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SURPRISE! SURPRISE !! SURPRISE!!!

 

Gimme Me Your Card

The Story

A few summers ago I was visiting my cousin at her summer home at Indian Lake. One day she made an appointment with a dentist to have her teeth cleaned since she had not had time to get them cleaned while still at her main residence in another state. I went with her because afterwards we were going to go antiquing.

While sitting in the waiting room browsing a magazine I happened to over hear a one-sided telephone conversation between the office receptionist and who I can only surmise, was a representative of my cousin’s dental heath insurance company.

The conversation I heard went something like this:

What is the yearly limit on dental procedures on her plan? ………………

Will you will pay for more than two cleanings a year………………..

How many crowns?………………………………………Up to $2000 a year……………………only ceramic, not porcelain?…………….

You are saying the plan covers no implants at all………….

What about root canals…..does her plan cover root canals…….only at 80%?……………

Whitening………does her plan cover any whitening?…………..No. OK………

What about……..

I think you get the picture here. The receptionist was simply finding out the total amount of money my cousin’s dental plan would pay out and for which procedures.

When we got out to the van my cousin showed me a detailed written Personal Plan of Action for Good Dental Health the dentist had given her for the coming year. The action plan spent the entire amount of money her dental insurance plan would allow.

SURPRISE!  SURPRISE!! SURPRISE!!!

                                                 
       xxxxx

For Twenty Years No Health Insurance

For most of the last twenty years I have had no health insurance. During that time I was a self-employed independent contractor (SEIC).  For the first few years of being an SEIC  I bought health insurance. But every year the rates went up, the coverage kept declining, and ninety percent of the time claims were denied.

So I made the decision to go without any health insurance at all. Luckily I am very healthy and most years I spent far, far less on my medical bills than I would have on a health insurance policy . So I came out on the plus side.

Medicare ~~~ Show Me the Money

Now last July I became eligible for Medicare. I thought about not joining. My monthly premium would have been far more than my past five year average monthly actual heath costs. The odds were on my side.

However, there are disincentives if you do not sign up for Medicare when you become eligible. So beginning July 1st 2011 I enrolled in Medicare.

These are my impressions of the program.

The program itself  is worthwhile, especially the preventative testing component. I can now get a mammogram and other similar preventive tests like this for a $10 co-pay. I used to pay full price when I had no insurance. This indeed is a  wonderful benefit!

CORRECTION: The paragraph above is incorrect. Medicare itself does not pay for this benefit. This comes from my Medicare Advantage Plan. It is still a great benefit, but is not part of Medicare. I attened a program for first time Medicare recipents sponsored by the Ohio Council on Aging. I learned of my misconception and my mistake in that program. August 15, 2012.

However,…….

the first thing I get asked when I go to any doctor now is, “Gimme Your Card.”  Or as I like to call it,

Show Me the Money!!!

                                                         
xxxxxxx

While I am waiting in a freezing cold tiny cubicle I know the Medicare person is calling and getting ALL the details of my coverage and that soon the doctor will join me in my freezing cubicle and try to talk me into spending as much of it as I can with him/her.

I went to a new chiropractor last fall.  I told them when I first called to make an appointment that only $10 of any chiropractic treatment was covered by my Medicare plan. I knew this because I have read my plan and know what is in it.

I asked how much a back treatment cost. I was told $55.  I said that was OK. And I made an appointment.  I was only in the treatment room for 20 minutes and the doctor did not do anything different than any other chiropractor. In fact, he did a whole lot less. He adjusted my back. Nothing more. He did not say I needed any other kind of treatment. Nor did he provide any.

I paid the $55 after treatment and the receptionist told me she would take care of filing for Medicare. I expected I would get $10 back.

                                                

Imagine my shock when I got a bill from the chiropractor for $135.  There was a notice with the bill that Medicare rejected all but $10 of the bill and I was responsible for the rest of the payment. There was an office call of $55 on the bill and a new $90 charge for a treatment I never heard of, could not pronounce,  and as far as I am concerned never received.

I called and asked what the bill was for and got the usual run around and explanations filled with medical jargon. I was told since Medicare turned it down I was responsible for paying it. It would have cost me far more to fight it. So I paid it.

I have to watch these “professionals” like a hawk.  I have to be extremely explicit with doctors and dentists and anyone else in the health care field as to what they can and cannot do. I also have to ask them dozens of questions to be sure they don’t sneak one in on me like that chiropractor did.

Micro Management

Once I had a $10 Medicare reimbursement denied because the doctor did not write the treatment up correctly. He put the charge on two lines: one line and charge for the office visit and the second line and charge for the treatment. When I called to ask why this covered expense was denied I was told the charge had to be on only one line, both charges combined together.

Well I never knew!!! *Hits head with palm of hand*

I have a Medicare Plan with a yearly out of pocket limit of almost $5000. At the time the $10 covered charge was denied I had spent a grand total of $26.95 toward that limit.

                                                     

Politics

Today we have politicians in Washington who want to cut Medicare because they say people are spending too much money and it is costing the country too much and we can no longer afford to pay for it.

Based on my very limited experiences it is not Medicare recipients that are bankrupting the system. It is greedy doctors who have learned how to game the system combined with greedy insurance companies who game the system too.

                                             

SHOW THE DOCTORS THE MONEY

                                             

eee

Featured Recipe        Raspberry Chicken

This recipe is so easy it is almost cheating calling it cooking. If you don’t tell anyone folks will think you slaved in the kitchen all day. Don’t tell them it is so quick and easy you made it after working all day and picking up the kids after school.

Did I tell you, it is also elegant, scrumptious, and absolutely divine.

This is what you will need for 4 people:

4 boneless, skinless chicken breasts*

1-2 tablespoons olive oil

4 tablespoons raspberry vinegar

2 tablespoon Dijon mustard

1 cup raspberry jam

2 tablespoon honey

½-1 cup fresh raspberries

Salt and pepper to taste

*You will note I only used 3 chicken breasts.

Here is what you do:

To make the sauce combine the vinegar, Dijon mustard, jam and honey in a bowl and mix well. Set aside.

Pat the chicken dry. Salt and pepper the chicken on both sides.

Heat olive oil in a large skillet over medium heat.

Add chicken breasts and brown on both sides.

Remove the chicken. No need to tent it as you will be putting it back in the skillet in a jif.

Turn heat to low and add about two-thirds of the sauce mixture and stir into the pan drippings scrapping up any brown particles on bottom of pan. Set the reserved sauce aside. You will use it after the dish is done cooking.

Return the chicken to pan, turn to coat both sides of the chicken with sauce, then cover and cook until chicken is cooked through, about 20 minutes; turning once at about the half way mark.

When the chicken is done, remove to a plate and spoon some of the reserved sauce over chicken breasts to.

NOTE: I do not use the sauce the chicken was cooked in because the first few times I made this recipe the sauce lost its raspberry flavor during the cooking. So I began reserving a bit of the sauce and use that to pour over the cooked chicken. Voilà! Problem solved. The uncooked sauce has that great raspberry flavor I craved.

Divide the fresh raspberries between the four plates. REMEMBER to give yourself a few extra raspberries. Or in other words: Kiss the Cook!

Serve with some rice or a vegetable and a salad.

Bon appétit!!!

Cost

4 boneless breasts                           $6.04                         

1-2 tablespoons olive oil                   $0.24

4 tablespoons rasp vinegar               $0.84

2 tablespoon Dijon mustard              $0.20

1 cup raspberry jam                        $1.00

2 tablespoon honey                         $0.34

½-1 cup fresh raspberries               $2.50

Salt and pepper to taste

 Total cost = $11.16
Cost per person = $2.79

Quote of the Day

Be more concerned with your character than your reputation, because your character is what you really are, while your reputation is merely what others think you are.

John Wooden

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9 comments to SURPRISE! SURPRISE !! SURPRISE!!!

  • Thank looks divine! Great easy to follow directions. Must try!

  • Dealing with health insurance is a headache. I know what you’ve been through.
    Thanks for the recipe, I’m going to try it tonight for dinner.

  • That chicken looks fantastic!!

    I’m not surprised at your findings and it’s very discouraging. It’s always about the money instead of doing a good job and letting the rewards come from that.

  • Boy do I relate to your story! I, too, have always been self employed and have had to pay for my HI. Last year I dropped it and now am uninsured. On one hand it’s a relief. On the other hand it’s nerve wracking. I’m looking forward to qualifying for MC but I have also heard negatives. Right now it looks better than nothing to me.

    • Roberta

      That is how it has been for me under MC; better than nothing. I am paying far more out than I am getting back. It has been a hard adjustment. And I know, insurance is for when you need it and spread the risk and all that. But still difficult adjustment. Going to an in-service on MC next week. If I learn some thing worth while I will share it with you, Dawn.

  • Thanks Roberta, I would appreciate that.