Friday, May 23, 2008

Fighting Time

How difficult can it be to get quality health care in America? Nearly impossible. My good friend Bob describes the scene perfectly: If you make the system as difficult as possible to navigate, a certain percentage of the applicants will simply give up. Reporting from the front lines of this tragic mess, I can tell you that his perception is deadly correct, literally.

I want to share with you what I have learned from battle. First, you must have the proper tools. The most important item to own is a working fax machine with a dedicated telephone line. This is the year 2008. You might suppose that the health and legal industries would depend completely on the efficient and expedient exchange of information electronically. Think again!

I am completely convinced that paper companies underwrite these industries. Absolutely everything is based on paper records. Create a paper document of thirty pages. Print it out and fax it to your lawyer and then your health care firm. You have already eaten up 90 pages of paper. Of course, now you need to file the document into a space-devouring file cabinet. Maybe you also have to send the original to your lawyer and make a copy for your records. There goes another 30 pages of paper and another donation to the postal service of your choice. It is cumbersome, inefficient, wasteful and time-consuming.

Don’t try to fight this methodology. I tried and tried and it is simply a huge waste of time. These industries have never heard of Adobe Acrobat nor do they want to. I’m convinced few of these people have heard of a zipped file and even fewer know how to deal with them. Advancing law and health care just into the electronic second half of the 20th century would be a huge step forward alone. I find all of this infuriating for one very good reason. It wastes time.

Time can be extremely important. If you are old or very sick or both, your use of time can determine your fate. For instance, in the State of Florida, the average time between application and approval for Medicaid coverage is about eight months. Add to this a couple of months of preparation time and thousands of dollars in fees to firms who exist just to prepare your application forms and additional documentation for Medicaid’s review. You can literally die waiting.

Do the best you can but realize your limitations. The system is too complicated even for the professionals to completely understand. Nearly everyone depends on collaboration to do business. American healthcare is certainly not for the faint of heart. You are bound to make mistakes, but learn from them. I did. Try not to be discouraged by Monday morning halfbacks coaching you about every move you make. Don’t get involved emotionally. Follow your heart. Steady on!

Take fastidious records and keep a log book. I keep two kinds of records for each company or entity I deal with. Make collecting phone numbers and names an obsession. Every clue you uncover will be helpful now and in the future. When you are prepared with complete and detailed information about your case, you garner more attention and become a much more effective warrior. Knowledge and connections equal power. Also, keep a chronological record. Always know who you have talked to at what time and what they said. Quote their actions from your records. This simple tip will accelerate your progress. What you know will keep them on their toes. Carry basic information in a notebook to be carried with you at all times. You don’t want to be unprepared if a customer service representative finally calls you back on your cell phone!

Accurate filing of your information and documents is important too. Keep all your paperwork arranged in a system that works for you. Make sure you can access your files quickly. Write down when everything is received and transacted. You may consider using an inked stamp for dating your records. If you want to be quite complete, number your documents but devise a method that allows the inclusion of support documents to existing trails of paper.

You may need to compose additional documents to help you chart the history of companies that have evolved over time. This may require detailed research. I traced an unknown home equity loan to a contemporary firm in this manner. The classical case of this dilemma is the development and eventual consolidation of the old Bell System and AT&T. This exercise is required for your Master’s degree in estate management!

Another major source of anxiety is your ongoing battle with computer automated telephone receptionists especially ones with voice recognition. This problem would make great comedy material if it wasn’t so infuriating and time consuming. Consider the next paragraph as group therapy between myself and my readers. Here’s a typical scenario:

Allow 90 minutes for each call. Be ready to take notes and call up information on a moment’s notice. Begin by dialing the main customer service number of your vendor. Don’t expect to speak to a human being. Most healthcare firms now use computer generated receptionists using voice recognition technology. Your family will think you are possessed as you sit and say, in a staccato voice, No! Yes! Billing! Something else! If you are lucky, eventually a human being will appear and, hopefully, you’ll get some results. Your worst nightmare is the live person transferring your call back up to the top of the sequence and you have to start all over again.

Predetermine your choice of assisted living and nursing home facilities before you become infirm. Visit and observe their cleanliness and practice of hygiene. If possible, try to reserve accommodations at your place of choice now. Learn as much as you can about Medicare. Know what Part A and Part B are all about. When you become eligible for Medicare apply for prescription coverage immediately. There can be out-of-pocket penalties if you don’t! Also, learn about Medicaid and how it differs from Medicare coverage. Each state has an individual system for instituting Medicaid. Discover the requirements for eligibility and plan your finances to meet them.

It is so important to become fluent regarding your care and finances. Once placed in a nursing home, you may be extremely limited in your ability to move elsewhere, especially if your Medicaid coverage is pending. Arrange everything you can while you are still adept and cognizant.

One thing will probably always be true: Involvement with the healthcare industry will consume endless hours of time. Your efforts may often seem in vain. Every once in a while, take a mental health break for yourself. I’m sure you have more than earned it! Do the very best you can. You can run for months, at all costs, and still lose the race. If a place in Heaven is earned, this pursuit could very well be the price of admission.

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