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Why is everything going to hell?
Published on September 5, 2015 By Phil Osborn In Current Events

 

12/19/2015  (This is where our medical coverage dollars are eaten by the system)

See also my earlier blog on errors in billing as well as major screw-ups at Social Security regarding Medicare...  http://philosborn.joeuser.com/article/464456/Medicare_FRAUD_-_1-800-633-4227

 

01/24/2016   What a NIGHTMARE!  If Medicare, Blue Shield, and Anthem/Blue Cross are examples of our future, then good bye, homo-sap.  I have spent averaging two hours per day for the past month on the phone, being told repeatedly that my corrected membership cards were in the mail, that Medilcare had been given corrected information as to what plan I was on, only to discover this past week, during a conference call involving an alleged supervisor ("Adriana") from Blue Shield (BS) that in fact all three cards promised by other BS customer support personnel were in limbo and it would require a new special investigation  to determine what had happened to them. 

So, this time I am expected to believe that Adriana has come through and the cards that she personally requested will be coming in 7~10 days.  She even gave us her extension # and promised to call and let me know the tracking number for the card processing.  Promises, promises.  Of course, there has been no callback and the extension doesn't work from the regular customer line, and no one knows a way around that problem, so I am expected to sit and wait for valid IDs again, with no more actual likelihood than before. 

I'm guessing that there is the equivalent of the circular file at BS for any case involving special processing, such as the initial failure to correctly register someone on a plan.  Just keep stringing the victim along until they give up and go away.  The main force of the customer support base is probably temps hired for the "open enrollment," with a much smaller group of supervisors who have permanent status and a limited time budget.  It wouldn't surprise me to learn that I and others who the system has failed get classified as trouble-makers or over-timers within the processing software, and who will realize that anything untoward is going on?  Just a random set of errors, right?  Just a poorly constructed and poorly run complex bureaucracy, right?

On the other hand, my new doctor gave me a prescription for an older drug not on the list of preferred drugs from BS and it took BS from the 18th to the 20th to send me a letter advising me to get with my doctor and come up with a reason for the prescription.  It is clear after 40 or so hours on the phone to BS that they are willing to talk meaninglessly to a customer - me - for any amount of time, but typically with no actual substantive action - or, that is, not until I started filing complaints with both BS and Medicare.

But my new doctor also gave me a list of referrals to specialists to deal with my collection of chronic conditions, only to discover that the medical group apparently did not have me in their system and would not have me authorized for up to 30 days, regardless of assurances from BS to the contrary.  A helpful call from BS actually straightened out that mess, but it is instructive as to BS's priorities.
 
Note that in general, and with rare exceptions, the personnel at all the agencies discussed here and below have been polite and helpful.  The exceptions have been the processing of medical claims at my previous personal physician's office, which is why, along with the attitude I got from Anthem/Blue Cross over the same issue, which was a pure failure of caring or competence, resulting in claims close to $1,000 - why I was vulnerable to the offer from Blue Shield. 

The problem is not the workers or their supervisors, but rather the apparent system problems at all these bureaucracies.  Different groups are responsible for different pieces of the jobs for the same member account - and they don't even have the means to coordinate to resolve problems, when someone fails at simple data entry early on, or fails to note alterations in an original document. What I frequently heard was ~ "Oh, don't worry; it will all resolve itself downstream eventually."  Which in practice became "que sera, sera." 

Too bad for me, but fine for BS, as they operate on volume, there is apparently no accountability, no penalty for failure to do due diligence, no feedback loop to ensure that the contract with Medicare and its roll in guaranteeing various affirmative duties is enforced, etc.

From late-December, a letter to the BS employee who switched me initially from the 65+ plan to the 65+ Choice plan on December 6th:

Dear Lynne L,
 
Here is where we stand regarding my signing up on the "Choice" option:
 
Blue Shield sent me a letter, which arrived on the 18th of December, containing two salient provisions:
 
1. I am, according to Blue Shield, signed up to the Advantage Plus plan, not to the Choice plan, which you promised me would be the one I would be getting.  All our work to walk me through choosing a Choice network physician from the list that you emailed me on the evening of December 5th, after the Choice Seminar put on be Mari R, and all the time you spent answering my questions on December 6th is as though it never happened.
 
2. Also included in the letter, for some unknown cause and from an unidentified source, Blue Shield is claiming that I may owe a penalty, based on an apparent allegation from somewhere of not having had a Medicare or equivalent drug plan during some unspecified period during my initial Medicare eligibility period.  Note that I have had Cigna since April 1 of 2014, together with original Medicare, plus the top of the line supplement plan from Anthem Blue Cross, and prior to that again a full-featured plan from Anthem Blue cross going back about a decade or more, including full prescription drug coverage.  I contacted Cigna and was told that their records show no penalty. 
Returning to point 1 above, as we discussed, I wanted to switch to Blue Shield's Choice plan for two major reasons.  First , with the Anthem/Blue Cross Supplement (A/BCS), there were the horrendous problems with billing errors, apparently sourceable to my personal doctor's office staff. Second, there was the difficulty of finding a high-rated alternate doctor who would accept Medicare plus the Supplement.  Finally, Choice offered added benefits such as transportation to the doctor, etc., which are not included in the Advantage Plus option or my current A/BCS plan.  Everything seemed finalized for us as of that December 6th conversation. 
 
However, a week or so later, I needed to verify who should be notified, and, after contacting my employer's insurance agent, I called Blue Shield to resolve discrepancies, only to be told twice by the answering computer that I was not in the system.  Finally I spoke with a human, who told me that I was not in the Choice plan at all, but rather had the Advantage Plus plan.  I was passed on or called back to a string of Blue Shield employees, who all had different ideas as to what my options were. 

To illustrate how poorly trained these people apparently are, at least one such employee assured me that the city of Santa Ana was not included in Choice, which contradicts the hand-out kits of literature from the seminar as well as the pdf files you emailed me on the night of December 5th.
 
To date, I have contacted Medicare and spoken to numerous reps there, including one lady who urged me to file a criminal complaint, stating as well that she would bump me up to “Choice” on the basis of apparent fraud if I were willing to go through that procedure, as well as more calls to yourself and Mari R and Cigna and Anthem Blue Cross.  No one has called me back from Blue Shield.  The letter that I received yesterday is the only communication I have received from Blue Shield.  I did manage to catch Mari R on her cell phone on I believe the 10th around 4PM, and she and I agreed to talk at 8:30 that next morning, but when I called, all I got was her voice mail and she did not return the call.
 
I am requesting again your help in straightening this mess out.  Otherwise, if nothing changes, I plan on contacting Medicare again regarding filing a complaint, and also perhaps going back to the Supplement plan plus Cigna.  Please get back to me ASAP, as my employer has a right to be upset over the hours of time lost in dealing with this and the company’s insurance agent needs to know what to do as well, plus I do not want to become involved in yet more time lost to dealing with Medicare regarding a complaint against Blue Shield.
 
Thanks for your attention to this. 

12/01/2015  Got handed a letter from Anthem Blue Cross about my medical, raising the deductibles to over 3 thousand dollars.  Problem is: I don't have any deductables.  According to the ABC rep I called immediately, they had been fielding such calls all day long from panicked customers.  A few weeks ago, I called the # on my ABC card for Customer Service and got connected to Cigna directly from the ABC phone #.  Then I got passed around to various employees of either Cigna or ABC, none of whom could figure out what was going on.

And then there is the German diesel scam...  HOW could they possibly have expected no one to notice???

Eventually it becomes impossible not to notice.  The local Tustin Haggen market is closing after 3 months in operation, after buying out the Vons, and the writing was on the wall.  Higher prices and poorer service from a location that already under Vons had had a poor customer rep.   One of my first encounters there was with the new manager, who informed me that I had to leave my backpack at the counter, where it would allegedly be under constant scrutiny. 

"Like the period a couple minutes back, when the cashier walked away completely, right?" I pointed out.  This did not set well with the new manager.  Challenge to authority!  "Backpacks have never been allowed in this or any local stores!"  (An outright and provable lie.  Tustin is a relatively "safe" city, and except for a short period after 9/11, backpacks have always gone with you everywhere. )

I left and consulted with the regulars at the Starbucks next door.  Yes, several of them, who often carry their laptops in their packs on their bicycles, had had similar confrontations with the same manager over the same issue.  I noted that Haggens was laying off employees like crazy.  The StarBuckers added that Haggens had allegedly managed, in three months, to cut their own customer base by 50% from the Vons days.

So, as the publicity and auto-response to police shootings has grown, so have the reports of actual criminals taking advantage of a natural reluctance to face animosity by the police, and suddenly there were multiple burglaries and tagging in the small industrial complex where I rent.  Where we had had a decade of peace, suddenly we had over 20 incidents within a month.  Someone tried twice to kick in the door of my office/storage unit, and ended up destroying the door for no good reason, as there was nothing inside of any value to anyone but me.

So, the landlord proposed a solution.   Do whatever to secure the doors temporarily (Meaning in practice, chain the doors, after buying a drill and cutting a chain hole in the man-door and in the roll-up.   Then hire a UHaul van.  Then move the tons of junk blocking the rollup and store it in the UHaul.  Then change out the door with a new high-security door. 

#1.  UHaul - 1333 S. Main, Santa Ana.  Should be a cinch, right.  Drive a couple miles.  Load everything in.  Fix door.  Load everything back.
Except that the lady who handled the rental did not apparently like me or spending any time at all in the 100-degree heat. 
She managed to screw up the rental contract at least three times. And, she wouldn't answer simple questions, which she treated as an assault, and I didn't notice the low gas gauge because of being distracted by her attitude.  I drove half a mile before I noticed it and drove straight back to no avail, all within five minutes.  I ended up paying $20 for the gas that was missing.  I also had to clean the floor of the van, which appeared superficially clean - until I placed the first white compactor bag and noticed that it had picked up a coating of some kind of oil and black sooty particles that was virtually unremovable.  And there were numerous bondo repairs to the body that were unrecorded.   (This is Santa Ana, where such service is the norm.   Whatever one can get away with goes, and power to overcharge or under-serve is held by the local jefe - store manager, office clerk, etc.)

Meanwhile, my bike ended up in the shop, for various reasons, on August 23rd, I think.  I'm amazed at how long the '83 NightHawk 550 has lasted - a relic of the time when quality meant something.  My motorcycle mechanic is a follower of Pirsig ("Zen and the Art of Motorcycle Maintenance") and offered to help me move after I offered  to give him several NightHawk carcasses that I had been using for parts and now had to get them out of the way - an impossible task, given that my muscles have shrunk about 30% over the past decade since those parts bikes have been sitting.  This guy arrived with his buddy, and at one point picked up a 650 NightHawk - over 600 pounds.

Finally the space was cleared and I noticed that the stock market was getting crazy.   Usually I follow Kai Rizdal's marketplace reports on NPR, but putting in day after day of 12 hours of heavy lifting kind of cut into my free time.  I was wondering how the bubble had lasted so long, what with all the negative news - IS, refugees, China, Ebola...

So, Thursday and time to install the new door, with a new hi-tech super lock.   Except that the installer arrived hours late.  Then he had to force fit the new door, as it was apparently not properly measured.   The installer hammered and chiseled away for an hour or two before he could make it fit, leaving, however wide gaps at top and bottom, as the door was too short by about an inch.  I wonder personally how long the rollup will last now, after all that mangling. Then he installed the new super-lock - on the inside of the door.

In a fatigue haze, I asked him how that was supposed to work?  The lock was inside the door, where I could only lock it from the inside.  Why would I want to lock myself in?   I went out and toured the complex and then came back and showed the installer the other super-locks - all on the outside.  He agreed that he had screwed up, but decided that he also had to attach new weights to the roll-up and the weight location was already full, and he hadn't thought to bring any heavier weights, so that meant that he or someone would have to come back on Friday.  He tried to get me to sign off on the job, but I refused, pointing out - after consultation - that the complex management and owners had ordered the job and were liable.

He came back sometime Friday morning with a new superlock and weights and proceeded to mount the new lock crookedly at the very bottom of the door.   I was so out of it by then that I didn't notice the screwup, which would require me to strain my bad knees in a super crouch or a kneel on dirty tar pavement to operate the lock.  The installer had taped the lock member and keys together, so that simply testing the lock would involve un-taping everything.  Of course, he didn't offer to instruct me or do a trial run, either, leaving open the possibility of catastrophic failure.  So the lock body sits empty and useless.

By then my back was hurting and I faced about 20 hours of pulling stuff back out of the UHaul.  Which I did, and then my mechanic drove me to Urgent Care at Harbor UCC, where the doctor diagnosed me as having back muscle strain, and gave me a pain-killer injection as well as a steroid and a muscle relaxant.  I read the docs on the relaxant and noted that it directly conflicted with my other meds, with a real chance of fatality, so I didn't use it.  The doctor had specifically discounted the possibility of sciatic nerve damage.   The next day, the shooting hot electric pains to my outside left leg started and continued to the present, although they do seem to be subsiding, slowly.  So that leads me to the next system failure - the busses of Orange County...

OCTA is a begrudged system.   The ultra-conservatives who run the county are not happy with anything public and would prefer that the barrios be physically removed to L.A. or Syrea.  Most of the buss users are low income Hispanic, with a fair number of the remainder low-life hustlers, drug couriers and local crazies, as well as a few students.  Connections between the few routes are few and hit and miss, meaning that it typically takes three hours to get to the gym and back, a ten-minute ride on the Honda 550, if I could ride it, which is precluded by my back injury.

I've already missed a couple of meetings as well, and the logical answer would appear to be Uber or the like, but, like so many millions in my age range, I have major difficulty using anything that requires extensive typing on a tiny touch screen.  Arthritis plus tremor make entering an ID difficult and entering a password torture.  I would happily pay extra for voice service, but the market does not seem to have the capability to focus on very many things at once, so that market goes unserved, while China collapses for similar causes, I suspect...

Then my LG phone, barely a year old, started behaving oddly, first with odd red scrawls on the screen, overlaying everything else, then with dropped calls, then one day of overheating, followed by reboots every minute or so.  The local Tustin RadioShack had Boost phones displayed starting at about $100, but I know that they usually have cheaper models in the back that are being phased out, so I asked for them.  But then their connection system was out of order, and I had several hundred Contacts stranded on a phone that could only stay up for seconds at a time.  I checked out what was wrong with my LG, and discovered that apparently all LGs are starting to fail.  Maybe time for a class action?

A week later, as I despaired at Radio Shack as their system would not recognize the LG, we finally tried Blue Tooth, which we had ruled out due to the time factor.  Suddenly my LG stopped rebooting over and over, and we made the transfer.  No stress, right?

Now, apart from my fridge starting to die, and my work losing half of my paycheck, everything is cool...  Wish me luck.

 and the near miss we had with ebola...  to be continued



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