I voted

…after I spent about three hours going through paper and throwing it out… ok, like a total numbskull I mislaid my ballot. Have you mislaid your ballot? FIND IT! VOTE!

” …that government of the people, by the people, for the people, shall not perish from the earth.

When I went across the country as a Mad as Hell Doctor in 2009, we talked to people everywhere. I joined the group in Seattle. I had never met any of them and had only heard about them two weeks before. But we were on the road, talking about health care, talking about single payer healthcare, talking about Medicare for All.

Some people said, “I don’t want the government in healthcare.”

We would ask, “Are you against medicare?” “No!” “Medicaid?” “No!” “Active duty military health care?” “No! We must take care of our active duty!” “Veterans?”  “No! They have earned it!”

…but those are all administered by the government. More than half of health care in the US. So let’s go forward: let’s all join together and have Medicare for ALL! And if you don’t agree… so you don’t think you should vote? Hmmm, I am wrestling my conscience here….

We need one system, without 20 cents of every insurance paid dollar going to health insurance profit and advertising and refusing care and building 500++ websites that really, I do not have time to learn and that change all the time anyhow. How about ONE website? How about ONE set of rules? We are losing doctors. It’s not just me worrying: it’s in the latest issue of the American Academy of Family Practice.

Vote. For your health and for your neighbor’s health.

____________________________________________

Physicians for a National Healthcare Progam: http://pnhp.org/

Healthcare Now: https://www.healthcare-now.org/

I can’t credit the photograph, because I don’t remember who took it…. or if it was with my camera or phone or someone else’s! But thank you, whoever you are!

stay or go?

For the Ragtag Daily Prompt: migration.

I took this on a beach walk with my aunt and uncle on Sunday. They were visiting from Virginia. They’ve flown back now.

This is taken with the zoom all the way out. I recognized the great blue heron, but in the first picture I can’t tell what the geese are. With a face in profile in this second photograph it’s clear that they are Canada geese.

The geese are migrating but the great blue heron stays and winters over. Most of our hummingbirds migrate, but the Anna’s can winter over. And I have been asked: stay or go? My landlord asks if I will renew my lease for my clinic in February.

I reply that I am waiting on the US Congress. My clinic is more than half medicare patients. 48% are over age 65. Congress is discussing paying a flat fee for medicare visits: about $43.00 dollars. At the moment I do not see how I could keep my small solo clinic open if that goes through. Stay or go? It is stressful. I want to stay. But I may have to migrate like the geese….

I think a frightening number of physicians would either migrate or stop taking medicare patients, opt out of medicare, if Congress passes this bill. The AAFP is fighting it. I contact Congress too, but I am tired of fighting for single payer, medicare for all. Patients spend more on their dogs’ health than their own. How can I do good care and feel valued for $43.00 per clinic visit?

I thought the thing most likely to close my clinic is the cost of my own health insurance. But Congress may close me down by dropping my payments from 48% of what I bill, to less than 25%. Yet they say they want good care for our country….

Message me if you contact Congress to say do not do this. And thank you so much if you do.

The proposal for medicare changes is 1472 pages. So I am supposed to find time to read that and comment on it in addition to taking care of my patients? What sort of insanity is this?

March for people

My daughter and I marched yesterday.

She decided to come home from college for the weekend, planning to leave Saturday night. I decided not to go to the Seattle Womxn’s march, but do the Port Townsend one and asked her to join me.

We went out to breakfast and then to our small downtown. I no longer have television and look at news sites daily though a bit erratically, so neither of us had a pink hat. I wore my Mad As Hell Doctors t-shirt, my lab coat from working at the National Institutes of Health with the National Cancer Institute Patch, my Rotary name badge and pins gathered from going across the country trying to get medicare for all, single payer health care, from 2009 until now.

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Four bus loads went from our county to the Seattle march. We heard that the Bainbridge ferry was FULL. That is, they couldn’t not take any more walk on people. Another thirty people or more flew to the Washington DC march. And in Port Townsend, my guess is that we still had 200-300 people, women, men and children, people in wheelchairs, babies, gay, lesbian, straight, bi, trans, that marched from a small park downtown to the Haller Fountain. Galetea, naked statue at the fountain, sported a pussy hat.

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Our local organizer spoke and our House Representative, Derek Kilmer.

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Older women spoke about demonstrating over and over in their lives. A friend of mine called me up to help her sing Holly Near’s Singing for Our Lives, making up new verses on the fly. They invited people to speak.

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I spoke: “I am one of your local doctors. I want to be able to treat anyone who comes to my clinic. We are one nation: health care for all. No discrimination: medicare for all.”

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Home then, and tired. My daughter has decided she wants to learn guitar, to play while people sing. I taught her basic chords and basic strumming. We sang Jamaica Farewell. She picks it up immediately, after all of those years of viola. And she will take one of my father’s guitars back to college.

And this is amazing: https://www.nytimes.com/interactive/2017/01/21/world/womens-march-pictures.html?smid=fb-share

Blessings all around.

Physicians for a National Health Care Program: http://www.pnhp.org/

https://dailypost.wordpress.com/prompts/successful/

Bruise, muscle and bone

I asked an older patient recently, “What is a bruise?”

She thought about it and said, “I don’t know.”

A bruise is blood, bleeding. Old blood changes color and is reabsorbed by the body as it heals. But where does that blood come from?

Any tissue in the body can bleed. Even a tooth, if broken into the center.

So what is bleeding for MOST bruises?

Muscle. Muscle, muscle, muscle, tendon, ligament, fascia, occasionally bone if broken and internal organs can bleed as well.

Somehow we entirely fail to teach this, at least in the US.

If you fall, or like my mountain biking daughter, hit something, your body will bleed. I tried to train the mountain bike team to carry an ace wrap and use it any time they hit something hard with an extremity. I pretty much failed. Why do I want an ace wrap and why use it immediately?

Trauma or hitting something hard causes bleeding. The more the muscle and tissue bleeds, the more swollen it gets. Usually the peak of bleeding and swelling is at about 48 hours after the injury. By then the body is sending immune system cells and repair cells to fix the trauma. It is swollen, red, hot, inflamed and painful! If we ace wrap our ankle or foot or elbow immediately, the bleeding stops faster. Wrap it, ice and elevate to keep the bleeding down. The torn muscles are held in their normal position, the bleeding stops more quickly, there is less swelling, less redness, inflammation and pain!

Our acronym is RICE:
Rest
Ice
Compression
Elevation

There are things that you can’t ace wrap: don’t ace wrap your neck or ribs and if it’s bad trauma to the head, neck, chest or abdomon, go to the emergency room! But even then, ice and compression help. First check airway, breathing and circulation, that the heart is beating if you happen on a trauma. But then try to use pressure on bleeding.

Do not put heat on a bruise for that first 48 hours. Why? It bleeds more and swells more. The exception may be if you do much more exercise than usual without a localized injury: hydrate, stay away from alcohol and a hot tub or hot bath may help. The hydration and hot water help the muscles relax and wash out the CK, creatine kinase, the protein from tiny muscle traumas that make us “stiff”.

The I in RICE used to mean ibuprofen as well. However, ibuprofen and aspirin and naprosyn are all blood thinners, so they may help with pain and inflammation, but may make the bruising worse. Acetominophen is not a blood thinner and also doesn’t do as much for inflammation, but it may be a better choice. It does help with pain.

In her third year of mountain bike racing, the Introverted Thinker had a quarter size bruise on her knee after a race.

“Are you going to do anything about that bruise?” I asked.

“No, it’s small.” she said.

“Ok.”

Two hours later: “Mom? Would you look at my knee?” Now the bruise is the size of an orange.

“Hmmm. What are you going to do about that?”

“I think I might ace wrap it and ice it and put it up for a while. Where is the ace wrap?”

Good plan. It didn’t get any bigger.

I see the handouts from the emergency room given for back pain and they are terribly misleading. It shows the spine and talks about the discs. 99% of the back pain I see is NOT a disc: it is the six layers of back muscles, and complex web of tendons, muscles and ligaments that hold the spine together and let us move in very complex ways. I pull my Netter Anatomy out daily in clinic and show people the six layers of back muscles.

What happens after a muscle is torn and bruised and bleeding? The muscle cramps up to stop the bleeding and attempt to keep from being torn more. No, I don’t like muscle relaxers much as medicines and they are useless long term. For sleep only right after injury. I am not talking about major trauma, but back pain and injuries.

If the muscle heals in the cramped position, it won’t work right any more. It can form scar tissue. It takes about six weeks for a muscle or ligament or tendon tear to heal and during that time we need to gently stretch the muscles without tearing them, so that they heal in the right position. Once they are healed in a scarred position, it’s more work to rehabilitate them, but it can be done. Physical therapy, massage therapy, chiropractor, acupuncture, but the most important work is done BY the patient, not TO them. I can’t fix it with pills. Yes, it is work.

You can bruise bone too. Ow. The surface of the bone is living cells and the bones are continually torn down by osteoclasts and rebuilt by osteoblasts. The bone can be bruised without breaking. Again, 6 weeks to heal, little kids faster and 90 year olds kind of slow.

Take care of your muscles, ligaments and tendons, and they will take care of you.

 

I took the photograph on the first Mad as Hell Doctors tour for health care for all in 2009. I will be marching again today:  WE ARE ONE NATION! HEALTH CARE FOR ALL! NO DISCRIMINATION!  MEDICARE FOR ALL!

 

Your health care dollar

I have been writing posts about fraud in medicine: but I think I am using the wrong title. Instead it should be your health care dollar: how the US medical corporate system wastes your health care dollar.

Think about it. What do you want to spend that dollar on?

Do you want it to go to 1300 different insurance companies and their web sites, their advertising, their competition and their profit? Do you want your healthcare dollar to go to complex coverage rules and contracts, to forms for prior authorization, for the weekly postcards and emails that they send me telling me that they have changed your coverage? Is it any surprise that I have no idea if your insurance company covers a test? They may have last week and not this week. The overhead for medicare is 2-3% administrative costs. Now why would we privatize that when the overhead for the health insurance companies is 20-30%?

How much of your health care dollar do you want to go to corporate competition?

I don’t want ANY of my health care dollar going to corporate competition and profit. I want my health care dollar going to my HEALTH. We spend the most per person in the world, almost twice as much per person per year as the next most expensive: and we don’t guarantee care. Hello, the next most expensive and all of the other nearly 40 countries, first and second world, have universal care for all their citizens. So is our care twice as good?

No, no, no, and no.

Hello, new administration. Let’s put the health care dollar where it is paying for health…. in medicare for all and in a single payer system. We have guideline after guideline on how we should treat illnesses, here:

US Preventative Task Force

The guidelines are regularly updated. If we have medicare for ALL then I will KNOW whether a test is covered or not. I have memorized the entire list of medicare covered screening tests and all the details: screen for abdominal aortic aneurysm is covered in male patients age 65-75 who have smoked more than 100 cigarettes in their life and any patient who has a family history. I have the whole list in my brain.

You CAN make a difference. Write to your congresspeople, state and national. Call them. Email them. They all have websites. Tell them YOUR health care story or the story of a friend or family member.

Join Health Care Now and Physicians for a National Health Program.

I want my health care dollar to go to HEALTH CARE.

For the Daily Post Prompts: gone and interior. Interior because I am so angry at the poor spotty costly health care for my fellow people in the US. And gone: your health care dollars is GONE: let’s use the next one wisely.

Fraud in medicine: why “help” won’t help

This article:  Doctors wasting over two thirds of their time doing paperwork showed up on Facebook yesterday.

The problem is that “hiring people to help with paperwork” will not help.

Why? We’ve already done that and it’s a huge mess.

For example: I was referred to an Ear Nose and Throat Specialist at one of the Seattle Mecca hospitals. I had to travel two hours and then in the waiting room I was given a four page patient history to fill out. I filled it out. I had been referred by a Neurologist, who sent a letter and note. After I filled out the forms, HIPAA and “you will pay if your stupid insurance won’t” and address and consent to be treated and yada yada…. I waited.

At last I was shown to a very luxurious room. There a medical assistant asked me many of the same questions that I’d filled out on the form and which were already in the letter and note from the neurologist. She typed these into the EMR- electronic medical record. Then she left. And I waited.

At last the distinguished otolaryngologist entered the room. He said, “I see that you are here for chronic sinus infections.”

“No.” I said. “I am not.”

Silence.

“I see that you did not read anything I filled out and I am a physician and I drove two hours to see you.”

Silence. “Um.” he said. “Uh, why are you here?”

“Strep A sepsis twice and we want to know if my tonsils should be removed.”

Right. So… all that paper you fill out before the physician saw you? Yeah, like, my impression is that physicians don’t read it until after you leave. And maybe mostly don’t EVER read it.

I plan to find out the next time I have to see a specialist. I will write “you don’t read this anyhow, so I am not filling this shit out” on page 2 and see if the specialist notices. Bet you money they don’t. Though when they yell at their staff for not entering my medication allergies or the review of systems, they might notice.

So… I am a primary care physician. What do I do?

A new patient has one form: name, address, insurance information, hipaa and “you pay if your insurance doesn’t”.

I do the health history myself in the room entering it in the first visit, which takes 45 minutes to an hour. WHOA! INEFFICIENT! Nope. Actually it is brutally efficient. For four reasons:

One — I enter it myself and ask the questions myself and I am really fast at it.

Two — now I know the person, because I went over all of it: complaint, history of present illness, past medical history, social history, allergies, review of systems, and I ask people to bring all their pills including supplements to the first visit and I enter them too. And I look at the bottles. I don’t like vitamins with 6667% of the Recommended Dietary Allowance of any vitamin, lots of vitamins now have herbs in them too and I would not recommend taking cow thymus, labeled as bovine thymus.

Three — Now I don’t have to spend time reading forms filled out in the waiting room or a history entered by someone else, because I don’t have time to do that anyhow. I did it all in the visit. I will still have to read old records and any labs or xray results or consult notes or pathology reports and hey, where do you think the waiting room paperwork falls in that priority list? Yeah, like never.

Four — I hand people a copy of the note as they leave and ask them to read it and to bring corrections if I got it wrong. They go from thinking that I am a drone staring at the laptop to saying, “Hey, she typed nearly everything I said (and she has three spelling errors).”

Because the truth is that medicine is really complicated now and it just doesn’t help to have more people “do the paperwork”. I have to read the notes and labs and reports myself, because I am the physician.

There are three things that WOULD help:

1. One set of rules. Hello, the insurance companies, all 500ish of them send us postcards and emails every week saying “Hey, we’ve changed what we cover, meaning we cover less and we have new improved and more complicated prior authorization rules! Go to our website to read all about it.” Guess how often I have time to do that. NEVER NEVER NEVER. I read medicare’s rules. So medicare for all, single payer is partly to have ONE SET OF RULES. I can memorize miles of rules, but not if they are changing in 500 companies every week. Shell game. Also, prior authorization means “your insurance company is making your doctor fill out paperwork in hopes that they can delay or refuse the care your doctor thinks is best for you.”

2. One electronic medical record. Right now there are about 500 of them too and none of them talk to each other so we are all “paperless”. Ha. It’s worse than ever, because we get 100 pages or 200 or 300 of printed out electronic medical record for every single new patient. I need two more big file cabinets for my “paperless” office. Hong Kong did it in 9 months. What, are we wimps? Make a decision.

3. Standardization of lab and xray and home health and physical therapy and nursing home and rehab and hospital order forms. Because every stupid lab form is different: not only arranged differently but also the lab panels are different, the requirements for what that lab wants to fill the order is different and the results are arranged differently on the page. Hello. Stupid, right? Any efficiency expert would laugh.

And that’s how we could really help doctors help patients.

Dear Mr. Donald Trump

Two weeks ago I sent this letter to Mr. Trump and all of the presidential candidates. To date I have gotten a form letter from Mrs. Hilary Clinton.

Dear Mr. Donald Trump and all Presidential candidates:

Mr. Trump, I am a rural family practice physician, a woman, who owns and runs my own medical clinic. I take care of patients from age zero to 104. Currently my oldest is 98. I take medicare and most insurances, but not medicaid.

I am running into legal immorality across the board from health insurance corporations that are maximizing profits at the expense of my health care dollar, our taxes and my patients. I would like your advice.

For example, the Veterans Hospital contacted me in May of 2015 and asked me to accept Veterans Choice patients, veterans who live more than 40 miles from the nearest VA Hospital. I accepted. I have 6 veteran patients, who are very complicated. To date I have not been paid for one visit. Now, before you say this is the fault of our government, it isn’t. It is the private for profit government contractor Triwest who is not paying me. They have my notes and we have followed their instructions on how to submit bills. Would you advise me to drop these patients?

For example, my father died in 2014. I called the oxygen company to pick up 6 tanks of oxygen. Then I found 8 more. I gently inquired why he had 14 tanks. The company said that his medical orders said that he should wear it continuously, so they delivered it. “Medicare paid for it.” they said. Ah. Well, I kept the other 8 tanks, because it is my and my father’s oxygen in those tanks: the company can have the tanks back when they are empty.

For example, the head of the sleep apnea supply company came to see me. He said, “You are getting in the way of your patients getting needed equipment.” I said, “Really? How?” “You only allowed a refill of one of the 8 necessary pieces of CPAP tubing instead of signing off on the whole group so we can fill as needed.” “Ah.” I said, “Actually my patients are tired of you mailing them 8 pieces of plastic that are filling up their closets and they don’t want extra plastic crap.” He mails it at the interval allowed by medicare, never mind whether the patient wants or needs it.

For example, I called a patient’s insurance to get a prior authorization last week for a limited sinus CT. They no longer do prior authorizations. They will decide whether to cover the CT scan once they read my notes. I asked if there was ANY way to see if it would be approved. They offered to let me send a letter to a PO Box in Wisconsin. My patient was sick, Mr. Trump. What do you suggest the patient and I do?

This is all legal. But it is not moral. So, Mr. Trump, where do you stand? Is our country’s highest value free enterprise and profit at any cost, no matter how many of our seniors are legally ripped off? Or do we have morals that health care and our elderly are important and need to be protected from legal but predatory businesses.

Please let me know, Mr. Trump. I would rather stick with my small clinic in the United States. At this point I would be financially and emotionally better off working as a temporary doctor internationally. I am sure that there is immorality internationally, but I will be less ashamed when it is not MY country.

Thank you.

 

Fraud in medicine: FAXMANIA!!

All right, the latest trend in the complete insanity that is the United States Medical Corporate Black Hole Eating The American Dream: FAXMANIA!!!!

I am a Veterans Choice rural provider. Well, I thought I was. But turns out even though the VA keeps calling me to accept new veterans who are more than 40 miles from the nearest VA, they have not paid me for one visit in 2015. And I did between 20 and 30.

Because, you see, even though they have me listed as a Veterans Choice Provider, the paper work is SPECIAL and it has to be PERFECT and we have to fax EVERYTHING.

So I have to fax every single clinic note to Veterans Choice. Where, presumably, they lose it and have plausible deniability. Also, when a patient comes to see me, they are only approved for ONE NEW PATIENT VISIT, TWO FOLLOW UP VISITS, WITHIN THE STATED DATES, which is two months. Then I have to fill out a form and send it to Veterans Choice, who sends it to triwest, to get approval to continue to be my patient’s primary care doctor FOR ONE YEAR ONLY. Then I have to remember to do it again. AND I have to fill out a form to send to Veterans Choice, who sends it to triwest, for every single referral or test more complicated (read: expensive) than an xray AND for labwork AND don’t forget to fax a copy of every clinic note to Veterans Choice so they know I did it AND now for one patient’s medicine, I have ALSO fax a copy of every note to his VA PRIMARY CARE DOCTOR so that she will refill his pain medicine because: Hell if I know, apparently it’s EASIER to fill from her than me because the VA has no frigging idea who I am.

And the Veterans Choice 40 mile rule? We have two patients now from Whidby Island. They have to take a ferry to see me. Yes, they can bring a car on the ferry. Yes, they can get here except when the ferry is canceled for very low tides or weather….Yes, it’s insane.

Meanwhile, this note from the State of Washington Health Care Authority, aka medicaid: “The Contractor shall require that when subcontracted provider organizations with certified EHRs see an Apple Health Managed Care enrollee, they send a care summary (CCDA) from the providers EHR to the WA Link4Health Clinical Data Repository beginning no later than February 1, 2017.” Translation? Oh, we have to send bloody proof that we saw the bloody patient in the form of a CCDA electronically OR ELSE! OR ELSE WE ARE BREAKING THE LAW! They wouldn’t want to fire us but you betcha they would love to fine the hell out of us. Note: This requirement only applies to provider organizations who have already invested in certified EHR technology.

Hi, Big Brother.

Now, fax is HIPAA compliant, as long as we include the cover disclaimer that IF WE SENT IT TO THE WRONG PLACE SHRED WITHOUT READING OR YOU WILL BE STRUCK DEAD BY LIGHTENING FROM THE SKY GODS AND/OR THE ORBITING LASER HIPAA POLICE.

And meanwhile I have lab order forms for the three labs in town (all completely different and even with different panels) and one in Sequim, also 6 different forms for 6 different places for xrays, CT scans, MRIs, a form for the Vascular imaging, a form for cardiology, different ones for each physical therapy office. Now the DMV disabled parking form must be accompanied by a prescription on legal Washington State prescription paper saying yeah, he is disabled. Why use one piece of paper when you can require two?

When I fill out lab orders for the local hospital, the patients sometimes say, “Can you fax that over?”

“Yes,” I say, “but they lose 50% of them.” No, really. We fax them and keep a copy and then the patient goes in and the lab calls and says, “We don’t have the order.” I am not sure if they are “lost” or just in a pile to be entered into the TIME SAVING ELECTRONIC MEDICAL RECORD COMPUTER SYSTEM THAT MAKES EVERYTHING FASTER AND MADE US PAPERLESS EXCEPT FOR THE TEN MILLION FAXES DAILY. “You are better off picking it up and handing it to them, or I can mail it to you.” The other day a patient asked if that was malice, since I am not in the hospital system. “No,” I said, “I think they have laid people off until there aren’t enough and the corporation dumps the long timers that know stuff and cost more.”

Once I was working on a holiday Monday. I had a patient who I thought had a new arrythmia. I called the hospital and asked the tech if we could do an outpatient ECG on this holiday.

“I don’t know.” the tech said.

There was a silence. I wondered if the tech would ask someone in authority.

“I’m new.” said the tech. “They’ve laid a lot of people off.”

Someone in authority WAS present. “We can do one on a holiday.” I said firmly. “I will send her right over. Call me when it’s done.” So the tech did it.

Where medicaid goes, medicare follows and then the insurance companies will too. Next, I predict that we will have to fax every note to the appropriate company every single visit, and to the secondary insurance too. And then they will install a video camera in each office and videotape every clinic visit…. and I will either be a physician in another country or be doing something else….

 

What, you say, does the shack have to do with this? I can always go live there, off the grid, if I can’t stand the paperwork and hoops I have to jump through. It is a play house at my family’s land on a lake in Ontario, built in the 1970s. Friends and I put a new roof on this year: their 6 year old was delighted. It would be frightfully cold in the winter and anyhow, I can only stand straight in the middle….

I will fight no more

I am tired of fighting
I am tired of fighting for justice
I am tired of fighting discrimination
I am tired of fighting for health care for all

I am tired of fighting insurance companies
I am tired of fighting medicare’s contractee
I am tired of fighting for prior authorization
I am tired

I will fight no more forever

I heal
I am a healer
I am trying to heal patients
I am trying to help patients heal

I am a healer
I help heal cancer
I help heal heart disease
I help heal PTSD
I help

heal cancer
heal heart disease
heal PTSD
heal addiction

I am a healer

heal the insurance company
heal the medicare contractor
heal the pharmaceutical company
heal

heal anxiety
heal depression
heal addiction

I will fight no more forever

I heal

The legs in the photograph don’t look delicate, do they? They are strong and beautiful and powerful. I took this at the National Junior Synchronized Swimming Competition in 2009. Those girls on the edge of being women are strong, they are a team, they work and play together. They have the skills and the strength to lift their bodies out of the water that far using their arms… think about the practice and strength needed to do that. We all want to heal and create fun and play and beauty. Let’s work as a team.

also on everything2.com

Fraud in medicine: medicare application

Medicare quit paying my clinic at the end of July, on the 31st.

I was still half time in clinic, we were interviewing a new receptionist as my receptionist of five years wanted to retire by August first. We got some sort of notification from medicare, but their letters are very cryptic.

My new receptionist was needing orientation and help and I was really tired after July. I redid the medicare application and sent it in. We continued to see medicare patients and turn in the bills.

Our medicare contractor is noridian. They sent us a cryptic letter saying that something was wrong with the application. This was, mind you, a renewal. I had been seeing medicare patients for five years in my clinic.

I call them. I am given a name and a number to identify the call. I have two Ptan numbers, one for me as a physician and a second for the clinic. The first call said that my personal Ptan application was correct but the clinic one wasn’t.

I did it again and mailed it. Second day air. He said that our payments should be released in 10-14 days.

Ten days. Nothing. Fourteen. Nothing. I am pulling from savings to run the clinic. I call a second time. Again I am given a name and a number. She said I had to CALL to get paid once the application was received. I said the first guy didn’t say that. She said another 10-14 days.

We wait. After ten days I call. A third number and person. Once again I have a cryptic email. I ask about the PTan number on the email, which is not my clinic’s Ptan number. Oh, says the man, that is what is wrong with your application. He says to do form (numbernumbernumber B) not form (numbernumbernumber A). And it will be 10-14 days after they receive it.

I do it AGAIN. I do notice that all of the old copies of the form in our file have the PTan numbers wrong. Weird. They have been paying me for five years.

Ten days. I call a fourth time. She says that it will be 30 days not 10 to 14 until medicare lets me know if my application is correct. Or they might pay me after 10-14 days. They aren’t, so I argue that something must still be wrong. What is it? She can’t tell me. I want a supervisor. She says that I can talk to a supervisor in 10-14 days. We figure out that the Ptan number on the application is correct. I say, “I am writing my congresswoman.” and hang up.

So I do. I find my Senator’s email and I write to her. I have been a rural family practice doctor for 25 years and I saw a 98 year old yesterday and a 91 year old today and I LIKE my elderly patients, but I have HAD it with medicare, at least with the contractor noridian that is running medicare for my state. I list the phone call dates and names and identifying numbers and I say FIX IT because otherwise I am for the first time in 25 years seriously considering quitting medicare.

Two days later noridian sends an email saying they are releasing my payments.

The next day we get a direct deposit for $9000.00. That is a START.

One week later we get a call from noridian explaining what is wrong with our application. Not just one thing. Noridian doesn’t seem to have a copy of our business license from five years ago. We have to put the personal Ptan on page xgyb-14. They want details about the nursing home. Do I do home visits?

The noridian person explains that our application has actually been wrong for five years, but now they are getting audited so they have to get everything cleaned up.

So THEY have KNOWN it was wrong for five years, but held my payments since July, while they try to get their act together and tell me what the hell is wrong with it?

I want to be paid INTEREST for all the time I have spent on the phone and redoing the cryptic application.

And many thanks to my congresswoman, for keeping my clinic open.

I took the picture at the Kinetic Sculpture Festival here in September. The outfits make more sense than dealing with noridian, that’s for sure….

first posted on everything2.com on 11/30/15