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?
