Did I really need that ambulance on the September night in question?

Most Americans, it seems, have been following the hunt for the murderer of United Healthcare exec Brian Thompson. But it’s not the manhunt that has received most of the attention. Instead, it’s the deeply flawed American healthcare system which, to most people, represents the American Healthcare Denial System beholden to Wall Street. Valid medical claims are turned down because they hurt Healthcare United’s bottom line. I shall throw my insurer in there, too, as my family has been denied payment by CIGNA for medical claims. Much of that is related to mental healthcare for my children. I could write a book on our experiences with various insurers as we worked to save our children. I will not write a book -- what’s the point? Inequalities of our system have been going on for decades and will continue.

My experiences with my healthcare claims and those of my wife have been great. Heart attacks, it seems, ring a bell with insurers. Near-death experiences with septicemia also resonate in the corridors of both CIGNA and Medicare. Those were claims made by me, the Widowmaker in 2014 and the septicemia in 2024. Seems as if I have a major malfunction every ten years.

The latest issue took me by surprise. I got a bill from Volusia County Emergency Medical Services for an ambulance transport to Advent Health Hospital in Daytona. They write that Medicare has turned me down for the $894.80 ride and said it was a “ ‘non-covered service’ because it does not meet Medicare’s medical necessity requirements.”

This seems quite odd to me as Medicare has partially covered at least one ambulance ride. In January in Cheyenne, Wyoming, I caught Covid and one cold January night I couldn’t breathe from the congestion and an ambulance took me to the local hospital where they got me breathing again and sent me home five hours later. That met Medicare’s medical necessity requirements.

At the ER on the night of Sept. 9, the Code Blue team was called out as my heart stopped twice  after I had two seizures. Chris said it was quite a sight to see as medical personnel rushed into the room and saved me. My vitals were wacko (medical term) and staff guessed I had a massive infection of some kind and they placed me in a coma for four days.

Pause here to let readers know that my dear wife took a photo of the comatose me and I will share it if you ask nicely and agree to publish my next novel. 

When I came to in ICU, I didn’t know where I was and what had happened. To read the full experience, go to my previous posts here and here. Turns out I had septicemia from an unknown source and it blasted my bodily functions such as walking and talking, eating and defecating. I was moved from ICU to a medical floor and then the twelfth floor which Advent devotes to physical therapy for stroke victims, the partially paralyzed, and mystery cases like me. I made enough progress by Oct. 4 that Advent released me back into the Florida Wilds and that’s where I’ve been ever since.

I am a lucky man. I am blessed more than I should be blessed. There is one thing I will not be and that is almost $900 poorer because I didn’t meet Medicare’s requirements for sick people. Twenty-five days in the hospital? A quick survey of my hospital history: I spent five days after my heart attack, three days after knee-replacement surgery, and two days following a spinal fusion. I am so glad I wasn’t sick enough in September and decided to take an Advent Health cruise.

Volusia County Emergency Medical Services sent me a list of items I must file for an appeal. They include all of my medical records from the hospital (“you may be required to pay a fee") and “a letter from any physicians you may have followed up with in regards to your ambulance transport.” I can see how daunting this might be for someone, possibly a retired someone recovering at home from a near-death experience.

There is some irony here. It wasn’t the bad guys at CIGNA that turned me down. That mega-insurer is my secondary and they haven’t had a crack at me yet. I pay too much of my pension for that coverage. I also paid for Medicare which is a government program. I should be railing against the stinkin’ gubment, right. Old Joe Biden let me down.

But during my recovery, I’ve noticed that Medicare is concerned about higher costs and wants all of us to use its new reporting system. This addresses higher costs and the millions, maybe billions, of fraud claims by people who should be strung up on the highest yardarm (archaic Navy term). One of the highest costs for patients and Medicare is the abuse/overuse of ambulance services.

Trump’s Project 2025 may be behind Medicare’s new cost-saving initiative. But wait – Trump is busy enlisting nincompoops to head government agencies and getting his ass kissed at Paris’s Notre Dame Cathedral and hasn’t yet assumed the mantles of power.

The only thing left to blame is the USA’s antiquated and rapacious healthcare system. The death of a healthcare executive is a tragedy. And it is tragic that some find humor in it.

Delighting in the suffering of others is a MAGA trait, is it not? What in the hell are we doing?