~ In the tradition of elders, despots and other rulers it is often only chaos that cares.
My last post was entitled Obama Care and carried the story of how I cancelled and otherwise have unwound from my healthcare plan that (if the truth is known) didn’t, or doesn’t care.
So who cares as in these final hours or minutes or days of America we can plainly see the fires burning on the upper floors and see the shadows of people jumping as we relive the harrowing hours of 9-1-1 “America under attack” and realize that this time we KNOW the outcome, we’ve seen the previews, we’ve all bought into or have been brought into the meme. Yes, America is the towers. Yes, the upper floors are already burning. Yes, as we all know the towers will fall, and fall quite suddenly, and fall at free fall speed because the supports at the base are not sufficient to keep the capstone or upper flights in place when all the little people at the bottom are just “blown away”.
OK, you can bring up planes and terrorists and the military and quasi-military and other things that fly. You miss the point. But I don’t fly anymore, so I guess it is only the building and the buildings that matter. And that, my friends, brings up the topic of John Calvin. Here is his picture.
If you carefully read the whole Wiki article (I just read part), you will learn the Mr. John Calvin and his good buddy John Knox were prudish or prissy or presumptuous puritans, some say reformed Jews, that had a little to do with the east coast version of the founding of America; dare I say in New Mexico we have traditions that go back a bit further.
Anyway my so-called “health care provider” is (until 11:59 tonight, March 31st) Presbyterian, which brings up presbyters and vespers and ancient religions and their ancient practices that are at the root of “modern” medicine and somehow (too) I guess how religions and their institutions can be constructive in the building plans of building pyramid schemes of the type that has often been the building blocks of America, and now the weight is so heavy on the backs of the bottom few that they are waking up and walking away and moving on and are not going to wait around to be blasted away like what happened in the movie and the media event known as, “The Twin Towers”. Amen.
The issue (MY issue) of late is about a few blood tests, count them, there were four that were ordered on March 19 by my Doctor (Known as my “Primary care physician”) of which my plan says that I have to have one and the one I have (and like) is actually on the Presbyterian Healthcare Plan approved list of doctors. The blood tests involves collecting “specimens” at a lab (not at the office) and that brings up the only lab that is available and that is TriCore.
If you think competition is good, and might help keep things a bit honest you should know that Presbyterian (in the ABQ metro area) ONLY uses TriCore for all covered insurance services that require the services of a lab, a laboratory or “reference laboratories” as TriCore calls themselves.
Before I go on I should show you their logo, so you can get an eye, a base or an idea of the point I made earlier about pyramids and schemes and building things the old fashioned way which does not involve “choice” or freewill or the freedom of the city or the freedom to be free from “blood work” and blood drawn by the worst or best of them. The TriCore logo.
And here is the logo at the entrance to the building in Albuquerque where I visited for two hours yesterday. In their front lobby is a nice black plaque that among other things states their “vision”. Their “vision” is to “offer a choice“. So since the choice is not about the laboratory one is allowed to use, what “choice” really is it that they offer?
My wife and I have had trouble with TriCore before. This lab did lab work for my wife that because of the way Presbyterian handled it she thought the bill was paid. Part of it WAS paid, but there was a TriCore laboratory balance owing. Tricore FAILED to access the mailing address on record at Presbyterian (as required by Presbyterian rules) and instead sent their “billing letters” to an unused street address, and to make matters worse even got the street address wrong. When they got no response do you think TriCore checked the phone book or the web or contacted the Presbyterian database? Absolutely No, of course not. We were (and are) dealing with corporate America, Pyramids and towers, things that go splish or splash in the night when we aren’t out there looking.
So, in time, they sent the $135 (or something) to a collection agency for collections. The collection agency used the same wrong address used by TriCore, but upon their “final notice” a substitute postal carrier was put on the route and got all HIS addresses wrong and delivered the collection letter to the WRONG ADDRESS, which was us, actually the “right” address after all. The point that I am making is (of course) that ALL of America is collapsing, burning, not working or something obviously much worse.
It took a little over two months to sort out this “TriCore Affair” through Presbyterian and TriCore and the Collection Agency involved. Needless to say we are VERY CAREFUL about TriCore and TriCore billing and things that go bump in the night and corporations that are having parties for their employees instead of adequately training them about how things really work and what to do and not to do to keep customers (and patients out of patience) out of trouble. OK, I may be dreaming; reform will not work, it is all corrupt to the tricore?
So now we have that majic word “training”, as if being trained were a good substitute for thought or clear thinking or being able to think at all. It isn’t. You can “train” fleas to turn left by eliminating all the fleas that turn right from the database or the life base if that seems appropriate. Training is about a process of selection that keeps as employees those that agree with you (and your goals) and involves firing or not hiring those that don’t. It is really very simple. Training is another word for the “yes” men and the “yes” women that want the “yes” men jobs. “Yes”, they will say anything you want them to and “no” they will deny saying anything they shouldn’t even though in reality they did, or really did, or “so help me God, I didn’t say that (though I really did).” They used to say that there was a very special place in hell for such liars. I don’t know. I haven’t been to hell, I’ve only experienced such people here on earth.
Presbyterian and probably John Calvin hires such people, or seems to hire such people on first blush and from the bush, and keeps them and retains them and puts them in places of influence and authority such as the modern equivalent of a phone room which is, well, a phone room. Enough said. It was the phone room, the “customer service representative” the member services agent” the “eyes and ears and mouthpiece of Presbyterian” that took the call when my wife called to find out how much of these FOUR lab tests my health plan at Presbyterian really covered.
The person who answered, we shall call her “Crystal” because we don’t have a last name and nobody like her ever does; anyway “Crystal” was on duty on March 21 (going on about noon) and had no trouble understanding that the question of “how much” really involved the issue of money and not the weight of the specimens potentially in play. Crystal (maybe a gay or a guy), to make it all polite and legal, evidently had no idea about all the pain she was about to create and cause by not asking for “codes” or the “type of visit” or other good and great things that might have had the effect of instilling care and confidence because such questions might quickly cut to the truth.
Health Care and Health Care Insurance is NOT about truth and soul or truth or soul or anything having to do about the truth at all. It is all about money, only money, and how to pick the pocket of the gullible and unwary and how to put the money in the hands of “doctors and lawyers and such“.
My wife said and asked all the right things on my behalf. She had the plan number, the member number, the right date of birth and social security number and full name and middle initial and mother’s maiden name (if they asked). She had me there to back up her requests in case the case arose, “yes I authorize this person to place this call”.
She explained the fact that I (Donald Clayton) had seen his doctor and that his doctor had issued a form for blood work to be done. She read off the tests from the form. She used the alpha codes (CMP, THYS, CBCD, ESR) that TriCore used on the TriCore form. There were no “5 digit codes” and there was no place for such codes on the form. In the bottom right corner another “code” V70.0 was written, a code meaning “Routine general medical examination at a health care facility”. This is the code that doctors use nationwide to indicate an annual physical or check-up, the code indicates to anyone in the know “Preventative Care”, but who really cares anyway?
So here is the form in question, and I still have questions – don’t you?
What do “codes” have to do with coverage at Presbyterian? It was so easy for “Crystal” to ignor the issue of codes and claim expertise and inform my wife that, “Presbyterian will NOT pay anything for the tests, you have a $5,000 deductible that has not been satisfied or met.” I hate to quote, the words may (slightly) vary, but you get the gist without having to hear the tape. The point is clear. Coverage by Presbyterian for the blood tests was clearly denied.
The point is that nowhere on the form does the form communicate the words “Preventative Care”, only the code in the bottom right corner indicates that these tests are for Preventative Care; and then the codes ONLY work if you know what they mean, which not one American in 100 does. Did you know a V70.0, before reading this post? OK then, what does a 715.9 mean? I was told by an LPN that the code meant “fatigue“.
Further, the four tests ordered are NOT known to be preventative care unless the five digit codes are entered (TriCore uses the term “populated”) and TriCore only “populates” (enters the codes) if the lab work has been completed and if an insurance company is to be billed.
The whole “lab test” procedure is surrounded in secrecy. The critical information is hidden from the patient by the fact that TriCore does not provide the codes that the patient needs to ask the EXACTLY right question to get an EXACTLY right answer. Presbyterian defends the call center communication of denial of coverage by saying that the customer (my wife, the agent of the patient) did not SPECIFICALLY SAY “the lab tests were ordered for preventative care, are they covered?” (exact script – you must use it). Even then, the call center would probably deny that there was insurance coverage if the “patient / customer” could not provide the codes for the specific tests.
Where are these SECRET codes to be found? Even the supervisors at Presbyterian Health Care don’t have them. They only have a list of numbers that are “covered” under preventative care, but not that are correlated to the TriCore names or TriCore alphabetical initials. The ESR “Westergren” test is an example. The codes are NOT even identified on the web. I did find a site that has some lab test numbers (insurance codes), but this facility seems to offer tests for far less than available through Presbyterian (TriCore) which quoted $239 for the four tests.
Using the form I was given (above), you try to figure out what you would have to pay and what codes exist that will unravel the mystery. It is curious that even the supervisors (team leaders) at Presbyterian would NOT call TriCore to gain access to the codes that “they” claimed were needed to confirm that the tests were for prevention and not a diagnosis or a cure. No organization could be so incompetent. If the “procedures” smell, there must be a reason.
Tomorrow (or later) I shall endeavor to continue my tale about the saga of the collapse of health care. Nobody is watching. Nobody really understands how things work, except those at the top that are making all the money. I’m glad that I am out of it, have unwound from the racket, have assumed responsibility for my own health and care and the bills that might come due. I recommend the same course to others.
Note: The reason behind this post is to reveal the truth, to tell it “like it is”, to offer in a public forum the information that those charged with overview and oversight might have missed. I honestly believe that, “Nobody stays stupid forever”. The top floors are falling, even Elvis has left the building. Maybe you should too, and quickly.
2012.03.31 – 05:45.