(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . My Medicare Disadvantage Story [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.', 'Backgroundurl Avatar_Large', 'Nickname', 'Joined', 'Created_At', 'Story Count', 'N_Stories', 'Comment Count', 'N_Comments', 'Popular Tags'] Date: 2023-02-24 So. I’m feeling slightly ranty today because Honey is sick again. He’s got sarcoma in a couple spots on his leg (big spots), and if we’re lucky, he’ll be able to walk again at some point. Or so we’ve been told. Short History: 5 years ago, Honey had bladder cancer and the removal of his bladder and prostate managed to turn septic and I almost lost him. He lost a kidney in the second surgery, due to the sepsis, and 10 hours later, they set him up in ICU for a week. Funhouse ride. PTSD on a silver platter. His wound dehisced and we spent literally all summer in the hospital. (Any of you guys who read my comments pretty much know this.) He lost 100 pounds, was discharged to home (because I used to work at those “rehab” places and we said, “No, no, no.”) I literally carried my formerly several hundred pound man into the house, with the help of my son. The entire experience was rather hellish, and it resulted in his being declared 100% disabled. After 2 ½ years (I think), he became Medicare eligible, and we hied ourselves down to the Senior Services office of our local township for some assistance in selection of a plan. I used to do Medicare billing, and I was really good at collecting money, but picking a plan seemed like such a crapshoot. And Honey was on the mend, and you know, supplemental insurance for disabled people on Medicare costs several hundred dollars more than our ACA insurance. Underwriting is alive and well in the supplemental insurance industry; the expense of already being sick is actuaried into the cost. And Honey was healthy, surely the Bad Thing wouldn’t happen again. Some of you “live” (exist) on Disability, and I think it should be called Inability, because we always have a couple of hungry days at the end of the month. So you can see why coughing up nearly ¼ of Honey’s total income might take a bite out of the budget, never mind the food we need, and the lights that we really like to keep on. Why, hello, Rock and Hard Place. Medicare Advantage it was. So we made a decision based on our primary physician and his (at the time small) group practice. I liked our doctor and I wanted to keep him; he’s a good guy, answers my questions through the medical app, will refill my prescriptions, and if I’m sick, I can ask him for a zpack and he doesn’t need to see me. So Doc is perfect for me, who is merely crazy and needs regular meds. Good guy. Tries hard. And now we come to the fun part of this story. It’s been such a riot. December of 2021, Honey had a small lump below his knee and it looked like one of those weirdo veins, so we went to see doc and he said, “Yeah, probably have to see the vascular guy for an adjustment.” MRI time. Imagine our surprise when we read the report and it came back as “possible sarcoma.” My daughter had DFP when she was 18, and everyone was excited about the possible genetic aspect of Honey’s cancer, but Nope was the verdict on that. But it was a definite Yes on sarcoma. Honey is just really sick. And within a couple months following the initial diagnosis, the second lump was found in his thigh. And every medical professional in our Medicare Advantage plan does not seem to want to touch him. Since we read the January 2022 report before Doc could tell us what it said, and I was seeing him for my regular refills that week, I went into the office and asked him to please look at Honey’s test results and please, please tell me why we were still waiting 6 weeks to see a vascular guy when this report clearly said “Danger! Danger Will Robinson!” So what the hell, Doc? We got an earlier appointment with some oncologist who promptly, without examining Honey, said, “Oh, you don’t need chemo, you need surgery.” Off we go to the surgeon, who says, “You don’t need surgery, you need radiation.” By now, it’s April of 2022. Tick tick tick. Honey was diagnosed in January 2022, officially, and here we are, in April, making the rounds of doctors who don’t seem to want to treat him. So we harass his Advantage plan for a second (and 3rd opinion), which came back as something like, “Well, you guys messed up by radiating him first, now it will be harder to remove the sarcomas because of the hardening of the tissue around the site, due to the radiation.” It’s now almost October of 2022. The surgeon sent us to a plastic surgeon (because Honey will need extensive reconstruction on his lower leg, we’re talking bone, mesh, and yet another round of wound vac most likely). Even I know this, and I was a freaking Medicare bookkeeper for heaven’s sake.) This plastic surgeon was completely unqualified to do this sort of thing; she said her specialty was grafting skin onto wounds, and Honey needed more than that. Yeah, thanks for nothing, I knew that, and I just stood up, and started to leave the office. We don’t need Miss Juvederm, we need a reconstructive person who is familiar with this problem. So why this surgeon sent us to someone like that, wasted our time like that, made me think he hasn’t even really looked at Honey’s medical records. Or is Generating Revenue. Oh, yeah, and that last scan (I swear to Gawd, they just put him in a photocopier it seems like he’s had so many scans), showed that the cancer had now crept into one of his lymph nodes. So I definitely think we should fuck around a while longer. I mean, I’ve been married to this guy for 42 years, and I would really, really like to keep him. I’m furious, because they are doing Nothing but watching the cancer spread, as far as I can tell. It took us until last month to get a second (and 3rd) opinion and meantime, I kicked up such a fuss about not having That Idiot Oncologist, we got a new one. In December of 2022. I like her. She is not full of shit, and I think if it wasn’t for her fierce defending of Honey, and her persistence, that appointment at the Fancy Hospital with the Expensive Doctors Downtown Consultation would have never happened. Or the appointment at the Nice Hospital that also isn’t in our group, with a doctor that spent an entire hour with us, and agreed with our New and Smarter Doctor about treatment. He has agreed to supervise from afar, in conjunction with our new Doctor who is not Full of Shit. And wow, does she have a hard-on against her current employer. Seems she dislikes Mismanaged Care as much as we do, and was not shy about saying so. I have never seen a doctor sneer when I said, “venture capital financed this new group, amirite?” and agree that these people are the Kings of Foot Dragging. to which I retorted that it would be really nice if Honey had two feet to drag, too. Treatment starts Monday and it’s going to suck so hard. Chemo is going to be so difficult that he will have to be hospitalized. This isn’t the way, to my mind, that it’s “usually” done, but the honest truth is that the odds suck hard for Honey, and if they don’t nearly kill him first, he has no chance at all. He had port insertion this week and Doc called him last night mentioned possible Monday admission, asked him how he was feeling, and Honey said, “Pretty good considering,” and she said, “Yeah, we’re gonna do something about that feeling good.” Ah, cancer humor. Doc was also sincerely miffed, because the lag time between the appropriate drugs arrival, and the fact that she had to go in front of some Medical Committee of Suits and Bean Counters and justify the way she was treating Honey, the reason he needed admitting for his chemo and every other damn thing that she said was necessary for his possible survival. She also pointed out that they had now been dicking Honey around (she was on speakerphone for this conversation and I almost laughed right then, goodness she was angry!) for more than a year and oh, please, could she have a bed for him that would be open on Monday. She also said not to show up unless she personally called us, because she didn’t trust anyone else to bother. I think the Medicare Advantage plan we selected is just trying to kill him. Today is our last scan before admission (I hope), and if they delay this any more, I’m just going to head down to their corporate office and camp out in their lobby and tell every single person who comes in that it’s taken more than a year for this group to bother to treat Honey, and gosh, I didn’t know that the much vaunted Medical Team that would review Honey’s treatment plan included bean counters and that their Medicare Advantage plan was the worst thing that ever happened to us. If he makes it to 65, we have another chance to switch back to traditional Medicare. Which we will, because Advantage isn’t, and any large group practice that has sucked up nearly every practice around, just to herd you into their group of Doing As Little As Possible Disadvantage Plan is merely looking to make money. And if the bean counters say it’s cheaper, they’ll drag their feet. Too bad that I will cut their legs off at the knees if they do kill him. They will be de-feeted. Thanks for reading. Wish us luck. [END] --- [1] Url: https://www.dailykos.com/stories/2023/2/24/2154735/-My-Medicare-Disadvantage-Story Published and (C) by Daily Kos Content appears here under this condition or license: Site content may be used for any purpose without permission unless otherwise specified. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/dailykos/