Wednesday, June 24, 2009

Louella Learns the Limits of Medicare

It was 10:05, and there were six other people in the doctor's waiting room when Louella signed in for her father, filled out the paperwork and provided her father's Medicare information. Looks like it's going to be hurry-up-and-wait today, she thought, looking around for some decent magazines to read. She tossed aside Golf and Travel, Woodworker and Rod and Gun, digging for a recent People or Glamour. Looks like this doctor subscribes to what he likes, she thought, not what his patients like. Gets that tax write-off and we get bumpkus. She settled next to her father on a black vinyl chair and patted him on his arm. "Let's snooze a little while we wait, okay?" "Sure thing, Lou! You don't have to tell me twice to take a nap!"

A half hour passed before the receptionist called Louella up to her little window. "You know your Dad only has Part A, don't you?" she whispered. "What's that mean—'Only has Part A'?" The receptionist looked uncomfortable. "Well, it means this consultation won't be paid for by Medicare." "It won't? Why not?" "Because you need Part B coverage for that. Then you only have to pay 20 percent for an office visit. Well, except for the first $135 in a year, but don't let me confuse you!" "Well, how do you get this Part B?" "It's something your Dad should have signed up for when he was 65," she said. "He might still be able to sign up for it, but it'll probably cost extra, and they can exclude pre-existing conditions."

"Hold on a minute!" said Louella. She went over to her dozing father and nudged him awake. "Dad!" she said. "They're saying you don't have Part B Medicare! Is that right?"

"Sure, that's right! Don't have Part B for the same reason I didn't get any whatchacall gap policy. Because I can't afford ’em, that's why. That Part B was gonna nick nearly a hundred dollars out of my Social Security every month, and the gap stuff was going to cost more than a hundred more. I figured if I needed to have a doctor's office visit or whatever, I'd just pay as I go. Be cheaper, seein' as how I never need to see a doctor!"

Louella felt a cold knot form in her stomach. "Oh, Dad! I wished you'd told me! Candy and I would've helped you out to pay the extra!"

"You sayin' we have a problem?"

"Not yet, but we could if this thing today is serious," said Louella. "Let's sure hope it's not!" She went back to the receptionist and took out her checkbook. "How much for today's visit?"

"That'll be $150 for today," she responded. "That's not counting any extras like tests and medicines and all." She cocked her head. "He does have Part D, right?" Louella flipped through the cards in her father's wallet and found nothing about Part D. She shrugged. The receptionist said, "I'll check online." She clicked some keys and said, "Nope, he didn't sign up. Sorry." "Well, can he still get it?" asked Louella. "Well, he might be able to," said the receptionist. "That's better than for that supplemental gap insurance—they might not take him at all now. They don't have to insure everybody with no questions asked, see, except in the three months before and after you're 65. Listen, you need to talk to the hospital social worker about this. Maybe something can be worked out. It's really complicated. If you choose the wrong Part D or supplemental plan you can be in real hot water real fast. I'm just telling you because we went through this with my grandmother, and she lost her house."

The receptionist glanced behind her, then said in a conspiratorial voice, "Look, the best thing would probably be for the doctor to put your dad directly in the hospital right away. Then your Part A might cover you pretty much, except for that deductible."

"Deductible for being put in the hospital?" Louella asked, numb. "How much is that?"

The receptionist, whose name Louella finally noticed was Ernestine, rolled her eyes. "That's going to be a little over a thousand dollars," she said, nodding sadly. "And honey, that's not going to include TV or telephone, either!"

Candy should have looked into this! Louella fumed. She lives with Dad and should have been paying better attention! She hastily wrote out the $150 check and handed it through the window. She thanked Ernestine, stuffed the receipt into her handbag and sat back down with her father. He was tapping his right foot and humming under his breath. Oh no! thought Louella. He heard everything we said!

A few minutes later they were called to see the doctor.

TO BE CONTINUED.