Thursday, November 12, 2015

Managing High Anxiety (or not).

Among Noel Tyl's articles, available at his website, I noticed this one: Managing Anxiety. I'd just returned from a follow-up appointment with our doctor, after a bi-annual routine blood test a few days ago. I'd suffered my own routine spurt of BP and heart-rate raising anxiety, if anything it seemed even more pronounced than usual this time. It's totally daft of me, but has always been thus, since childhood. I'm not scared of needles, or much of anything they could do to me, per se - it's just...well, daft of me! I've been told my type of anxiety is known as "white coat syndrome". There was nothing whatsoever to worry about this time, I didn't expect there to be, not really. But still the feelings of anxiety arose. I suspect my being out of control of results figures into this discomfort - a serious dislike of having my independence threatened.

I'd love to be able to manage that nervous silliness of mine. At my age though, it's unlikely to happen. I found the linked article interesting even so. Astrologically I blame First House natal Pluto opposite natal Sun, and maybe Chiron (the Wounded Healer) inconjunct Sun (but trine Jupiter) for my nervousness when facing a white coat.

I particularly liked Mr Tyl's last words regarding astrologers who counsel - though I've never actually been counselled personally by an astrologer, he makes it sound like rather a nice experience, if done properly.
Our job is not to read a planetary riot-act and pronounce gloom and doom; rather, our mission it is to support and free up our clients; to help with efficiency, helping to cast off extra, useless baggage, and illuminate the individual’s light as never before within the human condition.

Postscript: Before scheduling this I noticed an article on yesterday's Huffington Post about White Coat Syndrome. I'm not overly impressed by that kind of survey/study, but found the comments more interesting and informative than the piece itself.


mike said...

I tend to have the same medical-exam anxiousness. I hadn't seen a doctor for some time and was actually looking forward to the experience this time. I had wonderful insurance (no co-pay or deductible), which eased the financial pressure that most face. It took a year to finally be accepted by a doctor, then two months from booking until appointment. The blood-work was not performed and not realized by the medical office until I made an appointment to review the blood results. The tests were performed once again and another appointment to review the results. The results eliminated the thyroid concerns, which meant that I needed to be seen by an ENT for possible neck problems and have a CT scan. By then, my great insurance was expiring in two days. Oy! Now I'm in Medicare-ville with co-pay and deductible. The doctor told me that my neck problem probably isn't a killer, as I've had this for four years. I made the decision to not pursue this unless it becomes necessary in the future.

During this two-month venture, I had three doctor's appointments, two visits to the blood laboratory, and another to have my thyroid scanned. I didn't like my focus being centered on all of this medical stuff. I feel very relieved to be done with it! I feel short-changed, since it required two months to narrow-down the potential area of concern, only to meet a dead-end. I can't say it's anyone's fault...things happen. The time delays, laboratory mistake enhanced by the doctor's office not catching the lack of blood results, and my urgency in resolving this prior to insurance termination, made me realize just how ALONE I am in the sea of medicine.

Overall, I found this experience to be very unsatisfactory. On the positive side of it all, I had extensive blood analysis and all is fine, so that was reassuring.

I've shunned the medical profession in the past and I've found that it's very easy to become over-physicianed (over-egging the pudding, as you might call it, Twilight!) should I have anything more complex than an overt infection requiring antibiotics. I've had friends and relatives that visit the doctor for seemingly simple issues, but end-up on multiple prescriptions, feel worse than before, and have doctor appointments scheduled well into the future.

Twilight said...

mike ~ As we've commented before, it does seem so unfair that the benefits you had previously on the insurance front, due to your Native American background, should lapse once on Medicare. That seems like a loophole someone should campaign about to get fixed. We pay for a supplemental insurance to cover co-pays/deductibles, but it becomes very expensive, when added to the extra Medicare payment we make (about which I've forgotten the detail). It's all so different from the NHS in Britain - makes my head spin at times.

Like you, I've always, all my life, limited doctor visits to absolute minimum. Although I dislike the annual or bi-annual bloodwork visits here, they really are helpful in keeping well, spotting anything that needs attention.

mike (again) said...

Re - Medicare Part C, supplemental insurance: Medicare Part A & B is fairly generous with their co-pay and deductible. Part A hospitalization, surgeries, rehab, nursing, etc, is $1,260 total deductible, no co-pay, for days 1 to 60 (won't pay more than $1,260 for all days combined), $315 per day, days 61 to 90. Part B office visits and medical services is $147 deductible and 20% co-pay after...preventative services are free.

Part C supplemental insurance offered through private insurance companies is profitable. The private insurer receives a large premium payment from the government and any additional from you. The insurers don't do it because they are nice and kind! Part C will only work in your favor, if something catastrophic occurs, requiring very long-term hospitalization, to which most patients are placed temporarily in nursing-homes. Medicare Part A allows 20 days of nursing-home at no cost, $158 per day up to 100 days. In order to essentially minimize co-pays and deductibles for Part C, the monthly premiums are sky-high, as you said.

A neighbor of mine pays over $500 monthly premium for Part C, plus the $105 monthly to Medicare, well-over $7,000 a year total. There are various items that she still has to pay a co-pay and-or deductible, should she need them, but those are minimal.

Under normal circumstances for the average Medicare patient, Part C does NOT work in their favor, and the monthly premiums cost more than the patient would have acquired through co-pay and deductible under regular Medicare.

Insurance companies are making a KILLING off of the Affordable Care Act and Medicare Part C. They are a cartel.

mike (again) said...


"In more than 200 of these counties, the cost of some Medicare Advantage plans was at least 25 percent higher than the cost of providing standard Medicare coverage. The wide swing in costs was most evident in five states: South Dakota, New Mexico, Colorado, Texas and Arkansas."

This is several years old:
"Yes, the government does pay the carriers around $800 per person, but this amount increases if a senior qualifies for a chronic condition, such as high blood pressure and the a chronic plan is available in the seniors area. The plans receive even more money per person if the senior is on Medicaid, around $1200 per person."

And this using the year 2012 (Medicare Advantage Plan is Part A & B):
"Medicare pays the Medicare Advantage Plan or Part D plan for each beneficiary who enrolls a monthly amount based on a complicated formula. The Centers for Medicare and Medicaid Services takes vast amounts actuarial data, enrollment, local cost numbers and crunches it in a formula to create capitation rates or the average amounts they reimburse plans by county.

Medicare Advantage Monthly Capitation Rates for 2012 for All Plans except PACE Plans showed Medicare Advantage Plans were paid $838 per month in Sacramento and $850 in Placer counties for plans with 4.0 STAR rating. In an effort to reward customer satisfaction and efficiency, reimbursement rates are also adjusted based upon the plan’s STAR rating. There are also other plans and special circumstances that would have CMS paying more per month on behalf of the beneficiary.

On the Part D Prescription Drug plan side similar calculations are involved. However, all companies that wish to participate must submit a bid for monthly reimbursement to CMS."

Well, it appears that in previous years, our federal government paid between $800 to $1,200 per month to private insurers for Medicare Part C...that's on top of what the insured paid in monthly premiums to the private insurer.


mike (again) said...

I see that the US Postal Workers have endorsed Bernie!

Twilight said...

mike (again) ~ There should be a syndrome called Medicare Complexity Syndrome which has similar symptoms to White Coat Syndrome! Honestly - I don't understand any of it.
We don't do Medicare D or the Medicare Advantage thing, but we do have a private supplemental with Omaha Mutual, which picks up deductibles and co-pays, but bumps up the overall outlay quite a bit. I often wonder if it all doesn't add up to more than if we weren't on Medicare but just a basic ordinary plan. It obviously is better, especially if a real calamity befalls.


Good for the Postal Workers !! So pleased! I'm looking forward to Saturday's Dem. Debate.

By the way - we watched "Cruel and Unusual" last night - thanks again. It was weird but kept us interested. Yes, there was a bit of Twilight Zone flavour. It also reminded me, a little, of the book I read a few weeks ago "Replay" by Ken Grimwood. In that story the main character keeps having to re-live parts of his life.

mike (again) said...

You probably DO have Medicare Advantage, at least anyjazz. The government pays between $800 and $1200 per month to private insurers for handling. It's PPO and offered through private insurers, and known more commonly as Medicare Part C:

Twilight said...

mike (again) ~ I don't think so. We both have supplemental to Medicare insurances with Mutual of Omaha - but it's not Medicare Advantage....or maybe it's Part C - I didn't think so but I'm all at sea with this stuff.

Just been on the phone, yet again to the hospital in New Mexico who are still chasing me for $142+ a stray amount not paid. This is the second time! Mutual of Omaha say they never received this bill, the hospital say it was sent in July - Mutual say it wasn't received, though two others from NM were, and were paid (of which I have proof).
I've given up on the phone now, otherwise my hair would be torn out, and have written 'em a letter telling 'em to send the bill to Mutual again. I guess there's always going to be bills gone astray or to wrong department or wrong something.... GRRR!

mike (again) said...

Now you're a deadbeat, eh?...LOL. Peculiar how certain "things" are sticky and just won't go away no matter how one tries and tries. I mentioned previously that I'd made a mistake on selecting a Medicare Part D provider for the last two months of 2015, but all was fine for 2016. I had lots of trouble with Humana cancelling the 2015 coverage that I made in error, but finally was successful after numerous phone calls. Well, Medicare mistakenly cancelled my 2016 coverage when they corrected the 2015 error. Like you, hours on the phone for all of this trivia.

I do believe that you have Medicare the Wiki page. Few people call it that, but our congress does. From Wiki:
"The Balanced Budget Act of 1997 named Medicare’s managed care program Medicare+Choice and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 renamed it 'Medicare Advantage.'"

If you and anyjazz are on Medicare and pay your $105 per month to the gov for it, but have a private insurance plan, you are on Medicare Advantage, or Medicare Part C. Most retirees call it supplemental insurance.

That is why the cost involved is so staggering to me. The government pays $800 to $1200 a month (in 2012!), plus the monthly premium that you pay the private insurer. These private insurance companies are making a killing.

Twilight said...

mike (again) ~ Dunno mike - I suspect ours might be a Medigap Plan - one for each of us + Medicare A and B. Anyjazz is almost as confused as I am, as it's years since we talked to the insurance guy in Lawton about it, and the different avail abilities have become blurred. I only know that I've never had to pay any deductible or co-pay, or anything other than the Medicare A and B and the Mutual of Omaha premium. I think anyjazz, since being on Medicare, has had one small amount to pay, after an overnight hospital stay - for bits and pieces of stuff not covered by Medicare.

If I end up having to pay this stray $142 it could be related to the fact that my accident happened out of state, or involved something not approved by Medicare - that's all I can deduce - if so I'll make them explain that to me before I pay. But really, the large amounts for CT scan etc. have been paid already, and they were out of state.

Volume and complexity of paperwork involved in Medicare etc. is horrendous! My file bulges with it all!

Bob said...

Nightmare experiences caused by greed.

Twilight said...

Bob ~ I guess ! :-/