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Wiser’s Wramblings-Assured if Insured?

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By Chuck Wiser, I write the words to share what my eyes see and my heart feels

Sometimes the topic for the weekly (or weakly) Wiser’s Wramblings rumbles around in my head for the entire preceding week. Sometimes they just happen to fall out of the clouds. This week’s main topic focus actually started early this morning but it was only going to be a sub topic. A meme shared on Facebook by recently retired Scio Librarian Sue Moyer triggered the expansion of the topic to likely comprise the entire article.

Let me lead into that topical discussion by offering that I am by no means an expert on “insurance” issues of any kind despite having had a few harrowing personal experiences and some very rewarding wins. Therefore, all my comments should be considered “anecdotal”.

This Meme resulted in a couple of early comments and based on my response, and others, I sense that there might be a few more as the day(s) goes on. In my mind the message sent in the Meme has both truth and fiction aspects. If the Insurance Industry does to gun ownership as it has to the Medical Industry, and I use that term, in that fashion, to separate the “professional” from the “business’ focus. Nearly everything medical is now controlled or dictated by the Insurance industry. The medical profession can’t, or wont, go against the edict of Insurance regulations or mandated procedures. This relationship isn’t just between Medical and Insurance, but even overlaps over to Government agencies, if you consider Medicare, as well.

While I was employed at The Air Preheater Co. (Now having reverted to its former name, Ljungstrom Air Preheater) we had an excellent health insurance plan. Fortunately for me I was covered immediately. Less than a year after my hiring I required major surgery medically named “Vagotomy with Pyloroplasty”. I couldn’t remember the order of the terms so looked it up. Pyloroplasty normally is performed after the Vagotomy. Taking a step aside…the surgical procedure once was the common remedy for persistent Duodenal Ulcers. It is now known that most ulcers are caused by a treatable bacterial infection. My impressive surgical scar goes from my belly button to my sternum. It was an interesting conversation starter before people would blanch and turn away at the sight of my bare anatomy, even when just partial. I do not recall having any “out of pocket” medical expenses. The only limitation at that time was the need to return to work somewhat prematurely as my insurance only covered a few weeks of lost time due to lack of longevity. Not to make this into a personal medical chronical, but I now have periodic episodes of “Dumping Syndrom” which is a by-product of that particular medical procedure.

When I joined Alfred State College in 1983 their insurance plan, Empire Plan/United Healthcare under the New York State Health Insurance Plan (NYSHIP) picked up where my previous plan left off and it too was an excellent package. Upon retirement I “bought out” my insurance plan coverage trading in accumulated vacation and sick leave time. Since I didn’t “officially” qualify for the “Professor” rank I was a 12-month employee with vacation benefits.

All of that is preamble to my decision regarding insurance coverage when eligible for Medicare following “turning of age” in 2010. When applying for Medicare I had a choice of accepting Medicare B as my “primary” coverage. Not having been told, read, or understood the ramifications, my thinking was: “Why burden the government with my medical costs when I had a perfectly satisfactory Health Care plan of my own.” That was very nearly disastrous. Following a knee replacement surgery in the fall of that year I received an insurance claim notification stating that my “share” of the procedure cost would be nearly $70000. After “coming to” and picking myself up off the floor (figuratively) I started a flurry of panicked phone calls. It was explained to me then, well after the fact of my Medicare B decision, that since I had declined Medicare B as my Primary insurance, it was the policy of the insurance carrier to not pay the majority portion of the expenses, but rather, that it was my responsibility.

Thus, began what was initially thought to be an impossible task of “turning back the clock” on my decision. Without boring you further with the “blow by blow” details of my campaign, I finally was able to coordinate activities between Medicare, my Healthcare Insurance provider and even the Internal Revenue Service, all of whom had to approve of and sign off on making my Medicare Part B “retroactive” have been in effect prior to the surgery. This negotiation was by far my most challenging, but also most rewarding, considering the potential financial impact.

I mention that personal Insurance coverage history to illustrate the significant role it plays, and the component that the Insurance Industry is, or can be.

Here is a more recent example if you would consider Tuesday of this week recent 😉. This has happened to me more often than I like to remember given all the new bodily parts that have become bionic and likely with more to follow. I had a “consultation” doctor’s appointment in Rochester Tuesday, trying to get to the bottom of the problems I have had following my left shoulder Arthroplasty in October. In addition, I am seeking advice regarding the need for the same surgery for the other arm. Due to the likelihood that the problems with the shoulder(s) are related to the muscles or tendons which are not readily distinguishable in an X-Ray, a Medical Resonance Imaging (MRI) procedure was most likely needed. It is an insurance company requirement that X-rays be taken and analyzed before an MRI can be done. The Medical provider is the ultimate winner, in that my insurance will now have to pay for the Xray procedure as well as the MRI procedure. This has already happened to me several times throughout the initial diagnosis phase and now also during some remedial processes. My “out of pocket” expenses are not that significant, but the duplicate co-pays do add up, as do the travel expenses. Fortunately, my negotiating skills have once again proved beneficial at least travel wise, as I have been able to convince the “imaging” facility to expedite processing, so the image and report data, can be completed and communicated to the Doctor that day, in time for making it a one trip venture rather than two separate days. I have been very fortunate, and thankful for, the flexibility of these providers to accommodate my significant appointment travel needs.

My “brotherlike” near lifetime, friend Tom Geyer, appreciated my negotiating skills. On more than one occasion he had me go along with him when making a significant item purchase to help get him a better deal. He knew that he had a weakness in the presence of the sales sharks and often could be talked into buying shares in the “proverbial” Brooklyn Bridge.

It isn’t often that I get to reach out and thank an audience of a performance that I have been a part of, but I would like to, now. The Genesee Valley Chorus (GVC) had already performed to a couple of smaller, more intimate, groups this year following our two-and-a-half-year hiatus but last night was different.  Last night at the Scio Memorial Library we had the opportunity to sing for a “real” audience and boy, were they real! If I said there were 50 to 60 people in Carnegie Hall it would sound like the place was nearly empty. Had I not been otherwise occupied reading and singing the music before me I would have tried to count, but my attention to the music alone kept me occupied. Trust me when I say there was “standing room only.” This was my first appearance with the group since 2016, having been singing with the Olean and Hornell Barbershop groups, and most of the GVC music presented at this concert was new to me. Our normal several month “prep time” prior to performing was cut to a few weeks and that’s a short time frame for someone as musically challenged as I, in the music reading department.

Back to the thanks. As I gazed out at the audience, I spotted many faces familiar to me and I wondered: “what was their connection to the Scio library, and or GVC?” I do not know but it was heart-warming to see them. Some were chorus family members of course, but many weren’t.

 Despite our having some technical difficulties with the electronic equipment including our piano, not having access to our normal “stand alone” piano, the audience was understanding, patient and even laughed along as our accompanist Carole Aldrich, formerly Musical Director at Scio Central School, and our Director Norma Bartlett, bantered over the piano difficulties. Special thanks also to the Library Committee staff and some of our member guests who helped with the setup, arrangements and in general their support through the evening. I would like to mention names, but they might not appreciate it. We know who you are and I’m pretty sure you’ll know that I am talking about you, so Thank You!

Here’s hoping that you are having an enjoyable summer and taking advantage of the wonderful weather and get out to see the many events and avail yourself to the majestic beauty and scenic wonders available to you here in our little corner of the world.

I had planned to this week, but got sidetracked, so next week I plan to discuss a topic that bewilders me. Do you understand Cryptocurrency, Data Mining or even Bitcoins? Neither do I. As I did a little research thinking of how to understand and explain it in such a way to have it be understandable, and have it make sense, I came to a mental roadblock. The more I investigate it, the more puzzling it gets. I just wonder Why?

Again, I invite you to reach out if you have any comments or suggestions or topics you would like me to discuss. You can email [email protected], and they will be passed along to me. I would site my personal contact information but that is frowned upon, but those that are already in contact with me know how to do that.

And, also, thank you for reading and for the many kind comments, and others, that I have received.

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