Humana's response (*2) We'll send you a letter Within the next 30 days

Over the last two weeks I have gotten two (2) recorded messages from Humana's Medicare Advantage organization.

Each time the voice told me that Humana understands my concerns and it will respond my letter "within 30 days."

Is that 30 days from the first phone call or does the second call extend the initial 30 days to 37 or 40 or ?

I have been trying for nearly a month to get the Humana Medicare Advantage organization to answer a really very simple question.

I asked the question via Humana's web site. When I finally got a response it was the usual "We've been busy" (translation: you're stuck with us until December 31 2014 so you're not important to us now) followed words that fail to answer my query.

I ended up writing a paper letter to Humana's corporate office and that, I am certain, generated the "we'll send you a letter within 30 days" phone calls.

This is my first year with Humana; it very likely will be my last.

My previous Medicare Advantage provider was AvMed. As far as communications with its Medicare Advantage operation, I was spoiled. Frequent printed informative materials and email access to the organization's CEO and CMO (Chief Medical Officer).

If contacting AvMed's Customer Server failed to generate a quick, complete response, I could (and did) raise the issue with management. I don't know if either the CEO or CMO actually received my electronic missives, but someone acted on them on my behalf . . . and I never had to wait 30 days for a snail mail reply.

My question to Humana was simple:

Which of the following four Humana Advantage-listed Primary Care Physicians (PCPs) are allowed to refer to the following two Humana Advantage-listed specialists?

I

It seems the PCP I selected was not allowed (he told me) to refer me to my long-time ophthalmologist. Since an optometrist - who I was forced to see before I could get a referral to ANY ophthalmologist - said the developing cataract in my right eye might be ready for surgery - adding that surgery was the ophthalmologist's decision, not his.

Since I am new to Humana's way of doing things I was surprised that any Humana-listed PCP was prohibited from referring ("getting authorization for") to any Humana-listed specialist.

I selected Humana Medicare Advantage largely because it listed my specialists - the ophthalmologist and my vascular surgeon. (The latter performed an open AAA repair; tricky, time-consuming, but effective.) Humana also offered me a roughly $200 annual savings over my previous plan with AvMed.

My first Humana-listed PCP told me that he was not allowed (by Humana) to refer me to my ophthalmologist; the vascular surgeon was referable. Given that, he said, I had two choices:

1. Go to an ophthalmologist to whom he could/would refer

2. Find a new Humana-listed PCP who could/would refer to my ophthalmologist and surgeon.

I opted for Number 2.

The catch was that, PCP #1 said, I would have to either
(a) contact each PCP individually and ask "Do you refer to Specialist 1 and Specialist 2?" or
(b) contact each specialist and ask "Do you receive referrals from one or more of the following Humana-listed PCPs?"

I'm paying Humana more than $100-a-month AND Medicare is paying a substantially greater amount to Humana for "geezer care." That being the case - and, again, never encountering this problem with AvMed - my position was: Not my job.

I'm confident that Humana can, within a maximum of 5 minutes, plug PCP and specialist information into a computer and have it sort who refers to whom.

Meanwhile, the cataract is becoming as "ripe" as a two-week old tomato.

In the end I did some research on my PCP options. Three of the four have lousy on-line references; I discounted these since most people prefer to complain rather than praise (I am not "most people" and I have high praise for my practitioners.)

I made up a questionnaire for the PCP candidates:

Do you refer to the following specialists?

My thought was that how the questionnaire was handled would tell me a lot about the office and, indirectly, the practitioner.

Two of the PCP candidates were located near my favorite medical lab. (My meds force me to visit the lab four times-a-year.)

When I showed up around 10 a.m. there was no available parking. There were a few "Reserved for Physician" slots, but a four-story parking garage and surrounding surface parking was filled to capacity. (I get to the med lab at 7:30 so there is never a parking problem.)

On to the third candidate.

I had the address and I know my city. But I never found the practitioner's office.

On to the last - and most distant from my residence - candidate. This practitioner had no "knocks" on the WWW.

Lots of off-street parking.

I go to the receptionist and explain that I have a questionnaire about referrals.

Immediately I am told to go inside and talk directly with Melissa, the Sweet Young Thing (SYT) that handles referrals.

I present my list and to my surprise I'm told "We refer to all of these doctors." (The list included three orthopedic surgeons.)

When I explained my query about the orthopedic surgeons she volunteered that one of the surgeons specialized in hands and shoulders and one was hips and legs; she didn't know the third's area of interest.

On the way out I asked a waiting patient what she thought of the practice: her response was positive.

I contacted Humana by phone and set Leung Healthcare as my new PCP. I was told I would get a new card in about 14 days. The card arrived the other day; so far the ONLY thing Humana has done in a timely manner.

And, an added benefit with this new PCP's practice: it also works with AvMed.

Meanwhile, I'm still waiting for Humana's promised paper letter.

Why is it? Good doctors, Lousy office help

I've been looking for a new Primary Care Physician (PCP).

I found one; go to How I selected my new PCP to read how I decided.

Thanks to the internet I can learn what other people think about the physicians and their staffs.

Most rate the practitioner "6" or above on a scale of 1 to 10, but most also rate the practitioner's office staff in a minus scale.

Such was the case with my former PCP.

The doctor was a solid "10."

The office staff also was a 10, but a MINUS 10. My spouse is so frustrated with the non-medical staff she is threatening to abandon the PCP. I have complained to the office manager on more than one occasion; I get promises, but no improvement.

Maybe it is just PCPs that can't seem to hire competent people.

My specialists do better - much better.

Do the specialists pay their non-medical staffs better than a PCP?

Do they have less patient load (probably).

My vascular surgeon has a non-medical office staff of three. They work for 3 surgeons.

They are competent and personable.

My ophthalmologist has a larger office staff to support two doctors and a large technical staff. While there has been some turnover during the last several years, the non-medical staff remains competent and personable.

I just "researched" four prospective PCPs. Without exception patients complained about the non-medical staff. (In once case, they also complained about the practitioner. When the complaints greatly outnumber the kudos it's time to take them seriously.)

The question is: "Why are PCP administrative personnel rude and incompetent?"

One reason advanced is that the PCP's practice is so large - possibly thousands of patients - that the non-medical staff simply is overwhelmed.

The question then becomes: "Since the practices live on insurance payments, why don't the insurance companies, and Medicare where Medicare is accepted, threaten and then remove the practice from the list of providers?" That may be the reason my former PCP was delisted by the Medicare Advantage program I used at the time. Unfortunately, even though delisted, the non-medical staff is, if anything, worse than before.

Granted it is more likely to read complaints about a practitioner and the practitioner's non-medical staff than it is to read compliments. We take good service as a given; when it is lacking, we complain.

A lot of the problems with the non-medical operations in a practice - based on personal experience and on-line reports by others - is simply due to carelessness.

For example: Patient changes insurance provider. When the patient shows up for a doctor visit, the patient informs the receptionist and gives her the new insurance card.

In this particular instance, the insurance card is scanned into the system, along with the patient's mug shot (some places scan a photo ID rather than take a picture).

The patient has some tests performed in the PCP's office and the PREVIOUS insurance company is billed. The former company rejects the claim and the practice goes after the patient: "Your insurance rejected the claim." Duh! Of course the claim was rejected; the practice ignored the patient-provided new information.

Later the same practice managed to send a bill for services rendered to another patient with a similar name. (I'd hate to have these people handing out meds on a hospital ward!)

Years ago, I was an Air Force medic whose "specialty" was "medical administration" - the code back then was 90*30, the "*" indicating the skill level. We were not computerized and had to keep track of every patient in a rather large hospital that served two Air Force bases and a nearby Navy station. We had military, dependents, and VA patients. Some - officers and dependents - paid a daily rate for their stays in the hospital; VA was billed for its patients.

Medical records had to be maintained - on paper - for each patient. Unlike today's PCP, we accepted patients 24*7*365; no "If this is an emergency, call 9-1-1."

Now, while most PCPs still maintain paper folders for their patients, they also keep their records on computers (one hopes the data are backed up and archived in a HIPAA-compliant manner.)

Why is it, then, that in the PCP world there are so many non-medical department snafus? No one would tolerate such sloppiness on the part of the medical staff. Imagine a doctor ordering a medication for a patient and then the doctor's assistant administering a different, perhaps contra-indicated, medication.

To repeat what I suggested earlier, perhaps the insurance companies that pay these doctors need to take a look not only at doctor-patient cost effectiveness (cost is, after all, the primary concern of the insurers) but at the practice's non-medical operation as well.

How I selected my new PCP

I selected four practitioners from the insurance company's book. All were within "reasonable" distance to my residence.

I checked on each practitioner on line. Of the four, only one had no complaints about either the practitioner OR the office staff.

Still, few people go on line to compliment anyone or any thing, so while I took the complaints into consideration, I decided to visit each of the Final Four.

Two are close together and near my preferred medical lab.

10:30 a.m. and ALL non-reserved parking spots near their offices are full. (The medical lab opens at 7:30 so I'm in and out before any doctors office opens at 8 or 9 or ?)

Neither of these two almost co-located practitioners had a majority of "good" patient ratings.

I never found the third practitioner's office.

The fourth practitioner's office was right where I expected it to me. (No need for MapQuest of Google Maps; I know my city.)

Parking? Not a problem.

Walked into the office and was immediately greeted by the receptionist.

I explained that I wanted to know if the practitioner could refer me to several specific specialists.

"Come inside and see Melissa, the referrals person."

Graciously greeted by Melissa, I presented her with my list of specialists to which she said her boss refers to all of them. She even told me which of the orthopedic specialists was the best for my particular problem and why another was not - he specialized in hands and shoulders; my complaint is lower than that.

On my way out I asked a woman in the waiting room what she thought about the practice. She replied my new PCP has been her practitioner for years and she's happy.

The doctor's office is nothing fancy and the doctor himself is hardly a Marcus Welby* look alike, but from what I saw this morning, we may be in for a long, healthy relationship.

How easy was it to change a Humana PCP?

I never found a way to do this via the WWW so I finally broke down and called Humana Customer Service. After the usual Voice Response System's 20 (unrelated to my call) questions I FINALLY talked with a CS rep. It took him about 5 minutes to make the change - which will, as I knew it would, take effect at the first of next month - about the time my new patient ID card will arrive.

Robert Young as Dr. Marcus Welby (right)
and James Brolin as Dr. Steven Kiley.

Humana Medicare Advantage plan But it LOOKED Good on the web

Last October I changed Medicare Advantage providers.

My previous provider cancelled my Primary Care Provider's (PCP) practice.

I was loyal to the practitioner; I credit him with saving my life. On the other hand, the practice's office staff leaves more than a little to be desired; the word "incompetent" comes to mind; if I were not a gentleman I would suggest the old military acronym "SNAFU," but I'm polite so I'll forego the term.

Anyway, for reasons known only to the practice and AvMed, my previous Medicare Advantage provider, the insurer dropped the practice. I was left with several options:

1. Find a new plan that listed my PCP
2. Keep AvMed and find a new PCP from its list
3. Find a new plan and a new PCP

Ever since I signed up with AvMed I checked other plans during the annual sign-up period. I never found any to compare with AvMed, and my experience with the company has been better than pretty good. There were some hiccups, but since I had the email addresses of company executives and since the executives were responsive, all issues were resolved fairly quickly. (The email addresses and snail mail addresses were included in every AvMed customer newsletter.)

But, given that I was unhappy with AvMed's chutzpah to cancel MY PCP I checked out many other Advantage programs in my area. Since there are many geezers in my area there likewise are many plans.

I talked to a Sweet Young Thing at Blue Cro$$/Blue $hield. I rated BC/BS as "greedy." (Providers get substantially more from our favorite uncle (Sam) than a geezer's $104 and change-a-month.)

Humana caught my attention by its incessant advertising on the radio-with-a-picture.

What the heck; I'll check out the Humana site.

According to its on-line providers list, it had my ophthalmologist and vascular surgeon, two practitioners I see at least annually. Surprise, the co-pays to see a specialist were $20 less than AvMed.

I next went through the PCP options and found one I thought would be copacetic. We even interviewed each other before I signed on with Humana. Nice guy. Been around awhile. When I put my John Henry on Humana's dotted line and became a Humana client I named this practitioner as my PCP.

So far so good.

Most Medicare Advantage programs - now including AvMed - require a PCP to

     (a)    Determine if a referral is medically necessary

     (b)    Apply for an authorization to refer the patient to a specialist or for more than routine lab procedures

     (c)    Refer the patient to the specialist (or medical lab).

Meeting with my new PCP since I became a Humana client I asked for two referrals, one to my vascular surgeon and one to my ophthalmologist. The surgeon performed an open abdominal aortic aneurysm (AAA) repair and my visit was my anniversary follow-up. That referral was approved.

The ophthalmologist was a different matter.

First I had to have a refraction by an OD (optometrist) and then if the PCP was satisfied that I needed to see an ophthalmologist he would appeal to Humana for authorization to allow me to see an ophthalmologist.

The OD told the PCP that he considered my cataracts ripe for surgery.

Then the PCP told me he could not refer me to my ophthalmologist.

Why not? The man is listed as a Humana provider - TWICE.

"Well," the PCP said, "Humana tells me to whom I can refer and your ophthalmologist is not on my list."

LUDICROUS !

My Humana PCP is prohibited from referring me to a Humana-listed specialist.

The PCP called me at home and explained his situation and offered me two options:

1. Accept a new ophthalmologist, one to whom the PCP could refer
2. Find a PCP that could refer to my ophthalmologist.

In the latter case the PCP told me to check with potential PCPs on Humana's list and to check with the specialists to see who is allowed to refer to whom.

Bothering prospective PCPs or my specialists is NOT the client's job.

Humana has a "Contact Humana" web mail on its site. I used the web mail to ask Humana which of my prospective PCPS could refer to my specialists.

This was the second time I had to contact Humana.. The first time it took three tries before I got a response and an excuse: "We've been busy." Sounds like poor management to this customer.

So - after two weeks, I still am waiting for a reply from Humana . Not a difficult question and one that Humana should be able to answer with little effort.

PCPs A, C, E can refer to Specialists 1 and 2.

I finally gave up and sent a real, paper, letter to Humana. We're about to go into Week 2 of no response (Week 3 for the web mail query).

Somehow I came across the name of a person who claims on LinkedIn that she is the Director of Customer Relations for Humana. UNFORTUNATELY there was no address to contact the woman. Humana carefully hides the people in charge - unlike AvMed.

It's a pity that potential clients can't pretend to be clients to see how responsive the vendor is to customer inquiries. Had I suspected Humana to be so customer UNfriendly I would have stayed with AvMed and paid a slightly higher co-pay for specialist visits and Tier 3 prescriptions. (I don't visit specialists all that often and the difference for a year's worth of my costly meds is $100; overall, a small price to pay to have a Medicare Advantage provider that doesn't hide from its clients.)

If, at this point, anyone would ask me if I would recommend Humana, my answer would be an empathetic NO.

I watched as AvMed dropped and then restored my ophthalmologist so I have some minor hope that it will relist my original PCP. (If only his practice could straighten out the administration side.)

AvMed revisited

Why?

I received a very nice email from Corey Miller, AvMed’s PR and Communications director in Miami who wrote that “I came across your blog and would like to put you in touch with a member of AvMed’s provider network management team to discuss your concerns.”

I’m assuming that AvMed has a program that searches the WWW for mention of its name.

I thought I laid out my concerns fairly well on the previous blog entry, but I responded to the director’s request with a “by the numbers” email (substantially shorter than this entry). Since AvMed apparently monitors the WWW for references to it, this is my expanded answer to Corey’s offer to discuss my “concerns.”

 

The Good

I’ve always liked AvMed. I had AvMed coverage in the 80s, long before I came of Medicare age. The company for which I worked had it as its health plan.

When I returned to south Florida I was working and had coverage from the employer. Then my job was eliminated and with that, my health coverage.

When I signed up for Medicare, I checked out several Medicare Advantage providers. AvMed got my business partly based on my past experience with the company and partly because the sales person seemed to know what he was selling.

What I FAILED to check was to see if my Primary Care Provider (PCP) was on AvMed’s list of providers. He was not, and I was forced to find a new PCP. I did, but it was not a happy arrangement. Then, at the beginning of 2011, AvMed took on Dr. Pepe & Associates and my PCP, Dr. Eduardo (Eddy) Perez-Stable was available. I was back in a flash.

What make’s Dr. P-S special? He listens, he’s an excellent diagnostician, and when action is needed, he acts.

Between January of 2011 and October 2013 I’ve had two surgeries: an open Triple A* procedure at Hollywood Memorial Regional and repair of an umbilical hernia that resulted from the Triple A surgery. (The is a 20% to 30% chance of a hernia after the Triple A; I was a 25 percenter.)

Also between January 2011 and October 2013 I made twice-a-year visits to an ophthalmologist; I have developing cataracts in both eyes and my high (albeit controlled) blood sugar has the eye docs checking for diabetes. (So far no signs of diabetes have been found.)

When I was over charged by an AvMed/Delta dentist, AvMed pressured Delta to pressure the dentist to refund the over payment.

When the hospital billed me for 3 days (over my 5 free days), I complained to AvMed and the charge disappeared. (I was discharged during my free days.)

At the same time, being a good AvMed client, I recommended it to a number of people; I know several who did sign up with AvMed and with my PCP.

 

The “not so good”

When I made my first appointment in 2012 with my then ophthalmologist, Dr. Alan Mendelsohn of Eye Surgeons and Consultants I learned that AvMed had delisted him.

Fortunately, his practice partner, Dr. David Goldberger was listed with AvMed so I could at least stay with the practice.

At the end of 2012, Dr. Goldberger was delisted. I had to find a new ophthalmologist on AvMed’s list.

When calling around, several ophthalmologists told me they wouldn’t know if they would be listed with AvMed until March of 2013.

I found a new ophthalmologist and paid to have my records forwarded to the new practice. The new practice was “OK,” but it was “less comfortable” than Eye Surgeons and Consultants, lacked Sunday appointments (a major convenience), and was substantially farther from my residence. (Driving with dilated eyes in Florida’s sun is no picnic.)

I received a letter from Eye Surgeons and Consultants in September informing me it had been relisted by AvMed. I was delighted.

This month, October, 2013, I received a letter from my PCP’s practice telling me that AvMed had delisted the practice. I had a choice: I could

(a)   Stay with AvMed and find a new PCP or

(b)   Sign up with one of the four Medicare Advantage plans that listed Dr. Pepe and Associates.

I also could sign up with a PPO, a Medicare Supplement plan, of go back to "original" Medicare, although the letter failed to mention these options.

Since I see my PCP three or four times-a-year – and I owe my life to his diagnostic skills and ability to listen to the patient - the decision for me was a no brainer: good bye AvMed. Several of the people who followed me to the practice and are Dr. Perez-Stable’s patients also came to the same conclusion.

 

So

Given my medical history and knowing what lies ahead, AvMed’s delisting of yet another of my physicians has me checking with the four insurers who still list my PCP’s practice. I want to keep my ophthalmologists; they specialize in cataract surgery. I need to keep my vascular surgeon – I have a follow-up with him and a small iliac aneurism that will need attention “someday.” I want to keep access to Hollywood Memorial Health System facilities; the food’s horrible, but the care is great.

Fortunately, the four insurers who list my PCP’s practice all want my business so I am getting some replies to my “do you list” queries. Unfortunately, so far it seems that only AvMed had the desired “line-up.”

Even with its plan changes, I would have stayed with AvMed; I had every intention of renewing until I received the letter from the PCP’s practice.

I simply have too much invested in my PCP to abandon the practice. If I means going with a plan that lacks my specialists, I will reluctantly do that.

I’m fortunate. I have basic computer skills and the time to research my options. I feel for the people who lack the skills and access to the WWW. If I’m frustrated by AvMed’s move, imagine others that lack my mellow disposition.

I’m really sorry that AvMed, for whatever reason – and I am reasonably certain it was not a medical reason – delisted my PCP’s practice.

Will I go back to AvMed if it relists my PCP? Only if it does so before December 1 (the last day to sign up for a Medicare Advantage program is Pearl Harbor day which, any geezer will tell you, is December 7.

I'm not holding my breath that this will happen.

 

* Triple A: Aortic Abdominal Aneurysm

Iliac aneurism : An aortic aneurysm that extends beyond the aorta into the iliac arteries (the blood vessels that go to the pelvis and legs).

Medicare providers AvMed does it . . . again

AvMed, which promotes long-term patient-physician relationships in its PR, seems to make a habit of making such relationships impossible.

I’ve been an AvMed Advantage plan “member” since 2010.

Before signing on with AvMed I had an agreeable Primary Care Provider, a/k/a “PCP.” He’s an internal medicine specialist (“Specialize; you’ll do half the work and get twice the money” a cutter from my Air Force days told me) – in truth, he’s a General Practitioner (GP) and, I think, a darn good one.

BUT, in 2010 he wasn’t on AvMed’s physician’s list. I found a new, AvMed-listed PCP and went for a visit. I immediately disliked the new PCP, but I was “stuck.”

The I discovered that at the beginning of 2011, my old PCP was now on AvMed’s list so I quickly returned to his office. The medical staff is good; the office staff is not. But never mind.

The other day I receive notice that effective 1 January 2014, AvMed delisted my PCP.

This is not the first time AvMed has played the delisting/listing game.

I have high sugar and developing cataracts. A PCP of several years back told me to see an ophthalmologist to check for signs of diabetes. The result was negative – no signs of the disease. Since, I have had annual or twice-a-year visits with an ophthalmologist.

I had a good one listed by AvMed. Then he wasn’t. But a partner was, so I stayed with the same practice, but with a different doctor. Same office. Same techs and office staff. Different doctor.

Then AvMed delisted the second doctor. I was forced to find a new ophthalmologist and have my records forwarded – at my expense – to the new doctor. The new ophthalmologist is “OK,” but when the old practice advised me that AvMed had relisted my original ophthalmologist – and his partner – I planned to return to that practice come January 1, 2014.

AvMed has provided decent coverage and I have has two hospital stays under its Medicare Advantage plan. All-in-all, I was pleased with AvMed. (I’d had AvMed’s regular policy many years ago as an employee benefit; based on that I selected AvMed as my Medicare Advantage provider years later.)

The delisting of my PCP has a ripple effect on my health care.

I need to find a plan that lists both my PCP and the specialists and hospital I have used since 2011.

This turns out to be borderline impossible.

Last year, when my ophthalmologist was delisted, I tried to find out why. No success.

When I went looking for a replacement ophthalmologist, several told me that AvMed would have its physician’s list cast into concrete only in the following calendar year.

I’m not sure the other plan providers are any better.

One I just checked failed to list the hospital where I have a history, yet listed physicians who have privileges there.

In the end, I may start looking at Medicare Supplement plans that let me have access to any physician or facility that accepts Medicare. Unlike Advantage programs, however, the Supplement programs come at a cost over and above the Medicare Plan B premium.

Of course there always is “Original Medicare” with a Plan D (Rx) extra cost supplement. At least with “Original Medicare,” the patient doesn’t have to play “Find a new plan or provider” every couple of years.

I’m sure AvMed management (thinks it) has a reason for dropping my PCP, but it doesn’t win the plan any friends and it doesn’t promote long-term patient-provider relationships, and that (patient-provider relationships), in the end, is the true “bottom line.”

Promises vs. political foolishness

 

Obama's adventure in Libya

   vs. Medicare coverage.

Bush's misadventure in Iraq

   vs. Social Security benefits.

Presidential peccadillo in Afghanistan

   vs. education and other social needs.

OK, my ox is being gored. I admit it.

Surely, go after Osama bin Mohammed bin Awad bin Laden and his cohorts, but do we need to send in thousands of military personnel on the ground and more thousands to support attacks from the air?

In a word: No.

The Iraq war has been over for some time; Bush II declared it over, remember? Unlike Japan and Germany after the second of the world wars of the 20th century, the locals are more intent on killing each other than they are in rebuilding their county, to which I add: Let the US remove itself from their country so that can get on with killing one another.

As for Libya, what is the US' interest there? Libya contributes only 2 percent of our inflated oil needs. Countries go to war for a purpose, the US' attacks on Libya are based on pure altruism - we have no business involving ourselves in Libya's civil strife. Unlike Egypt - where we managed to avoid military interference - the (Libyan) army has proven to be on the dictator's side; that has to say something to even the greatest Gaddafi hater.

Despite our growing deficit - the US is owned by China, which may account for the US governments continuing to allow dangerous goods from that country to find sales here - the political powers-that-be of both parties continue to make the US the world's policeman.

In the meantime, seniors and others receiving "entitlement" (remember that word, "entitlement") benefits from the US treasury are being squeezed from both ends.

Social Security Cost-of-Living (COL) increases will be smaller and smaller and the eligibility age will climb to - what?

Medicare benefits will be more and more difficult to receive, taking life and death decisions farther from the patient's and doctor's hands and making life-or-death a politico-financial decision.

As an aside, how is it that my Medicare payment that is given over to AvMed, a Medicare Supplement provider, buys me so much more than it would if I let Medicare keep the money? And why are medicines so much less expensive in Canada than in the US? Or how can Target and Wal-Mart and some others charge $10 for a prescription that until those companies' plans came into effect cost much, much more for people on Medicare?

If, as some insist, countries go to war for gain, what did the US gain from its incursion into Iraq?

What has it gained by its adventure in Afghanistan? What benefit will Americans gain from taking sides in Libya's civil war?

Is Gaddafi another Saddam Hussein who tortured his opponents and gassed non-Sunnis by the hundreds? Another Hafiz al-Assad of Hama fame, or his son Bashar al-Assad who carries on his father's "traditions." Perhaps Sudan's Omar al-Bashir of Darfur fame, whom the UN blames for “murdering, exterminating, raping, torturing, and forcibly transferring large numbers of civilians, and pillaging their property.” Bashir’s military campaign has been accused of driving 2.7 million people from their homes since 2003." Or on the other side of the word, is Gaddafi another Kim Jong Il or his despot-in-training son, Kim Jong Un. Never mind comparing Gaddafi with the ayatollahs.

For a list of Parade magazine's pick of the "Worlds Worst Dictators" (of which Gaddafi is at the bottom of the Top 10), see http://www.parade.com/dictators/.

At the beginning of this tirade I asked "do we need to send in thousands of military personnel on the ground and more thousands to support attacks from the air" to eliminate Bin Laden?

No, no, and no again.

What the US should have done - and perhaps should be doing - is sending in a relative few well-trained people to assassinate Bin Laden and his top associates. Navy Seals perhaps? Problem is, finding an American who can infiltrate Bin Laden's inner circle is more than a little difficult; perhaps "renting" an assassin is in order.

Apparently someone in Washington had the same idea; in the May 2nd blog entry, Bin Laden is reportedly killed by a team of Navy SEALs; see http://tinyurl.com/3tsyhmd.

I cannot see the US getting involved in internal conflicts such as Egypt or Libya or Iraq or the Balkans. Iran, because it threatens the world, yes. North Korea the same answer for the same reason. But Saudia or Syria?

It does nothing for the US and after things settle down, the US is hated no matter which side prevails.

And my ox lies bleeding, dying for presidential misadventures.

How is it possible?

I have AvMed's Medicare Advantage plan.

It costs me a few cents less than $100-a-month (we have not had "pennies" since the Brits went home in 1776).

My Primary Care Physician (PCP) co-pay is $0 - zip, nada, effis. I pay $5 for visits to specialists. My medicines are free to me.

How is it then that if I had "original" Medicare I would have to pay more - a great deal more?

On one of my visits to a specialist in January I asked how much would I have to pay if I was using my Medicare card. The Sweet Young Thing did the math and came up with a figure close to $150. I paid $5.

Each month I get three prescriptions refilled at a nearby Target. Cost to me: $0. A one time prescription for special eye drops at CVS was, likewise, $0. My monthly bill at Target for 90-day supplies was, pre-AvMed, $30.

The question is: If AvMed and other private insurers can get me into the PCP for no dollars from my pocket, and if AvMed and other private insurers can get me my prescriptions for zero dollars, why can't Medicare do the same thing?

Medicare gets my $100-a-month and pays it out to AvMed.

Somehow AvMed managed to turn a profit. It did so well it managed (in the face of competition) to lower it's specialist co-pay from $25 to $5.

Back to the prescriptions. In order to have prescription coverage - which I found out is a requirement - there is an ADDITIONAL change by Medicare . . . and if you fail to sign up for (I think) Part D prescription coverage when first eligible, Medicare penalizes you - forever.

The current CEO of the U.S. proposes an omnibus health plan that will "control costs." If Medicare is any example of how the government will control costs, please - I can't afford it.

We DO need universal health care and we DO need to care for those who truly cannot care for themselves.

FOR THE RECORD: I have no interest in AvMed other than being an AvMed Medicare Advantage customer. I cite AvMed only because I know how it works for me.

AvMed member "services?"

 

Sometimes I'm left scratching my head when dealing with "customer service" folks.

I recently sent a copy of a complaining letter to my insurance carrier; the original went to the physician with whom I am less than happy.

The electronic copy went to the insurer's Member Services Department. Like the paper copy, it contained details "by the numbers," details that could get lost or overlooked if I called the insurer's 800 number. Besides, I don't care to listen to elevator music-on-hold for 20 minutes while my call is ignored.

My email to AvMed generated the following scripted and totally useless response.

Dear Mr. Glenn,

We have received notification of your concerns regarding your physician services. Member satisfaction is of utmost importance to AvMed Health Plans and we regret any inconvenience this situation has caused. Please contact Member Services at the telephone number below if you would like to file a formal complaint.

If you have any further questions, please email us or contact Member Services 24 hours a day, 7 days a week at 1-800-782-8633.

Sincerely,

{name hidden to protect innocent}
Correspondence Coordinator
Member Services Department
Phone 1-800-782-8633

I would have thought a written message would qualify as a formal complaint.

There's always next November 15 (when I can change providers).