The Medicare Morass

The twilight years can lead to a health care black hole

Published: Wednesday, March 5, 2008 - 22:00

I retired in 2003, and when I made that phone call to add my name to the millions who are enrolled in Social Security, I was transferred to a knowledgeable, personable, courteous lady in Alabama who quickly and efficiently led me through the whole process. Like clockwork, my Social Security disbursement is deposited to our checking account the fourth Wednesday of every month. As an added perk, there have been two increases in benefits without my having to endure a performance review, another advantage of being a retired senior citizen.

Having made the transition from workplace to leisure pace, my next task was signing up for Medicare. This was more of a hurdle, because my special Social Security representative in Alabama couldn’t help me.

The Medicare registration process is not for the faint of heart. One needs a team of physicians, pharmacists, and legal beagles to assist in the navigation. It’s similar to a take-home exam, except most of the answers aren’t in the book. One can only hope that when the complicated package is completed, the road taken is a clear path to reduced health care costs and not some side road to confusion and denied reimbursement. Meeting and exceeding the expectations of customers has yet to reach the Medicare process, and guess what? If you make the incorrect choices you have to wait another year before changes can be made.

To make matters worse, it’s virtually impossible to contact any of the customer service centers by phone for guidance through this process. Let me explain.

Several weeks ago, my wife, Mary, and I were at a local shopping center when I decided to contact one of these customer service centers. These centers provide information on Medicare and the supplemental insurance that one needs for what Medicare doesn’t cover. I called the toll-free number and spoke to a delightful young lady who gave me the address of a center that was nearby. When I asked for the phone number, I was told that the center doesn’t accept phone calls. Fair enough. Just give me directions from the mall to the center because I had no idea how to get there. The delightful young lady had no idea how to get there either, so I again asked for the phone number.

I was politely informed that she was not authorized to release the phone number, and neither was anyone else in the office. I then asked for a supervisor and was told that a supervisor would call me shortly on my cell phone.

Mary and I then left the mall and went to a local restaurant for lunch. Once there we received a phone call from a health care supervisor who again reminded me that not even supervisors were allowed to release phone numbers of these customer service centers. Being the politically incorrect person I am, I suggested that the governor’s office has a listed phone number, the White House has a switchboard that handles calls, and I even have a 13-digit phone number for the Vatican. “Are the people in the customer service center more important than the Pope?” I asked. I was given a polite “No.” I asked, “Don’t the people who work in the office receive phone calls from spouses, children, and relatives”? The polite answer was, “I can’t answer that.”

Here’s where it gets zany. The supervisor asked me for the address of the restaurant where we were dining. When I inquired about the reason, she stated that she would provide me with Map Quest directions. Well, after getting the address from a curious hostess, who wondered why I needed the address of a location where I was already ensconced, I provided it to the supervisor. Sure enough, five minutes later I received a call back. Her opening words were: “First of all take a right hand turn out of the driveway. And there are eleven other instructions I will give you.”

Wouldn’t you think that just giving me the phone number would have avoided all this? My caustic comment, “Is this what you do as a supervisor—get Map Quest directions for customers?” didn’t sit well with her, and based on my condescending air, I couldn’t blame her.

As someone who has spent a career reviewing performance-excellence activities at various organizations, I marveled at such a breakdown in customer service. I suggested that maybe a phone number could be provided for customer service centers with a recording that states, “We do not accept phone calls, but here are our hours, and we are located between American Way and Customer Drive just north of Quality Street.” She took it under advisement.

When we finally located the office, the people were personable and professional, and guess what? All of them had phones and I overheard several of them talking to friends and spouses. Go figure.

We then discussed a myriad options covering such decisions as, “Do you want option A and option B for Medicare or just option A? Do you want to be billed monthly or quarterly for Medicare or do you want it deducted from your Social Security benefits? Do you want a supplemental policy to cover prescriptions, and will you be purchasing a 30- or 90-day supply of drugs? Are you familiar with the Medicare Advantage Plan, the Medicare Cost Plan, Medigap, or Medicaid?” This, my friends, is the gauntlet that every senior citizen must pass through before Medicare becomes effective.

As one goes through this journey, which I’m sure is tantamount to a tricky trek through the Grand Canyon on a burro but with less bravado, it becomes clear why the politicians who devised this Rubik’s Cube of choices have their own special insurance coverage. If any of these stalwarts of government red tape were to even attempt to wade through this quagmire of confusion and redundancy, the whole process would be shelved. I suspect that federal employees’ guaranteed health insurance for life attracts thousands of people to serve in government positions. It’s interesting that the politicians who crafted and enjoy these benefits don’t see fit to share a similar process with the people who elected them to office.

The Medicare process needs to be streamlined. It’s confusing, challenging, and steeped in language that left me frustrated and angry. Now that I have emerged from the Medicare morass I have no less than three identification cards to produce anytime I visit my doctor’s office or the pharmacy. It reminds me of the multiple remotes we have in our home to control electronic devices. We finally opted for a universal remote that does it all. Can’t Medicare do the same and come up with a universal card that would eliminate all the others?

To complicate matters, right after I completed the Medicare process I had to suffer through a series of illnesses and tests that tried my resiliency and patience, and the whole insurance-coverage process. The milestone of turning 65 and signing up for Medicare has turned out to be a millstone.

My parade of tribulations included a nasal biopsy, pneumonia, unforgettable medicine-induced constipation followed by a molasses—yes, molasses—enema, and finally a diagnosis of prostate cancer. As a daily runner for 30 years, I enjoy a good hurdle now and then, and I’m confident I can once more land on my feet.

I realize that many of you will conclude that this is too much information and perhaps a bit maudlin. But as someone who writes for a hobby, I find that this cathartic disclosure has elevated my spirits and physical well-being to a state higher than the multitude of pill bottles in my medicine cabinet.

Let me make it clear about what I refer to as the Medicare morass. Throughout all my meetings with health care and hospital staff, I always encountered caring, knowledgeable, courteous people with extraordinary bedside manners. While in my estimation the system is complicated, obtuse, and in some instances broken, the people who administer the process are trained professionals. Patients and health care staff seem to be partners in traversing a complicated process of forms and rules, and it was refreshing to know that people focused on exemplary customer care were at the helm.

As I write this column I’m almost back to running my usual five miles a day. I’ve met with four oncology physicians, and I’m trying to decide which treatment I will choose for my prostate. Of course I’m awaiting notification from Medicare and my supplemental insurance company on my coverage. I hope I filled in all the appropriate boxes on the multitude of forms, so that my financial exposure will be limited. In any case, I’m confident that a cadre of caring professionals will be looking out for my best interests.

Oh, for the days of a simple runny nose!

About The Author

Bill Kalmar

William J. Kalmar has extensive business experience, including service with a Fortune 500 bank and the Michigan Quality Council, of which he served as director from 1993 through 2003. He served on the Board of Overseers of the Baldrige Performance Excellence Program and has been a Baldrige examiner. He was also named quality professional of the year by the ASQ Detroit chapter. Now semiretired, Kalmar does freelance writing for several publications. He is a member of the USA Today Vacation Panel, a mystery shopper for several companies, and a frequent presenter and lecturer.