STATE OF THE STATE: LAST YEAR, REDUX

It took me five months to see an oncologist from Fallon who ran my 2013 Medicare Advantage plan. In 2014, I switched to Blue Cross Blue Shield’s Value Advantage PPO. It came as a blast of clean air. Life has been so much better ever since. Not perfect, but better.

Still, this is a story worth retelling because although the names change, the same situations recur. Right now, I’m going through a similar snafu with the Commonwealth of Massachusetts. It has me convinced that my state is run by morons. Garry says I’m being unfair to morons.

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This story had a beginning and an end. It started when, in November 2012 I gave up my expensive Humana Medigap policy and joined Fallon’s Senior Medicare Advantage plan. It sounded okay on paper.

The customer service person who signed me up assured me Dana-Farber in Milford was covered by Fallon. Untrue. It left me without an oncologist. I was not too upset. I could see my Dana-Farber doctor once more and get a referral from him.

custSVC

Wrong. My oncologist didn’t know anyone at UMass in Worcester which is Fallon’s only cancer care facility in the county.

Even this didn’t faze me. I’m in the maintenance phase. I go for checkups and blood tests. Nonetheless, cancer runs in my family. Mother. Brother. Both maternal grandparents. I’ve had cancer twice. It’s too soon to stop monitoring.

My Dana Farber oncologist said the UMass facility is good, but he couldn’t help me find a new doctor. He told me to call the HMO and ask them who they have in medical oncology with a specialty in breast cancer. I already knew my PCP couldn’t give me a referral.

I called Fallon.

She said — this is a quote: “We do not list our doctors by specialty.”

“What,” I asked, “Do you list them by? Alphabetically?”

I mean, seriously, if you don’t list doctors by specialty, how can anyone get an appropriate referral? This is senior health care . It’s cancer — not rare among the senior set. Not rare among any set.

Dana Farber lobby

I explained I needed a medical oncologist specializing in breast cancer. Cancer doctors are specialized and it did make a difference. No, there’s no such thing as “just an oncologist.” If ignorance was bliss, this was a happy woman.

I explained (again) it would not be okay to send me to “just any” oncologist. I needed a doctor who knew my cancer.

I spent an hour or two being told I needed to go to my primary care doctor for a referral. It was like talking to a robot. Another 45 minutes passed until I was transferred to a supervisor. I retold the story. She said she would “research the problem” and get back to me.

I called my doctor’s office, explained that I hadn’t been able to get a referral from the oncologist at the Dana-Farber, nor could I get a referral from Fallon who seemed to think my PCP should send me to the right doctor. Even though I told them that Dr. S. didn’t know the doctors at UMass, Worcester. I needed help.

A few hours later, my doctor’s office called back and gave me a name, an appointment, and a phone number. The appointment was for just a few days hence, also my birthday. I didn’t want an oncology appointment on my birthday. I called the office.

I got transferred, then transferred again. I ended up talking to Lisa, the administrator for the Breast Cancer Care department. It turned out the doctor with whom I’d been booked was a surgeon Also, they couldn’t do anything without my medical records — scattered through 3 hospitals and a doctor’s office.

Lisa said not to worry, she would take care of it. She did.

She changed the appointment, booked me with a doctor who specialized in my type of cancer, called the various offices and ordered my medical records sent to UMass. Said if I had any kind of problem, give her a call and she’d fix it. Women with cancer didn’t need extra problems. What a difference she made!

My PCP’s assistant called to ask why I’d cancelled the appointment she’d made. I explained that doctor was a surgeon. I’d already been surged. I needed a different doctor. She was pissed because it hadn’t been easy to get that appointment. She could not grasp the difference between a medical oncologist and a surgeon.

CustomerSvcFallonQuote

I explained again I didn’t need a surgeon. I have no breasts. I did need my medical records. She said yes, Lisa from UMass had called, but she wasn’t sure where to send them.

“Didn’t Lisa tell you where to send them?” I asked.

“Yes,” she said.

“Then … why don’t you send them where she told you to send them?”

“But you cancelled the appointment I made!” she said.

“I changed the appointment. Actually, Lisa changed it. Because the doctor to which you were sending me was the wrong doctor. Now I have an appointment with the right doctor. I’m not blaming you. Why are you mad at me?” I reassured her I truly appreciated her efforts.

“Oh,” she said. Not “I’m sorry.” Just “oh.”

“Right,” I said.

I subsequently got many calls from Fallon, all wanting to explain again why I was unhappy with their customer service. I said a patient should be able to call and get names of appropriate doctors and basic information about the doctor. This is fundamental to medical care.

Everyone agreed with me, but I was sure nothing would change. Inertia always wins.

The day was only half over; I was not done.

When I finished the marathon calls to Fallon, I got a call from Humana to remind me I hadn’t made a payment this month.

I hadn’t made the payment because I had cancelled the insurance when I switched to a Medicare Advantage (HMO) program. At the end of November, I had signed up with Fallon, then called Humana to cancel my policy as of the first of the year. I was told that as soon as my new program kicked in, the old policy would be automatically cancelled. There was nothing for me to do.

“Are you sure?” I asked.

“Absolutely,” I was told.

In was the middle of March. Humana was harassing me for money. When they called again, I got a person on the phone,  pointed out I’d cancelled the plan.

The representative said that he could see in his records I’d called to cancel. I’d been given incorrect information. I had to send them a letter. I could not cancel by phone. I said I signed up by phone. Why did I have to write a letter to cancel?

“Those are the rules,” he said.

“I want to speak to your manager,” I said. He explained that the manager would tell me the same thing. I pointed out that I didn’t care, I wanted to talk to a manager. I didn’t owe them any money.

He said I’d have to file a dispute to not pay them. Although it was their fault and they could see I called to cancel the policy, I would have to fix the problem, though they caused it.

I thought my head would explode.

customer-service

The manager reiterated indeed they’d given me incorrect information, but it was my problem. Tough luck lady. I hung up, steam coming out of my ears.

I took a breath, called their other customer service department.

The lady I spoke to looked it up, agreed they had given me erroneous information, contacted the cancellation department and assured me it was fixed. I have a name and a number in case it isn’t. I pointed out they had burned a whole year of good will in an hour. And any further harassment and I’d call the Attorney General and report them for sharp business practices.

It had grown dark while all this was going on and as the day had gone from morning to evening.

How come so many incompetent people have jobs? Why are they working when so many more intelligent and better qualified people are out of work? It’s a mystery.


STATE OF THE YEAR, REDUX, 2013 EDITION WITH UPDATES

A COMING OUT STORY

A few years ago at this time a Facebook status, some stories in the news and a number of You Tube videos on “coming out” compelled me to write on a topic I might have otherwise avoided. 

As you will see below, I could not find a dramatic You Tube video at the time on the harrowing coming out story to which I referred.  I subsequently found it and posted it in a follow-up article.  I have linked it to Angel‘s name here if you would like to see it.  It is a tough 12 minutes.


Despite everything that has been in the news lately, I thought I would shy away from this topic. It is often a political hot potato fraught with emotional arguments that have little to do with rational thinking. There seemed no reason to be another voice among the already countless raised voices. Then I caught a status message on Facebook that got me to rethink my position.

A relative posted a status message that his daughter had put up. As I read through it, I was impressed with the thoughtful counter arguments regarding the opposition to gay marriage, as well intelligent remarks about being gay. I thought I need some of this when the haters start in with their venom.

As I read down the lengthy post I began to realize this was not just a rebuttal to recent actions in the news, particularly the gay marriage ban in North Carolina, but also a commentary by a relative of what it was like to grow up gay. I was totally unaware of the circumstances of her personal life or the problems that it brought her. She did not avoid the most difficult parts of the story, but put it out there bravely for us to see. I was moved by the willingness to try to help people understand by pointing to a personal story.

Unless you are a member of the 1 in 10 who grows up feeling different and alone, it is hard to understand what it is like. You may be picked on at school, bullied by classmates in ways much more hateful than mere childhood teasing. You might find the very thought of going to school as terrifying, and return home each day depressed, perhaps with thoughts of suicide. Recently a 14-year-old boy in Iowa took his own life as a result of the bullying at school and online. “Mom, you don’t know how it feels to be hated,” he had told his mother. He just could not live with it anymore.

What drives people to this kind of hatred? Recently I viewed some coming out stories on You Tube. The story of one young man absolutely stunned me. Angel did not appear to be overtly gay in his video. He told that his coming out was actually an accident.

His father saw him kissing his boyfriend. The boy was often dropped off a block or more from home so his father would not see them. When the father got home he confronted Angel and demanded to know if he was a faggot. Angel knew if he said he was gay, he would get a beating, but he got one anyway. It was a severe beating the boy could hardly survive. When the father had to go out, Angel called for help. He did not call the police, his father was a cop.

He called a hotline and then a family he thought might help. The woman told him to just get out and she would meet him at the corner. He did not make it that far. Bleeding he fell to the ground throwing up blood. He was found and eventually taken to a hospital emergency room. What father would beat his child almost to death because he dared to love someone not of his father’s choosing? Obviously, Angel recovered and was able to tell his story.

Imagine the terror many in the 10 percent may feel, if not for themselves, perhaps for their friends. Will today be the day they are bullied, beaten, or worse? Imagine not knowing who to trust, at home or at school. Imagine not knowing if life will hold anything of worth for you. “Imagine all the people living life in peace.”
Angel has forgiven his father, strange as that may seem. They have even talked since. When I saw his story, I did not have any idea about writing this, so I did not keep track of the You Tube link. I thought I would go back and find it to put at the bottom of this. I searched “A coming out story” since I thought that was the title and I got 149,000 results. For all the young gay people afraid to be who they are, you can be assured, you are not alone. I did find that most of these stories actually turn out well. Some were surprised at the acceptance they received. If you need some hope, search “it gets better.” It is the popular campaign of videos started by syndicated columnist Dan Savage and his partner, Terry Miller. Watch and you will find hope shining through the dark night.

I can not explain to you how people can use the Bible or other religious book to support a position of hate, it taught me that we should love one another as we should love ourselves. If you find it tough right now, for you or a loved one, don’t give in to the haters. It gets better.

http://www.itgetsbetter.org/
http://www.thetrevorproject.org/

Note:  Last year I wrote a short story to dramatize Angel’s video.  I sent Angel a message to ask if it was OK to proceed.  He said it was spot on and to go ahead.  You can read that story here.

SERENDIPITOUS PHOTO STORY PROMPT – 2015 #4 – ON MEDICAL ADVICE

SERENDIPITOUS PHOTO STORY PROMPT –
WEDNESDAY – 2015 #4 – MEDICAL ADVICE

I’ve decided to do this once weekly. I will publish it out every Wednesday (because Wednesday is the middle of the week). Yes, that’s the real reason.

Please try to add your own ping back (links). If you aren’t sure how to do it, put your link in a comment. That works too.

Every Wednesday or until I throw in the towel, I’ll publish a picture and write something about it. You can use any of my pictures — or one of your own — as a prompt. If you find my subject interesting, by all means, extrapolate. Any length is acceptable from a couple of sentences, to a chapter from your upcoming novel.

Please link it back to this post (ping back) so other people can find it.

What do I mean by “story” and “pictures”?

Story. Words. Poetry, prose, fact, or fiction. A couple of lines, a fanciful tale.

Pictures. Video if that’s your thing. Scanned pictures from your scrap-book. Weird pictures from the internet. Cartoons. Pictures of your family vacation and how the bear stole your food. Any picture you ever took and would like to talk about.

SIMPLE

It sounds simple. It is simple. Every picture has a story or ought to. There are no rules. Follow my lead, ignore me, follow someone else’s idea. Any picture plus some text. Short or long, truth or fiction. Prose or poetry.

One final thing: If you want to get notices of these posts, you’ll have to subscribe to Serendipity. I’ll try to title relevant posts so you can easily recognize them.

My effort for this week follows.


MEDICAL ADVICE

I’ve had a hard decade and a half. The past 15 years have featured one life-and-death medical emergency after another. Just over a year ago, I went into Beth Israel Deaconess in Boston.

The cardiac surgeon replaced my mitral valve, performed a bypass and a cardio-myectomy, also known as a septal myectomy. For dessert, they installed a pacemaker because my heart has forgotten how to beat without an electronic reminder.

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I’m much better. My energy is coming back. I’m five-years post cancer — a big milestone for cancer patients. And my cardiologist says I’m doing great.

A week ago, my PCP demanded I show up and have a physical. Since he was holding my prescriptions hostage, I went.

Complaints aside, I’m a compliant patient. I have too many dangerous medical conditions to mess around with anything. So, I whine and bitch, but I take my medications on schedule and in the correct amounts. I am cautious about anything health-related.

I eat healthy. I don’t have much of a choice. Sugar free. No soft drinks. Don’t eat cake. Don’t have chocolate. I have complicated digestive issues after two bariatric surgeries, so there are a lot of things I can’t digest. I eat very little.

Imagine my dismay when my doctor sent me a letter informing me I have high blood sugar. I am “pre-diabetic.” Under other circumstances, I wouldn’t have been surprised. All 6 of m y father’s siblings were diabetic, so I knew it was a strong possibility it would strike me at some point. Having gotten this far, I thought … Well, maybe I just wasn’t thinking.

I’ve been hypoglycemic my entire life. “Low blood sugar” is not the opposite of “high blood sugar,” aka diabetes. Both conditions mean your body doesn’t properly manage sugar, which is why I eat like a diabetic. After all the shit I’ve been through, I thought I was entitled to — if not a pass — at least a respite. Time off for good behavior.

Somehow, I have to lose at least 10 pounds. It’s going to be an epic summer. I really know how to have fun.

YOU’RE JUST FINE!! GARRY ARMSTRONG

This week, I had my six-month checkup with my primary care doctor. I’ve had the same doctor for 15 years. She has seen me through some rough times. She knows me pretty well, physically and mentally.

I’ve been feeling my age recently and was sure it would be reflected in the examination. My vitals were taken, my prescription list tweaked and I received a pneumonia booster.

The doc chatted with me about how things were going at home, with life in general. I mused about recently celebrating my 73rd birthday and not feeling very celebratory.

I explained how my hearing was getting worse. Almost gone in my right ear. “My hearing aids help,” I volunteered, “But not enough.” I told her I didn’t socialize much anymore because of my hearing problems and found it to be demoralizing, if not outright depressing.

The doctor knows Marilyn fields most phone calls because of my hearing. To some degree, my wife is my “handler” in many situations because I’m so hard-of-hearing. I admit here my hearing problems are also the source of unnecessary arguments with Marilyn. She’s a trouper.

I hate the word “deaf.” but that’s probably the reality these days. The doctor shook her head sympathetically as I vented.

The conversation (my jabbering) crisscrossed over the lousy winter, the mediocre (or worse) Red Sox pitching, agitated conversations at home about old movies and too-often-watched repeats.

Frustration with lousy drivers involving a conspiracy to drive me crazy.

Garry with Bonnie and Nan

I’m absolutely convinced there is a conspiracy using high-tech eavesdropping and radio equipment to alert slow drivers I’m about to leave home. Marilyn concurs.

The doctor smiled as I whined. I was sure she could see how my world was turning.

A recheck of my pulse and then another careful monitoring of my heart. The doctor looked up at me with a funny smile, almost like she was flirting with me.

“You have the heart of a 25-year-old”, she beamed. She said I was in terrific physical condition, concluding with a robust: “You’re just fine!”

I groaned and left the doctor’s office.

MY BIBLE BUMP – THE CYST ON MY WRIST, REDUX

I’ve got a bible cyst (also known as a bible bump) on my left wrist. No kidding. It’s not quite as funny as it sounds.

It has been a nuisance for a while. Since the last round of life and death heart surgery, it has moved down the priority list from a serious problem to a minor aggravation. Everything is relative.

It’s been on my wrist for years. It’s annoying. It came and went (typical behavior for cysts) and has made it impossible to wear a watch. Hardly a medical emergency.

This is a ganglion cyst on the inner right wri...

One day, about two years ago, it blew up. Got huge. Too much typing? It hurt when I moved the wrist.

I talked to the doctor about it. He thought I should address the cyst and the arthritis in my hands at the same time.

Before that happened, the cyst deflated — and my heart blew up. It’s two years later. A lot of heart surgery, but I’ve still got the cyst, which still comes and goes. Sometimes it hurts, other times it itches. I live with it. I have bigger things on my plate.

What makes it a Bible Cyst? 

Ganglion cysts, typically located on wrists (though sometimes on knees, fingers or toes) are known as “bible cysts,” alternatively as  “Gideon’s disease.”

Why? Glad you asked. In the good old days, the treatment for ganglion cysts was to give them a hard whack with a heavy book, breaking the cyst and draining it. Since the bible was usually the heaviest book in the house (often the only book), though I’ve heard a full-size dictionary, Oxford or Webster, will do the job just fine. You see the connection, right?

Somehow, getting whacked on the cyst with a heavy book seems a solution I’d rather skip.

Ironically, the old “whack the cyst with the bible” apparently works every bit as well as any modern surgery. Better. Cysts thus whacked rarely return. I suspect the whackee would never tell anyone if it did recur. One bible whacking is probably enough for any wrist.

It gives a new meaning to the expression “bible thumper”!

FIVE PHOTOS, FIVE STORIES – THE CHALLENGE

FIVE PHOTOS, FIVE STORIES CHALLENGE

There is a new challenge called Five Photos, Five Stories.  And I secretly hoped to be asked to participate in it. Looked like it was right up my alley.  Sure enough, Cee at  Cee’s Photography Blog asked me to join!

I have been following Cee and participating in her challenges for a while.  If you aren’t familiar with her and her beautiful work, I invite you to visit her.

The rules of Five Photos, Five Stories Challenge are:

1) Post a photo each day for five consecutive day

2) Attach a story to the photo. It can be fiction, non-fiction, poetry, or a short paragraph. It’s entirely up to the individual.

3) Nominate another blogger to carry on the challenge. Your nominee is free to accept or decline the invitation. This is fun, not a command performance!

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When you have had a lot of heart surgery or other heart-related issues, you develop a relationship with a cardiologist. You don’t get a choice about this. It’s a package deal. They fix your heart, you show up and let them check you out. Because I also have a pacemaker, they also tune me up.

They turn my pacemaker up, then lower it. They take a readout of everything that has happened to me since the last time I was there. The make adjustments, then tell me how much longer I’ve got before my battery needs changing. I’m battery-operated at least for the next 11 to 12 years. I’m not sure whether I find this information reassuring or icky. Maybe both?

It was, overall, an interesting day. When we drove into Boston around noon, nothing was blooming. Not a bush, a tree, a flower. When we began our drive back 3 hours later, the magnolias and dogwood were blooming, and I was cleared to not see the cardiologist for an entire year.

I got the thumbs up. Really. He gave me a thumbs up, said I am looking good, and asked the question we all want to hear: “Have you lost weight? You look thinner!”

I have lost a little bit, and I do look a lot better than I did — which would not be hard.

It was a pretty good day, as this kind of day goes. Traffic was no worse than normal, which means heavy but moving, mostly. We got to the Kenmore Square exit, and it had ceased to exist. The ramp was gone, and the entire area was in tatters. It’s good we used to live around there because they didn’t even have a detour sign up. We went to the Copley Square exit and backtracked through Back Bay and Kenmore, past Fenway Park (how glad we were no game in progress!) and finally, the hospital area.

Without a single wrong turn. Yay, US! Finally, at last, Beth Israel and the worst parking garage ever built. Despite the odds, we found a parking spot — a good one — on the first pass. The lab tech was waiting for me; the doctor was available. And we were out in an hour. Holy moley, it was a miracle.

While we were in Boston, spring arrived in New England. I wish I could have stopped and taken pictures of the blooming trees, but traffic was not cooperative, and the streets of Back Bay and Brookline are not park-and-stop friendly.

The picture was taken from the car window as we left the city via Route 9. Normally a terrible, crowded nightmare of a road that combines narrow lanes, lots of traffic, with limited access … it was pretty good yesterday.

Pretty good. And my battery won’t run out until at least 2026. Imagine that!


I’ll nominate someone to carry on the mission tomorrow. Right now, gotta run!

I’M BANNED!

eyeglasses-displayI’ve been banned from the Vision Center at our local Walmart. Why, you ask? Did I make a scene? Did I do something inappropriate? What could possibly be inappropriate at Walmart?

As it turns out, reporting the eye doctor to Medicare for double-billing was it. You can do almost anything at a Walmart, except report fraud. Never mind that it was fraud.

I know many seniors don’t look at the volumes of paper they get from Medicare. It isn’t easy to understand, but it does give details of what you’ve been billed for, by whom, and how much you can be charged for each service.

I go through the papers. I don’t read every word, but I scan it all. So I won’t be blindsided by unexpected charges. There are a lot of errors in doctors’ bills. Many errors involve “balance billing,” which is illegal. When you are on Medicare, you do not owe the difference between what the doctor charges and what Medicare pays. You owe the amount specified by Medicare.

Doctors’ offices prefer billing for the entire balance, ignoring the amount set by Medicare. Presumably, they hope you won’t know what you really owe and will pay anyway. I don’t have a lot of spare money lying around, so I check.

Eyeglasses by Walmart

Eyeglasses by Walmart

I was going through my husband’s paperwork and I saw a charge for $220 for a doctor I’ve never heard of. I looked up the supposed date of the visit on my calendar. Garry wasn’t at any doctor that day because he was at Walmart, getting an eye test. The bill was from a doctor in a different town about 40 minutes away. Garry couldn’t possibly have been there — and I have the records of payment to prove it.

I called the unknown doctor’s office. I explained I’d found a charge on my husband’s Medicare paperwork for a visit to Dr. P. Explained that I’ve never heard of this doctor and it was impossible for Garry to have been there as he was at Walmart getting an eye exam at the time. For which I had receipts specifying time and place.

“Oh,” said the spritely receptionist. “Dr. P is his wife.” As if this explained everything.

Garry paid $110 for his exam at Walmart. Which was full price, no discount. I might have felt more forgiving if the Medicare charge had paid for — or even discounted — Garry’s out-of-pocket costs, but it was just a second bill from a doctor he never saw. I suggested they might want to cancel the charges as the visit never took place. The young woman explained that they always bill Medicare for a visit to Dr. P when her husband has a Medicare client. At Walmart.

That did it for me. I said, “Okay, I guess I’ll have to discuss it with Medicare.” And I did. So the eye guy at Walmart is mad at me for reporting him. I guess Medicare didn’t ignore my complaint. Go figure.

That’s how come I’m banned from the Walmart Vision Center. When the (same?) spritely receptionist called today, she told me the doctor was upset with me for reporting him for fraud. I said “It was fraud. Sometimes, you get caught. It’s the risk you take when you commit fraud.” She said she wasn’t allowed to discuss it.  I’m a curious kind of gal. A brief internet search showed Dr. P’s office is closed. I’m surprised he is still working.

I will have to go to LensCrafters. I’m banned from Walmart.

PERMANENT CURE FOR “MUFFIN TOP” FOUND!

Marilyn Armstrong:

Nothing makes us feel better about our bodies than accepting them! Great — funny and true — post!

Originally posted on Stuff my dog taught me:

UnknownLike about 99.99% of women, I gained a few pounds as my 50th birthday approached, with most of the weight settling into the inches around my belly button.  I like to think that I am a self-confident woman who knows that beauty is more than skin deep, but something about this newfound roundness just ate away at me.

I started using a phone app to “track” my diet.  In principle, this seemed like a grand plan… enter my weight, set a goal, then eat the number of calories necessary to get to the finish line… how simple is that!?!  Super simple… except that I now spent every minute of the day thinking about food.  It is impossible not to obsess when every bite that goes in your mouth has to be entered into your “food diary”.

Most mornings, this meant that by 9am I was already stressed because a slice…

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