Anchor ads are not supported on this page.

4S Ranch Allied Gardens Alpine Baja Balboa Park Bankers Hill Barrio Logan Bay Ho Bay Park Black Mountain Ranch Blossom Valley Bonita Bonsall Borrego Springs Boulevard Campo Cardiff-by-the-Sea Carlsbad Carmel Mountain Carmel Valley Chollas View Chula Vista City College City Heights Clairemont College Area Coronado CSU San Marcos Cuyamaca College Del Cerro Del Mar Descanso Downtown San Diego Eastlake East Village El Cajon Emerald Hills Encanto Encinitas Escondido Fallbrook Fletcher Hills Golden Hill Grant Hill Grantville Grossmont College Guatay Harbor Island Hillcrest Imperial Beach Imperial Valley Jacumba Jamacha-Lomita Jamul Julian Kearny Mesa Kensington La Jolla Lakeside La Mesa Lemon Grove Leucadia Liberty Station Lincoln Acres Lincoln Park Linda Vista Little Italy Logan Heights Mesa College Midway District MiraCosta College Miramar Miramar College Mira Mesa Mission Beach Mission Hills Mission Valley Mountain View Mount Hope Mount Laguna National City Nestor Normal Heights North Park Oak Park Ocean Beach Oceanside Old Town Otay Mesa Pacific Beach Pala Palomar College Palomar Mountain Paradise Hills Pauma Valley Pine Valley Point Loma Point Loma Nazarene Potrero Poway Rainbow Ramona Rancho Bernardo Rancho Penasquitos Rancho San Diego Rancho Santa Fe Rolando San Carlos San Marcos San Onofre Santa Ysabel Santee San Ysidro Scripps Ranch SDSU Serra Mesa Shelltown Shelter Island Sherman Heights Skyline Solana Beach Sorrento Valley Southcrest South Park Southwestern College Spring Valley Stockton Talmadge Temecula Tierrasanta Tijuana UCSD University City University Heights USD Valencia Park Valley Center Vista Warner Springs

Who would want to replace this?

National healthcare? If it is anything like Medicare or if Medicare stays in place, it won't be much help!

So, there is this 60+ year old female. MRIs show several periventricular deep white matter lesions, small vessel disease in cerebellum. Lumbar puncture did not confirm nor did it rule out MS (Multile Sclerosis). She has severe RLS (restless legs syndrome); hyper-reflexes(4++); akathisia, a condition characterized by uncontrollable motor restlessness; vertigo; headaches (not migraine but likely related to C-spine); post c-spine (C5-6, 6-7) discectomy & fusion in 2007; Parkinsonism (R/O); Optic nerve head Drusen resulting in 50% loss of vision, lower half of both eyes; ataxia (an inability to coordinate voluntary muscular movements that is symptomatic of some nervous disorders); balance problems, resulting in numerous falls; low back pain, L-5 nerve impingement; arthritic right thumb joint & right upper extremity carpal tunnel syndrome, both will require surgery; long history of depression; obesity, due to major decrease in physical activity.

The patient's primary care physician requested approval for a motorized scooter. The Health Plan denied that request. The patient wrote an appeal, providing copies of records from her Ophthalmologist, Neurologist, & GP. That request has also been denied. Now, the records have gone to New York for review, based on Medicare guidelines. The NY company does not have a toll free number!

A call was made to the health plan. Miguel is the "coordinator" of this case. He does not make any decisions and he is the only person allowed to communicate with the patient on this matter. The medical issues and decision for denial are made by a medical director, who will not talk to the patient. It should be noted that the patient initiated all communication and left messages for Miguel, who did not return the calls. Now, as of last Friday, the claim is denied and sent to New York. Therefore, discussions are pointless as there will be no change in the health plan decision. This next stage is also supposed to be 30 days. The health plan appeal was mailed on 6/16/2009 and decided on 7/24/2009. Isn't that more than 30 days?

Apparently, the Medicare criteria requires that a scooter or wheelchair must be necessary for activities of daily living, in the home. So, the next logical question is, do the people who are approved for scooters have to pay some sort of fine if they use the vehicle outside???

This is HMO/Medicare at its finest. Given the patient's eye condition, she walks around with her head bent to see what lies beneath. This is causing major problems with her neck. If Medicare is cognizant or cares a whit about cost, it is most probable that a scooter would be less costly than further C-spine surgery and post-op physical therapy. (Miguel says he has no information on costs).

So, the patient waits. Insurance wheels turn very slowly as the patient must walk, keeping her head bent, because the HMO refuses to provide a motorized scooter, based on Medicare criteria. Our medical system is definitely broken and in need of fixing. An update will be forthcoming in 30 (doubtful) to 45 (maybe more) days.

So long

Here's something you might be interested in.
Submit a free classified
or view all

Previous article

Best Sports Betting Sites - 10 Online Sportsbooks Ranked for 2024

Best Sports Betting Sites (2024) - Reviews of TOP Online Sportsbooks
Next Article

20 Best Online Casinos USA For Real Money (2024 List)

USA Online Casinos: Top 20 Online Casino Sites of 2024

National healthcare? If it is anything like Medicare or if Medicare stays in place, it won't be much help!

So, there is this 60+ year old female. MRIs show several periventricular deep white matter lesions, small vessel disease in cerebellum. Lumbar puncture did not confirm nor did it rule out MS (Multile Sclerosis). She has severe RLS (restless legs syndrome); hyper-reflexes(4++); akathisia, a condition characterized by uncontrollable motor restlessness; vertigo; headaches (not migraine but likely related to C-spine); post c-spine (C5-6, 6-7) discectomy & fusion in 2007; Parkinsonism (R/O); Optic nerve head Drusen resulting in 50% loss of vision, lower half of both eyes; ataxia (an inability to coordinate voluntary muscular movements that is symptomatic of some nervous disorders); balance problems, resulting in numerous falls; low back pain, L-5 nerve impingement; arthritic right thumb joint & right upper extremity carpal tunnel syndrome, both will require surgery; long history of depression; obesity, due to major decrease in physical activity.

The patient's primary care physician requested approval for a motorized scooter. The Health Plan denied that request. The patient wrote an appeal, providing copies of records from her Ophthalmologist, Neurologist, & GP. That request has also been denied. Now, the records have gone to New York for review, based on Medicare guidelines. The NY company does not have a toll free number!

A call was made to the health plan. Miguel is the "coordinator" of this case. He does not make any decisions and he is the only person allowed to communicate with the patient on this matter. The medical issues and decision for denial are made by a medical director, who will not talk to the patient. It should be noted that the patient initiated all communication and left messages for Miguel, who did not return the calls. Now, as of last Friday, the claim is denied and sent to New York. Therefore, discussions are pointless as there will be no change in the health plan decision. This next stage is also supposed to be 30 days. The health plan appeal was mailed on 6/16/2009 and decided on 7/24/2009. Isn't that more than 30 days?

Apparently, the Medicare criteria requires that a scooter or wheelchair must be necessary for activities of daily living, in the home. So, the next logical question is, do the people who are approved for scooters have to pay some sort of fine if they use the vehicle outside???

This is HMO/Medicare at its finest. Given the patient's eye condition, she walks around with her head bent to see what lies beneath. This is causing major problems with her neck. If Medicare is cognizant or cares a whit about cost, it is most probable that a scooter would be less costly than further C-spine surgery and post-op physical therapy. (Miguel says he has no information on costs).

So, the patient waits. Insurance wheels turn very slowly as the patient must walk, keeping her head bent, because the HMO refuses to provide a motorized scooter, based on Medicare criteria. Our medical system is definitely broken and in need of fixing. An update will be forthcoming in 30 (doubtful) to 45 (maybe more) days.

So long

Sponsored
Here's something you might be interested in.
Submit a free classified
or view all
Ask a Hipster — Advice you didn't know you needed Big Screen — Movie commentary Blurt — Music's inside track Booze News — San Diego spirits Classical Music — Immortal beauty Classifieds — Free and easy Cover Stories — Front-page features Drinks All Around — Bartenders' drink recipes Excerpts — Literary and spiritual excerpts Feast! — Food & drink reviews Feature Stories — Local news & stories Fishing Report — What’s getting hooked from ship and shore From the Archives — Spotlight on the past Golden Dreams — Talk of the town The Gonzo Report — Making the musical scene, or at least reporting from it Letters — Our inbox Movies@Home — Local movie buffs share favorites Movie Reviews — Our critics' picks and pans Musician Interviews — Up close with local artists Neighborhood News from Stringers — Hyperlocal news News Ticker — News & politics Obermeyer — San Diego politics illustrated Outdoors — Weekly changes in flora and fauna Overheard in San Diego — Eavesdropping illustrated Poetry — The old and the new Reader Travel — Travel section built by travelers Reading — The hunt for intellectuals Roam-O-Rama — SoCal's best hiking/biking trails San Diego Beer — Inside San Diego suds SD on the QT — Almost factual news Sheep and Goats — Places of worship Special Issues — The best of Street Style — San Diego streets have style Surf Diego — Real stories from those braving the waves Theater — On stage in San Diego this week Tin Fork — Silver spoon alternative Under the Radar — Matt Potter's undercover work Unforgettable — Long-ago San Diego Unreal Estate — San Diego's priciest pads Your Week — Daily event picks
4S Ranch Allied Gardens Alpine Baja Balboa Park Bankers Hill Barrio Logan Bay Ho Bay Park Black Mountain Ranch Blossom Valley Bonita Bonsall Borrego Springs Boulevard Campo Cardiff-by-the-Sea Carlsbad Carmel Mountain Carmel Valley Chollas View Chula Vista City College City Heights Clairemont College Area Coronado CSU San Marcos Cuyamaca College Del Cerro Del Mar Descanso Downtown San Diego Eastlake East Village El Cajon Emerald Hills Encanto Encinitas Escondido Fallbrook Fletcher Hills Golden Hill Grant Hill Grantville Grossmont College Guatay Harbor Island Hillcrest Imperial Beach Imperial Valley Jacumba Jamacha-Lomita Jamul Julian Kearny Mesa Kensington La Jolla Lakeside La Mesa Lemon Grove Leucadia Liberty Station Lincoln Acres Lincoln Park Linda Vista Little Italy Logan Heights Mesa College Midway District MiraCosta College Miramar Miramar College Mira Mesa Mission Beach Mission Hills Mission Valley Mountain View Mount Hope Mount Laguna National City Nestor Normal Heights North Park Oak Park Ocean Beach Oceanside Old Town Otay Mesa Pacific Beach Pala Palomar College Palomar Mountain Paradise Hills Pauma Valley Pine Valley Point Loma Point Loma Nazarene Potrero Poway Rainbow Ramona Rancho Bernardo Rancho Penasquitos Rancho San Diego Rancho Santa Fe Rolando San Carlos San Marcos San Onofre Santa Ysabel Santee San Ysidro Scripps Ranch SDSU Serra Mesa Shelltown Shelter Island Sherman Heights Skyline Solana Beach Sorrento Valley Southcrest South Park Southwestern College Spring Valley Stockton Talmadge Temecula Tierrasanta Tijuana UCSD University City University Heights USD Valencia Park Valley Center Vista Warner Springs
Close

Anchor ads are not supported on this page.