Beating Myself In the Head & You Can't Trust a Donut

Wouldn't ordinarily write twice in one day on this blog but I have some things to say and nobody to listen. I hear R's snores coming from the bedroom where he's taking a nap after all his plowing and playing in the snow. I'm the one who deals with finances here - very scary actually. But we got a bill today from the hospital - for one of R's hospitalizations in Dec. The bill was for drugs he had while there. Medicare denied his claim. So I called them. They said he was not an inpatient but an outpatient. The reality is he was in the hospital three days and two nights that time. The person kept saying no he was not an inpatient, he was an outpatient. I stopped talking to him the third time he said outpatient and I literally beat the phone on the kitchen counter. I wanted to beat myself in the head with it. Then I called the secondary insurance which said of course that they do not pay if Medicare denies a claim. Soooo I called the hospital. The person in billing said yes indeed Mr. W was an outpatient during that time. He was under "observation." Which I now realize is observation = outpatient. Like he was being administered to out on the hospital lawn or something. I said no he was an inpatient. I saw him there on the third floor in an uncomfortable bed, hooked to monitors and machines. If he'd been outside I surely would have known it. Nope, she said. He was an outpatient. AND she said it was thanks to the physician for putting observation on the chart. How far will these companies go to keep us from getting what we are paying for? I could go on and on. I sent a prescription to our mail in pharmacy last week. The order came back with the RX and a bill for $227. I called and was told that my insurance this year had combined my pharmaceutical coverage with the medical coverage and the RX part was included into the medical deductible. I'd have to meet my $2500 deductible before I could pay the usual co-pay for drugs. She said I should have read the small and getting smaller print on the letter I received from the insurance Jan. 1. Wonder if there is anything else I've missed...We learned the end of Nov. 09 what the donut hole meant in R's RX coverage with Medicare. The donut hole means you are out of benefits. So before we got out of the donut hole we paid $300/$200 for two drugs.
I've always likened donut holes to something sweet and sugary. No more. The cold hard truth is you can't even depend on a donut anymore. As for me, I'm heading in to have a second piece of that good old cowboy coffee cake.


  1. You can get extensions on your Medicare Plan D. Yesterday I was going through my Mother's mail and she happened to have a letter from SSA explaining just that. You have to meet certain criteria, and honestly, I forget what it was because it did not apply to my Mother, and one less thing I have to remember. But you can easily find out by calling Social Security or maybe you can try their website. It might be worth a try.

  2. Not sure what you mean by extensions Pam. I'll look it up.
    I'm turning my frustration into an article - that helps.


Post a Comment

Popular Posts