Is Medicare Missing The Boat?

 

 

December 17, 2021

 

Medicare Contact Center Operations

Box 1270

Lawrence, Kansas 66044

 

Dear Medicare

 

In July 2018 I suffered a back injury that likely resulted in me breaking two ribs.  Three months after the accident I began to experience excruciatingly painful and debilitating muscle spasms in the area of the broken ribs.  I visited my primary care physician who diagnosed me with injured muscle. He prescribed a muscle relaxant that did absolutely no good.  A summary of my attempts to fix this problem follows

 

·         Primary Care Physician – October 2018 – Prescribed a muscle relaxant that offered no resolution.  Medicare and GEHA Insurance paid for all of this

·         Primary Care Physician – October 2018 – Ultrasound of kidney to rule out any issues since the spasms were directly over the kidney.  Medicare and GEHA Insurance paid for all of this.

·         Primary Care Physician – November 2018 – Ultrasound of liver and gall bladder to rule out any issues.  Medicare and GEHA Insurance paid for all of this.

·         Primary Care Physician – November 2018 – Examination and palpitation to rule out pancreatitis.  Medicare and GEHA Insurance paid for all of this.

·         Acupuncture Doctor – November 2018 to January 2019 – 20 sessions of acupuncture that provided momentary relief. Medicare or GEHA Insurance paid for all of this.

·         Massage Therapist – February 2019 (I paid for this) – Two visits that provided temporary relief

·         Orthopedic Physician specializing in pain – February 2019 through October 2021 – Five trigger point injections of a steroid into the muscle to relieve the pain.  The first two injections each provided 4 months relief.  The third injection provided 3 days relief.  The fourth injection provided 2 days relief.  The fifth and final injection provided 1 day relief.  Medicare and GEHA Insurance paid for all of this.

·         Physical Therapy – 2020.  Recommended by pain doctor and 8 sessions (all Medicare would cover) provided no change. Medicare paid for all of this.

·         Partners Imaging Center – 2020 - an MRI of my thoracic and lumbar vertebrae to determine if there were any disc bulges or nerve obstructions causing the pain. There were none.  The pain continued.  Medicare and GEHA Insurance paid for all of this.

·         Emergency Room at Doctor’s Hospital in Sarasota – 2020 – A middle of the night ER visit because the pain was so intense, I could not sit down or stand.  I was given 3 different steroids and muscle relaxers and the pain subsided long enough to drive home. Medicare and GEHA Insurance paid for all of this.

·         Primary Care Physician – 2021 – Another office visit to discuss what options I had to get rid of the pain.   The spasms continued. Medicare and Insurance paid for all of this.

·         Pain Doctor – 2021 – Another consultation.  Medicare and GEHA Insurance paid for this visit.

·         Premier Surgery Center – April 2021 – An epidural spine injection of a steroid into the base of the nerve affecting the muscle causing the spasm.  This provided 4 months relief.  Medicare and GEHA Insurance paid for all the expenses by the Surgical Center including the Pain Physicians time and expertise, an Anesthesiologist’s time and expertise and an array of surgical nurses who took care of me before and after the procedure.

·         Pain doctor – October 2021 - Consultation paid for by Medicare and GEHA Insurance.

·         Akumin Imagery Center – October 2021 – Another MRI ordered by the Pain Doctor looking to see if something had changed in my spine because none of the treatments were working.  Medicare and GEHA Insurance paid for all of this.

·         Premier Surgery Center – October 2021 – An epidural spine injection of a steroid into the base of the nerve affecting the muscle causing the spasm.  This provided 3 days relief.  Medicare and GEHA Insurance paid for all the expenses by the Surgical Center including the Pain Physicians time and expertise, an Anesthesiologist’s time and expertise and an array of surgical nurses who took care of me before and after the procedure.

·         Pain Doctor – October 2021 - Follow up visit after the latest epidural spine injection that provided 3 days relief.  Medicare and GEHA Insurance paid for all of this.

·         Neurologist – November 2021 - Consultation with a neurologist who ruled out any nerve problem.  Following all earlier physicians, he said the problem was with my muscle and the scar tissue that would not go away from the injury in 2018.  The neurologist prescribed a muscle relaxant that did no good.  He then prescribed Gabapentin a drug used for muscle issues related to epilepsy and similar diseases.  It provided partial relief.  Medicare and GEHA Insurance paid for all of this.

·         CVS Pharmacy – 2018 through 2021. I have had multiple prescriptions for drugs prescribed by the above physicians including muscle relaxants, opioids (Oxycodone), Gabapentin, and others.  GEHA Insurance paid for everything except a very minor co-pay on my part.

 

I have not kept my explanation of benefits from Medicare and GEHA Insurance for all of these treatments so I do not know the exact cost of all of the medical treatment I have received. I would guess given the two visits to the surgery center, two MRI’s, 2 Ultrasounds, and visits to primary care physicians and high-priced specialists. that between Medicare and GEHA you have spent at least $15,000 if not more for treatment of a muscle spasm issue that will not go away.

 

At my wits end and tired of living with the constant muscle spasms I did a search on Google using the key words “Deep tissue Laser treatment for muscle spasms.”   Google returned a link to a laser treatment that is fairly new and shows remarkable potential for eliminating muscle spasms.  The only local source for this specific high-energy Laser treatment is Hudson Chiropractic in Sarasota.   This brings us to the final bullet in this letter.

 

·         Hudson Chiropractic – I have had four high-energy Laser treatments in the last 2 weeks.  I have not had a muscle spasm in a week.  Before the Laser treatments I was having spasms at least once every hour and often 5 or 6 times an hour.  Now I have none.  I have two more appointments next week and then we are going into much more infrequent long-term maintenance treatments.   Each treatment costs me $60 because neither Medicare or GEHA Insurance will cover them. 

 

After three long and painful years filled with visits to surgery centers and specialists and emergency rooms and lots of expensive drugs, the issue seems to have been resolved with $240 worth of Laser treatments that neither Medicare or GEHA cover.

 

I was not an economics major or a business major. I was a wildlife biology major. Despite that lack of business education, it seems to me that both Medicare and GEHA Insurance would save a tremendous amount of money if you covered several $60 treatments at a Chiropractor’s office that resolved the issue, instead of tens of thousand of dollars that you did cover that only helped some physicians pay for their children’s college education at Harvard or Yale. 

 

My suggestion is that you consider covering deep tissue Laser treatments.  But that’s just me.

 

 

 

cc:   GEHA – Government Employees Health Association