Your Medicare bureaucracy at work

If you are under the impression that bureaucracy works well, efficiently, and at an acceptable pace, allow me to disabuse you of that notion. Or, at the very least cite a couple of examples to the contrary.

Last month I received a “Medicare Summary Notice” dated January 18, 2012. I get these occasionally. As nearly as I can tell, they are akin to the EOBs (Explanation of Benefits) you receive from most health insurance companies. I usually glance over them, drop them in a drawer in case I ever need to refer to them again, and forget about them.

A line centered prominently in the middle of the page caught my eye. “This is a summary of claims processed on 12/21/2011.” Nice turnaround time, I thought. Just under a month.

Then, glancing on down the page, I saw the claim in question was a flu shot from September 23, 2010! Claim denied.

Below that, the Notes Section added: “The time limit for filing your claim has expired therefore, appeal rights are not applicable for this claim” (their punctuation, not mine). Understandable. Yet on Page 2 there was a form for an appeals claim which “must be received by May 22, 2012,” if I disagree with the claims decision. Also on Page 2 was my Deductible Information: “You have met the Part B deductible for 2010.” Duh.

I briefly considered calling someone to find out what was going on and why I was getting this information 18 months after the fact but thought better of it. I didn’t want some clerk spending another 18 months trying to figure out why the original claim took so long to process. They’d already spent way too much time, paper, and postage on a $25 claim.

I forgot about it until I had an appointment with my doctor today and mentioned the tardy bit of bureaucratic paperwork. We bemoaned what the practice of medicine has become, how much of her time is spent doing paperwork instead of actually seeing patients, and how she tells inquiring young people that perhaps they might want to consider another line of work. Sad.

On my way home I picked up the mail and found what was obviously a check from Patient Business Affairs at the hospital where my doctor practices. It was a refund check in the amount of $60. Cool! Who doesn’t love surprise refund checks? The check was dated 2/13/12. Odd, I thought. I’ve only seen the doctor once this year before today, and that was a simple, straightforward office visit. So I scanned the cover letter for more information. There was no hint whatsoever of what the refund was for. There was, however, a date of service: 06/04/08!

There was also a phone number to call if I have any questions about the check. Oh, believe me I do. A refund check almost four years later!? But if you think I’m going to call and re-open that can of worms, you are seriously mistaken.

Besides, $60 more than covers that flu shot back in 2010. Not to mention the one from last fall that is probably still working its way through the system.

Clearly things are getting seriously bogged down in the Medicare system and there is a crying need for some cost-saving efficiencies. But to be fair, Medicare and my doctors have done pretty well by me so far. These two incidents were, in my experience to date, unusual exceptions. I just hope the fact that they both occurred in the last month isn’t a warning of things to come.