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The Medicare Scam

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Entrance to El Centro emergency room

Entrance to El Centro emergency room

Saturday evening, March 13, 2010, Jim was rubbing his right eye furiously. “Darn it, my eye is itchy!” he said.

Jim went to look in the bathroom mirror, and called me to have a look at his already reddened right eye.

“I think I rubbed my eye, to much, Maryann! Maybe I rubbed something right out of my eyeball.” said a worried Jim.

Jim’s eye was getting angrier and redder while I looked at it under our ceiling fan light.

“Jim, we should go now to the emergency at the Almater Hospital.” I said.

We got into our truck, and in no time were parking it in the car park of the Almater Hospital here in Mexicali.

We entered the emergency section of the hospital, only to be told that there was no doctor on call.  It was Saturday night.

Well, I don’t understand why emergencies have to happen on weekends or holidays for us, but it does.

“I have our passports in my handbag, and we are going to cross the border to go to the El Centro Hospital in the U.S. Jim,” I told him calmly.

“Shall I drive or do you want to with your one red swollen eye Jim?” I asked.

“I’m drivin’, and I can see Maryann? What do you think I am one of them Cyclops guys like in the movies?  Geez, I can see!” said  Jim.

“Okie Dokie!” I said.

It took us a quick one hour to cross the border on a late Saturday night, and Jim drove carefully to the El Centro Hospital. I must say the roads are not that well lit, but we got there in one piece.

After parking the truck, we walked quickly to the Emergency Room of the hospital.  The waiting room was empty! Great!

Jim went up to the girl behind the window counter and told her that he needed to see a doctor for his swollen eye.

“I have Medicare” said Jim giving his Medicare card to the girl.

The girl said we could enter the door to the next room, where the nurse told Jim to sit down, asking him what had happened, all the while taking notes.

A doctor was on duty, and a nurse signaled Jim to a room with a bed. “Oh, Mr. Dogooder, you’ll be just fine now,” said the nurse, “doctor will be right with you—don’t you worry about a thing now.”

“Hey, these folks are real nice,” said Jim calming down.

Two other nurses came into the room, “Mr. Dogooder, it’s your eye?” asked one of the nurses, “that’s the only problem—anything else?”

“Nope that’s it,” said Jim who was now lying down on the bed, while I sat on the chair by the side of the door.

A doctor came into the room and greeted Jim, “Well, hello there! You are Mr. Jim Dogooder? Eye itching correct? And you live in Mexicali.”

“Yes, there were no doctors at the main hospital in Mexicali so we came here. I’m on Medicare Doc” said Jim.

“Yes, good,” said the kind doctor, “Now let’s just take a look at that eye.”

“Yup, it’s looking red and angry. Tell you what we are going to do.  I am going to put some eye drops into your eye.  With these drops, we can look and see if there is any damage done to the cornea. Ok?” said the kind doctor, cheerfully.

“Nurse, the drops please,” said the doctor. Then, turning to Jim, “You’ll be just fine; there’s no pain whatsoever, and we will know what to give you for that little nasty redness. OK?” smiled the doctor.

After the eye drops, and looking at Jim’s eye with a special magnifying glass, the cheerful doctor called me over and said, “See, all those straight lines, scratches, on his eyeball?”

“Yes, I can see them,” I said, “that’s where Jim was rubbing his eye.

The doctor pushed back in his chair and said, “Only scratches, he’s fine—no eye damage at all!  I am going put some antibiotic eye ointment in Jim’s eye—Garamycin.”

The nurse handed the doctor a small tube, and the doctor moved forward and squeezed a bit of ointment into Jim’s eye, and handed the tube back to the nurse.

The doctor then said, “I am going to give you two Vicodin tablets, and a prescription for more.”

Jim sat up. The doctor continued, “Now, I would watch that eye Jim. Here’s a list of ophthalmologists if you have any more problems, just make an appointment with one of them. You’re good to go!”

As Jim stood up, the nurse handed him a small plastic container, “Here’s your Vicodin and a prescription for more.”

“Thank you Ma’am,” said Jim.

The nurse replied, “Now, that wasn’t so bad was it? You will be just fine. Let me put a patch on that eye.”

“A patch on my eye? I won’t be able to drive back to Mexicali!” said a worried Jim.”

Mrs. Dogooder, you can drive?” asked the smiling nurse.

“Yes no problem” I said.

The nurse smiled, “Men, they can be such babies—now when you feel pain, Mr. Dogooder, just take one Vicodin and you’ll be just fine! Your wife will be in charge for now.”

The doctor waived a cheery goodbye and left saying, “Yes, the nurse is going to put a patch on that eye, so let the little lady do the driving tonight.”

Jim and I left the El Centro Hospital, happy that Jim’s eye was fine, even though he felt out of place in the passenger seat.

On our way back home to Mexicali, we stopped by a Denny’s near the Wal-Mart in Calexico, where Jim and I ordered grand slam breakfasts, pancakes, and chocolate milkshakes.

“When we got back home, Jim said, “Well, MaryAnn, that was great! Everyone was so nice and all.”

“Well, all’s well that ends well,” I said.

And Medicare will take care of it!” smiled a contented Jim, removing his eye-patch.

The $911.45 bill - click to enlarge

The $911.45 bill – click to enlarge

A month later a bill arrived from the El Centro Hospital. It was for $911.45.

We were stunned – what about Medicare?

For that little bit of ointment the doctor squeezed into Jim’s eye, the charge was $87.46—and the doctor kept the tube! The charge for the eye drops the doctor put in Jim’s eye was $63.44! The use of the emergency room area cost $738.29. With some other incidentals and accidentals, it all added up to $911.45.

We had been paying $96 a month for Medicare Part B for over ten years – they take it directly out of your Social Security check.

During that time Jim went to the doctors twice at most. Ten years at $96 a month equals $11,520, taken out of our Social Security. I think very few folks on Social Security can afford that.

Jim showed Matthew and me the bill, while he looked for his recliner to sit down. “My head’s spinning!!! How can it be $911.45 for what they did?” Jim asked. “I have Medicare!”

The next morning, Jim telephoned Medicare. The conversation did not last long. The Medicare lady explained that if you don’t have Medicare Part B—you’ve got virtually nothing, and that the $911.45 charge was correct and that Medicare would pay nothing.

“But your website clearly states that Medicare Part A gives you coverage for hospital both inpatient and outpatient.”

The Medicare lady said she was sorry, but the website was misleading.

She went on to say that, without Medicare Part B, even in a hospital, the doctor’s charges are not covered.

This means that if you don’t have Part B, and you are rushed to the hospital, and a doctor has to operate, you could be faced with a huge doctor bill.

Looking at Jim’s $911.45 hospital bill, it seems that Medicare Part A pays nothing, which is more or less what the Medicare lady told Jim.

All those years of Medicare deductions from Jim’s salary—all for nothing. Jim couldn’t even get Part B if he wanted to, as the door for that closed last March.

Just last week another medical bill arrived!

It was for $246.00 and was from some outfit called the Alpine Emergency Medical Group in Westminster, CA. We figure that this must be the bill for the cheery El Centro doctor bringing the total to $1,157.49. This is price gouging by the health care industry. No wonder medical costs in America is double what they are in any other country.

The Medicare website stated that Part A paid for Inpatient AND Outpatient care.

Since Jim complained—Medicare has changed its website.

Originally the Medicare website used to be red and said that Part A provided inpatient AND outpatient hospital coverage.

Now the Medicare website is green and blue and  has eliminated the outpatient coverage. What a bunch of crooks!

If you have only Medicare Part A, you have NO insurance at all.

What a scam!

That combined with the fact that Jim’s job went to some guy in China makes my blood boil!


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6 comments to The Medicare Scam

  • Thanks, Rob. Let me know how it goes.
    God Bless,
    MaryAnn

  • Rob

    Hi MaryAnn, just wanted to say a BIG HUGE THANKS for the dentist recommendation. I have just had a crown pop out and will be going to Mexicali in October to have it replaced…..Will be glad to check the place out and also to save the money!!!!! Thanks again for having this website up and running! Sincerely, Rob A.

  • Galjew

    Scams in Medicare??? This is really discouraging! And our health matters a lot!
    Take vitamins! We can’t allow diseases to deprive us a good life. To have a healthier future, let’s meet at Abdominal Pain Symptoms.

    Elevate your Health!

  • Rebecca Crawmer

    Wow! Thanks MaryAnn for the info! Do you know if she speaks English; since she has an American number I am hoping so but just thought I would check with you first to see if you knew. Glad to hear you are having such great results with your braces too. Don’t know how old you are but when it comes to our mouths and oral care we are never to old from everything I have read & been told. That is why I have to get this all done, unfortunately! At my age and with all the time & money I already have in my mouth (and my daughter too like you said about your kids) I am not looking forward to this expense but we got to do what we got to do to keep living a healthy, happy life since we have been blessed with the ways & means to do so & now with your help affordable…
    May God bless you also, Rebecca

  • Thanks, Rebecca: I haven’t been to a “regular” dentist in Mexicali. HOWEVER, when I went to see about having braces (for an old gal, like me – why not?) the orthodontist told me that I had gum disease and would have to see a periodontist before he would my braces on. (Hey, in Arizona, they want to cap some of my teeth, and made no mention of the fact that I had periodontal disease). The orthodontist sent me to Dr. Luis Marquez, who had been his university professor. Dr. Marquez, who is still a university professor did a great job for $550, and I could feel the difference. He is located at Av. Obregon No.779, cell +54 686-554-1404. He is generally in his office in the afternoon, from 4:00pm on. Dr. Marquez speaks English. For regular dental work, my orthodontist recommended Dr. Karla del Valle, Av. Madero No. 998, and she has an American number, (760) 670-4403.
    So, back to my braces – I have them on – they are the latest greatest new tech type, and my teeth are moving very quickly – for about a tenth of what we paid for one of our kids back in the US.
    God Bless,
    MaryAnn

  • Rebecca Crawmer

    Hi
    My husband & I have enjoyed your info on Mexicali for quite sometime now; thanks. My husband worked there for about 18 months @ the Honeywell plant.
    I was hoping you could provide me with information regarding dentistry there. I have just been told I need to have some very expensive dental work done. I would have it done there if I could be directed to a qualified dentist and could save money. I would appreciate any info you could give me!
    Thanks,
    Rebecca

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