sitting around thinking up new ways they can change their little fiefdom of healthcare.

As one that has spent 20 years in healthcare, the time has come to consolidate these 28 mountains into one.  Why should the federal government have so many different facets of healthcare, each with its six figure pukes for policy, and each with its separate system to process the claims for folks that fall into that facet of healthcare?  Simply not necessary.

The hundreds of billions of taxpayer dollars squandered to support this insanity must end.  It can all be incorporated into one system by adding one field of data, and reduce contracts to support this insanity by tens of billions each year.

[Smokin Joe]

The problem with the federal government is that they support at least 28 different healthcare programs, each with its own bureaucratic mountain of six figure pukes sitting around thinking up new ways they can change their little fiefdom of healthcare.

As one that has spent 20 years in healthcare, the time has come to consolidate these 28 mountains into one.  Why should the federal government have so many different facets of healthcare, each with its six figure pukes for policy, and each with its separate system to process the claims for folks that fall into that facet of healthcare?  Simply not necessary.

The hundreds of billions of taxpayer dollars squandered to support this insanity must end.  It can all be incorporated into one system by adding one field of data, and reduce contracts to support this insanity by tens of billions each year.

I agree. If I wanted a Dead Sea Scroll of my healthcare history, I'd go dig through MY files. What's worse, is that providers have to wait to get paid, to find out that Medicare rejected the claim (for what turned out to be an essential test--my A1C went from 7 to over 13 in three months.). In keeping with that theme, though, there was a screwup and I was not notified for six months (changed providers because mine had moved out of state).

Damn. Just call the Medicine Man and go hit the sweatlodge.

[libertybele]

Our medicare summaries are generally 3 months old if not older.  So far, our secondary insurance has picked up charges, but there are charges that are not covered (supposedly) and I don't know if we are going to be liable.  These are expenses incurred by an approved provider (by our secondary insurance) -- it would seem that the provider should have checked to see if Medicare covered the expenses.

The gov't forces people onto Medicare once they turn 65 which then makes your private insurer secondary.  Either way most pay for Medicare and supplemental insurance.  It's not cheap -- we've met our deductible and we've been notified we could owe ... and it's not a trivial amount .... so we'll see if we get billed. 

[Smokin Joe]

Our medicare summaries are generally 3 months old if not older.  So far, our secondary insurance has picked up charges, but there are charges that are not covered (supposedly) and I don't know if we are going to be liable.  These are expenses incurred by an approved provider (by our secondary insurance) -- it would seem that the provider should have checked to see if Medicare covered the expenses.

It isn't even that I am worried about the bill, really, it isn't that much. But a summary that ends in April arriving in October seems like anything BUT timely.

[libertybele]

It isn't even that I am worried about the bill, really, it isn't that much. But a summary that ends in April arriving in October seems like anything BUT timely.

The summary I just received starts in February -- so -- you are correct it is NOT timely at all. Accruing medical bills that we thought were covered wasn't expected.

[jafo2010]

It's not timely, and it is inexcusable for a patient to be held in suspense for that long.  Same for supplemental insurers of coverage to wait that length of time.  In Medicaid, most states require a 10 day adjudication of a claim by the companies processing the claim.  Should be the same for all healthcare.

[Kamaji]

Ain’t socialized medicine great. 

[Bigun]

Ain’t socialized medicine great.

Hell no!    

[IsailedawayfromFR]

The problem with the federal government is that they support at least 28 different healthcare programs, each with its own bureaucratic mountain of six figure pukes sitting around thinking up new ways they can change their little fiefdom of healthcare.

As one that has spent 20 years in healthcare, the time has come to consolidate these 28 mountains into one.  Why should the federal government have so many different facets of healthcare, each with its six figure pukes for policy, and each with its separate system to process the claims for folks that fall into that facet of healthcare?  Simply not necessary.

The hundreds of billions of taxpayer dollars squandered to support this insanity must end.  It can all be incorporated into one system by adding one field of data, and reduce contracts to support this insanity by tens of billions each year.

Couldn't the states handle healthcare as per the tenth Amendment?

If we do role them all into one, then it should be only to cover federal employees, with the military and the VA having their own healthcare groups.