Two years ago, my doctor prescribed the ForeseeHome AMD Monitoring Program, and I have used it consistently since. My mother was blind because of wet AMD, and the data available online about this technology convinced me that I could improve my odds of saving my sight if I monitored daily.
I learned that Medicare covered the monthly cost of the screening and assumed that my health insurance, a Medicare Advantage Plan, would as well. (We have all heard the Advantage Plan commercials … “Everything covered by Medicare and additional coverage.”) What I quickly discovered, however, is that my insurance company would cover less than 4 percent of the $77.90 monthly cost for the service.
With the assistance of a fellow Patient Advisory Council member, as well as the team at the Notal Vision Monitoring Center, I learned how the healthcare system really works. Medicare pays the Notal Vision Monitoring Center directly for charges. With Medicare Advantage, however, the government pays the insurance company that then pays for medical expenses of enrollees. Simple. One would think there should not be a problem. Medicare has blessed the efficacy of ForeseeHome technology to provide early detection of possible progression to wet AMD. Shouldn’t insurance companies offering Medicare Advantage Plans follow suit? Yes, but they may not, and here is why.
Insurance companies are typically for-profit enterprises, and those that are (like mine) operate on a business model that requires them to collect more cash than they pay out. The sad truth is that the priority in this revenue structure is the bottom line–profit–not the welfare of enrollees.
For two years I have battled with this system. With the help of the Monitoring Center’s Patient Financial Services team, I have filed numerous appeals and reached out to government organizations who monitor health care programs, e.g., the Centers for Medicare & Medicaid and Maximus. To date, nothing has resulted in a satisfactory arrangement. At every turn, my insurance company has created a pattern of obfuscating its approach to determining its share of costs. On occasion I have been notified that it will pay almost the full amount charged only to have that decision reversed and my “co-pay” shoot back up to over 96 percent. Twice I received calls from an insurance company representative and suddenly felt like a contestant on “Let’s Make a Deal” as the person tried to barter an amount I would agree to pay. Eventually, however, the “deal” disappeared, my portion of costs snapped back to almost the full amount, and I was once again sending another appeal.
One might be tempted to chalk this laborious, erratic, and maddening process up to incompetency on the part of the insurance company. I believe, however, that the process is one that is calculated to increase the chance that I will give up and allow the company to pocket the government money that should be used for my care. And this is where the title of this article comes in.
In The Atlantic a couple of years ago an essay appeared describing what the writer called the “time-tax,” the “levy of paperwork, aggravation, and mental effort” imposed on citizens when dealing with government bureaucracy.1 This “you figure it out” system often results in diminished benefits for citizens who simply do not have the time to persevere through the bureaucratic tangle.
My experience with the company that administers my Medicare Advantage Plan confirms that it is also levying a “time-tax” on me, one that is the byproduct of a system designed to exhaust and intimidate enrollees and one that puts profit ahead of healthcare. If what I describe above is like what you have experienced with a Medicare Advantage Plan, I encourage you to join me in continuing to fight the good fight. If, however, any reader has found an Advantage Plan that matches Medicare’s coverage, please let us all know!
Jeannie
Retired educator, PAC Member and advocate for ForeseeHome
Reference:
Lowry, Anne. “The Time Tax.” The Atlantic, July 27, 2021.
