Opuscula Ubiquitous Form 17 17 טופס

THINGS ARE DIFFERENT IN ISRAEL, at least for an ex-pat American. 

An aside: Because transliteration is never perfect, this scrivener prefers to write the English-language word in Latin letters followed by the Hebrew word in Hebrew letters: thus > ככה

 

SINCE ARRIVING (THIS TIME) I have spent entirely too much time in a hospital or getting medical tests.

It turns out I have a small malignancy in my left ureter. Eventually it will be removed and, hopefully, that will be the end of my hospital stays and visits.

Over the course of the processes, I have been seen by doctors who work for my insurance company (Macabbi – מכבי) and by doctors who are employed by a hospital.  

USA way

IN THE U.S. with a Medicare Part “C” all-inclusive or “advantage” plan, my primary care physician (PCP) would refer me to a specialist.

If the insurance carrier got involved, that involvement was between the carrier and my PCP.

PCP to me: I’m referring you to a specialist.

PCP to insurer: Insurance company, my patient needs a specialist; this one is on your providers’ list; send a referral to the patient.

Sometimes, the insurance company sent the referral to the PCP and the PCP forwarded it to me.The PCP usually alerted the specialist to expect me to call for an appointment.

In one case I was delayed in making an appointment. The provider called me: When are you coming in?

 

The Israel way

Here, the PCP determines there is a need for specialist intervention, same as in the States.

The patient makes an appointment with the provider.

If the provider is employed by the insurance carrier, the PCP makes a referral and the patient sees the specialist. It’s all in the family.

BUT, if the specialist belongs to a state-funded hospital, the patient needs a referral AND a code on a Form 17 that basically states the insurance company (kupat holim – קופת חולים) will pay the bill.

Two of the first things a new comer learns in Israel are:

1. Savlanute (patience – סבלנות)

2. Form 17 (טופס 17)

Before the specialist outside of the kupat holim can see the patient — more accurately, before the hospital can be paid for the specialist’s time — the patient must have a Form 17 code from the insurer.

Lacking the Form 17, the patient might be billed for the hospital employee’s services

Lacking a Form 17 will not preclude medical care, but it may cause the patient to pay a fee that will be reimbursed by the kupat holim.

 

Just what is ‘FORM 17”

Form 17 is a Financial Obligation Form

The best description I found of Form 17 and its use at on the Anglo-List.com (https://tinyurl.com/xxtjvz4m).

It actually takes things step-by-step.

The Shira Pransky Project (https://tinyurl.com/3au6e4kx) offers 5 Things To Know About Your Kupat Cholim. While it is not “Form 17 specific,” the information is well worth reading.

Emergency care will not be denied for lack of a Form 17.

Once admitted to the hospital, Form 17 goes away for all intra-hospital procedures; e.g., if the hospital doctor determines a CT scan is needed and the hospital has the facility, the patient is scanned with only the doctor’s order; no supplemental Form 17 needed until the patient is discharged.

On the other hand, all “out patient” procedures require a separate Form 17 with the “code” from the kupat holim for each procedure or interview.

Need an MRI? Get a Form 17.

Need to meet with a radiologist? Form 17.

Telephone interview with a cardiologist? Form 17.

Meet with anesthesiologist? Form 17.

 

Bureaucracy vs. efficiency

Bureaucracy wins.

Perhaps because Israel is a nation of clerks — the government employs more people than other industries — bureaucracy is safe and always will prevail over efficiency.

It would be, IMO, more efficient to have a family doctor refer to a service. The fact that the doctor, an employee of the kupat holim ordered the service should guarantee that the service will be paid by the kupah.

The patient should never be bothered to run around to get a Form 17.

Israel is an “SMS” nation, a country that expects everyone to have a mobile phone with Short Message Service (SMS or text messaging).

SMS is the primary form of communication between the kupah and the subscriber (patient) and between the non-kupah vendor (hospital, diagnostic center) and the patient.

Fortunately, if the patient’s Form 17 code failed to arrive before the patient arrives for the service, an SMS message with the code satisfies the vendor.

It sounds efficient, but compared to the U.S. process that normally does not require patient input, it is sorely lacking.

Admittedly, when I had a referral in the States, I printed out the insurance carrier’s authorization and carried it with me to my appointment; just as "CYA" since the vendor should have received the authorization from the insurer.

There I had a printer. Here I have a SMS-capable mobile phone.

SMS is efficient and as long as vendors accept SMS messages, a printer is not necessary.

But having the patient chase after a code from the insurance carrier — when the physician has a contract with the insurer and usually someone who daily deals with the insurer to get insurer approval for a process, the patient should be free of this task.

It’s an old truism: It’s not WHAT you know but WHO you know, and having an on-going relationship with an insurer and service provider expedites things and reduces errors.

If the patient has special requirements, e.g., a walker taller than the usual height, then the patient and the office person who deals with the insurer need to work together.

 

Paperless office?

Not in my lifetime.

SMS does eliminate some paperwork.

But having just signed a dozen times during one pre-operation session at a government hospital, the future of a paperless office is still in the distant future. (Banks are a little better, but a real estate transaction in Israel can cause writer’s cramp. Five pages in the U.S. to sell a house vs. more than 20 pages in Israel to buy an apartment.)

Granted, this scrivener is a curmudgeon and I prefer paper. It doesn’t (usually) get DELeted by accident as an SMS message or email might. It is (for me) easier to read.

But why should a patient have to deal with a form that requires a code from the doctor’s office.

Even if the form is sent to the patient as an email or SMS, it should not be the patient’s job or responsibility to chase down a code for a form used between the doctor’s employer (the kupah) and the service provider.

Israel is a nation of clerks. Let the kupot (health insurers) add one more clerk to handle doctor-to-provider documentation and left the patient try to get well.

 

Will it change?

In a word: No.

There is an organization that claims to help new comers navigate the system.

When it was suggested that one thing the organization might consider as a project — especially since the organization’s founder is a former member of Knesset — the reply was “It’s always been that way.”

Inertia.

 

After thought I know it will sound like “sour grapes,” but I had far less trips for tests when I had open abdominal aortic aneurysm (AAA) repair and even less for hernia surgery.

To be fair, the hospital (Hollywood Memorial a/k/a Regional) had my medical records and the records followed me from doctor to doctor.

My surgeons' referral persons handled everything with the insurer at the time. All I had to do was show up for the Grand Opening.

 

THAT IS HOW IT IS SUPPOSED TO WORK.

Will progress ever come to Israel?

Will we ever have world peace?

 

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Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.

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Comment on Form `17 – תופס 17

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.

A Geezer's Trials & Tribulations

Medicare "Pick-a-Plan" time again

It's a frustrating time of year for geezers - that's anyone of Medicare age.

It's the annual time to "Pick A Plan."

I have a pretty good plan. I like my Primary Care Physician (PCP), a fellow by the name of Eduardo Perez-Stable. He's a Family Practitioner which, as a geezer, I translate to be "general practitioner" or "GP." I've got a lot of respect for GPs and this one in particular.

(When I was in the Air Force, back when Orville and Wilber were testing the winds at Kitty Hawk, NC, a surgeon told me that if I ever went into medicine - I was a corpsman then - I should specialize because, he said, you work half as hard and make twice the money. The guy was a gas passer and cutter and only slightly crazy, but that's why most GPs became Family Practitioners or Internal Medicine specialists.)

Anyway, I had my PCP before I had my Medicare Advantage program. When I joined The Plan, he wasn't a provider and I was forced to find a new PCP. Shortly thereafter I discovered that he had signed on with my Advantage plan and I immediately went back to his office.

Now, when it comes time to renew with The Plan I make certain that Eduardo Perez-Stable still is on the PCP list; if he's not, I'll go elsewhere.

The first year I was with this plan I had a really good ophthalmologist.

But he got dropped.

However he had a partner who the plan deemed acceptable.

Effective January 1, the partner no longer will be a plan provider, so I have to find a new ophthalmologist. Since I have borderline diabetes and since I am developing cataracts, it's in my best interest to keep the same physician over the long term.

But apparently that is not a concern of the Medicare Advantage provider.

I also am dealing with a cutter and that is "double jeopardy."

The cutter (surgeon) was on the provider list, but he and his partner changed practice affiliations, basically from one hospital to another. My plan has him on its provider list through the end of the year - but after that? When I called the plan's Help line I was told the cutter was terminating his relationship with the plan. The cutter's office manager denies this.

With Medicare Advantage, anything costing more than $9.95 (I'm being facetious) requires pre-approval, "authorization." It took about 3 weeks to get a CAT scan authorized. Question is, was the delay due to the plan or was it due to the cutter's office manager dragging her heels. She told me last Friday she would start the pre-surgery authorization process that afternoon; now, Tuesday, it still hasn't gone to the insurance company, I'm beginning to suspect the problem is with the cutter's office staff.

Less-than-efficient medical office staffs seem a constant in south Florida.

Approvals or not, the surgery - which is not an option - will result in a long-term relationship with the cutter; not just a few weeks or months, but annual checks. I would hope he and the Medicare Advantage provider can put the patient first - that's me, by the way - and engage in their own long-term relationship.

Of course there are other cutters who can read my records. I've moved around the country and transferred medical records from one doctor to another, but now I'm "situated" and have no plans to relocate.

I've got a good PCP - he actually listens (which is why he's always running late) - and I will sign up for any plan that includes him.

But I don't like hunting up new specialists every year.

To be fair, I don't know if my second local ophthalmologist quit the plan or the plan quit him.

The plan I'm on is pretty good - I compare plans annually - but I really would like a continuing relationship with my specialists. Apparently that is not a luxury I will enjoy.

Political lies

Lies and half-truths are making up many - of not most - political advertisements in this campaign season.

If you have eyes to see and ears to hear, there is no escaping from the advertisements.

One example that effects all legal Americans is Medicare.

Pretty much everyone - from the Government Accounting Office (GAO) to the man and woman in the street - knows that Medicare as we know it is doomed. It will run out of funds. How soon is anyone's guess - some say within a few years, others within a decade.

There's no argument that Medicare's future is limited; it's demise is imminent.

President Barak Obama's campaign tells us Mitt Romney is going to end Medicare.

Period.

Seniors will be left on the medical garbage heap.

Trouble is, that's both a half-truth and lie.

Romney and his figure-crunching VP candidate, Paul Ryan , DO intend to try to change Medicare - this cannot be done by White House fiat - BUT, anyone 55 years old or older is "grandfathered". When a 55-year-old "youngster" hits Medicare age, that person will be covered by Medicare as we know it today.

People currently less than 55-years-old - like my sons and daughter, will have a different program, BUT they will have a program.

Let me put this into very simple English.

Medicare as we know it will be around for all those currently 55-years-old and older.

Medicare as we know it will be going away for those currently less than 55 years old. There will be a "safety net," but it will be structured differently.

What about Social Security?

It, too, is in jeopardy. Not from the Republicans but from the simple facts that

(a) politicians - Mr. Obama among them - have been stealing from Social Security to pay for other government programs; never mind that Social Security was supposed to be sacred, untouchable, and

(b) population - the working world is getting smaller, partly due to the economic disaster with which we still are struggling, and partly because of demographics.

Someone looked at the federal budget and determined that entitlement programs - Social Security, Medicare, etc. - take up the entire Federal budget income. Everything else - the military, the sundry Federal departments - are paid for by selling America to, at the moment, primarily the Chinese (who, in addition to sending shoddy and dangerous goods to these shores and stealing our technology, buy our IOUs at a favorable - to whom? - interest rate).

The person who claimed entitlement programs ate up all of the Federal government's income (taxes and fees) noted that in order to pay our bills - that is, stop borrowing - taxes would need to be much higher.

If anyone looks at countries with cradle-to-grave entitlement programs, they will see tax rates well above 50% of a person's or organization's income.

During World War 2, the Feds put a 10 percent excise tax on certain products - primarily jewelry. That "war time tax" lasted will into my lifetime. Perhaps it's time for another "temporary" tax.

There is advertising talk about a "flat tax" which, Obama's supporters allege, would increase the tax on the "average middle class person" by several thousands of dollars.

That simply does not compute.

A flat tax would set the same tax rate for earned income (compensation for work performed) and for dividends. Currently the super rich and the less rich, including Romney, make their pocket change from dividends and pay a lower tax rate - according to Obama's ad folks, Romney paid taxes at a 14 percent rate -than the working stiffs who pay 28 percent (twice Romney's rate) or more.

If Romney, Bill Gates, Warren Buffett, and others on the Fortune 400 list of richest Americans (see http://www.forbes.com/forbes-400/list/) paid their "fair share" of taxes, in theory, the overall tax rate should go down or, the increased Federal income might be used to pay down our debt (that is, buy back America from the Chinese).

At the same time, does America REALLY need to be the world's policeman? Do we REALLY need to have troops stationed in, for example, England; is the air base in Thule Greenland REALLY necessary in this age of in-air refueling and intercontinental ballistic missiles? (It was necessary in the 1940s and maybe into the 1950s, but today ??)

Does the U.S. REALLY need to send troops into harm's way during a foreign civil disturbance.

(I have no problem with humanitarian aid if we are not expected to carry the full load.)

Do we REALLY need to give billions of foreign aid to countries that prove, again and again, that we cannot "buy" friends - or even reliable allies.

At the risk of offending someone, political advertising is following the Josef Goebbels' philosophy: "the principle and which is quite true in itself and that in the big lie there is always a certain force of credibility; because the broad masses of a nation are always more easily corrupted in the deeper strata of their emotional nature than consciously or voluntarily" (see http://en.wikiquote.org/wiki/Joseph_Goebbels).