Take Two

Regarding the Public Option

It’s been a long time since I’ve put anything of substance in this space but here goes.  Last week, the House of Representatives voted to overhaul one sixth of the US Economy.  This is a massive train wreck waiting to happen.  I know this because I work inside the system on a daily basis.  Allow me to explain.

Years again, Congress passed the Medicare Secondary Payer Act.  What this basically says that if you have a settlement regarding future medical and the plaintiff is receiving Medicare benefits or there is a reasonable expectation that they will be receiving Medicare benefits within the next 30 months you have consider Medicare’s interests in your settlement.  In the workers’ compensation world (and increasingly, the medical malpractice and liability world) this is handled through a Medicare Set-Aside proposal that is submitted to CMS for their consideration and approval.  This can be, to say the least, an arduous task.  For example, our firm submitted a Medicare Set-Aside proposal some weeks ago on a case we’re consulting on.  To appreciate the asininity of the situation, understand Medicare’s time frames.  To enter a fax into imaging takes seven (7) days.  Normal addressing of proposals and requests is 45-60 days; expedited is 21 days.  These are time frames that will cost you money in the real world.

Our proposal received a request for additional information which we submitted… three times.  Here’s the kicker- if you don’t respond to the request from CMS in 30 days, the case is closed and you get to start over again.  We submitted our info three times within the 30 days.  I know this because we called the requester to confirm receipt all three times.  Each time, we got the response that they were backed up on their imaging and to call back which we dutifully did.  Still not received.

I followed up on this again today to learn that the case had been closed because we had not responded to their request.  What this means is that despite our sending the information three times, it never made it into their system.  As such, it was assumed that we did not respond and the case was closed.  From there, the case was sent from CMS in Maryland to the regional office in Chicago.  I called Chicago on the advice of CMS of to see what the status was (you know, since nobody receives faxes that are sent even multiple times) and I got voicemail.  The gist of the voicemail was leave a message and “do to limited staff we will get back to you at our earliest convenience”.  Yes, they mentioned in their voicemail that they were understaffed.  Again in the real world, this is a firing offense.  In the government, it’s SOP.  I have yet to receive a call back.  Meanwhile, a judge in Missouri waits to act on a number of other items until Medicare responds to us.  The sequelae of untimely imaging has now gummed up the docket of a court in an unspecified county in Missouri.

I say that to say this- this is a cautionary tale if you’re in favor of a public option.  This tale does not come from government interaction with the Department of Transportation or Veterans Affairs.  These are the folks that will be handling your medical insurance if the bill as passed in the House of Representatives becomes law.  If you don’t like it, you can be fined $250,000 and go to jail for five years.  My hope is that everyone who favors a “public option” should know what they’re getting.  Specifically, they should get to work in and with the system for one week.  My guess is that once exposed to the system, it will tamp down the enthusiasm for this debacle.  Then again, I have heard a number of folks express excitement for “free health care”.  Problem is, there’s no such thing.

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