11 October 2007
Thursday, 11:55 PM
High-Level Journal Summary: Getting the results of my physical exam that is needed within the first six months of having Medicare Part B (the part that provides Medical Insurance).
This testing showed me to be a healthy citizen from the neck down, which one minor exception. I was diagnosed with Atrial Bradycardia, which was revealed on my electrocardiogram (or EKG/ECG). This is a slow heart rate of less than 60 beats per minute. Apparently, it is caused by reversible things like low oxygen and electrolyte abnormalities. It could also be a heart blockage of some sort.
This online journal also reveals many of the details for how to report all this information to Medicare. It all left me wondering if this was a altruistic exercise of preventative health care on the part of Medicare OR an exercise to ensure that people are not using Part B of Medicare for fraudulent reasons. Either way, my task is pretty much complete at this point. Amen! One more thing off my October checklist regarding proper health care coverage.
Countdowns:
1.) Day 11 of 28 in my 26th 5/23 Temodar chemotherapy cycle.
2007 Seizure Activity:
1.) Last Simple Partial Seizure, or SPS, was 6 days ago. It's amazing how my overall seizure activity has decreased in the past 30 days, ever since I slowed from my August pace and stress levels. Once again, proof of the correlation of stress, rest, and seizures (given my current seizure prescriptions).
2.) In 2007, I have had 68 SPS's in 284 days. This is an average of 1 SPS every 4.2 days.
Website Updates:
Many small changes continue to be implemented by Blue Water Media this week. As with previous updates, there are too many to list. The highlight from today is that readers now have the ability to send individual messages to another person on the Messages tab.
So, if you are reading a particular message and you think of a patient, caregiver, or doctor who may value reading that particular message, you can click on the e-mail icon on the bottom of that message. A quick "send message" form pops up that allows you to quickly send the message without having to go to your personal e-mail box to send it. Quite simple and easy to use. There is also an icon that allows a reader to print an individual message if it is wanted on paper.
Actual Journal: I kept chuggin' along today on items related to Medicare. One of the items I want to get out the way completely is my physical exam. I already had my physical exam on 10/1/07 because this is required by Medicare. But, what are the details? For example:
• How is this billed?
• Where does the report go?
• What type of report is needed by Medicare?
• How do I ensure the right report gets in the right hands of the right people?
• How do I make sure that the right "sign-off" is given that this physical exam has been properly conducted and reported?
Notes from my internist
The only way to start answering these questions was to hop on the phone. The first call I made was to the office of my internist. They conducted the physical exam, and I just assumed that they would know all this Medicare information inside and out.
Wrong!
They turned around and asked me for all the details. Even when I stopped by their office to pick up copies of all my labwork and test results, it was not in a format that I could even interpret as a "physical exam." It was just a series of test results without a cover page. In fact, there was nothing at all in my test results that even indicated I have brain cancer.
Documentation
While I gathered copies of everything that was done on 10/1/07, I could tell that a letter needed to be dictated for Medicare. I asked if this would be done, and I was told that it could be done. However, there was about a month delay in completing this task since my doctor had that many letters to dictate before he could get to mine. A real backlog. It made me glad that I had taken on this task early and not at the last minute.
So, I told my doctor's office to prepare a letter and that I would call them with all the particulars on where it needed to go and to whom it needed to be addressed.
Calling Medicare
Next, I called Medicare to find out all the details about my physical exam. Here are my notes from this conversation, which may be of value to other patients and caregivers dealing with this same type of issue.
1.) The purpose of this physical exam? Here is what the literature from Medicare says. "One very important benefit is the 'Welcome to Medicare' physical exam. You must have this exam within the first six months you have Medicare Part B."
2.) I need to have a letter that gives a thorough review of my overall health. This is where brain cancer will be discussed, as well as my past and present treatments for this brain cancer.
3.) Medicare told me that one of the purposes of this physical exam is for me to get a "preventative health exam" where I am told of risks that I may need to know about. I certainly beat them to the punch on this one. I had every imaginable test done, knowing that just because I have brain cancer does NOT mean I am immune from other deadly diseases, as well. Here are some of the tests conducted on 10/1/07:
• Urinalysis to test for "diabetes mellitus, various forms of glomerulonephritis, and chronic urinary tract infections."
RESULT: "Few" bacteria were detected (10-25).
• Fecal Immunochemical Testing to see if a colonoscopy is warranted or not. This is an effort to help detect colon cancer.
RESULT: Not detected.
• Prostate-Specific Antigen (PSA) to detect prostate cancer.
RESULT: My score was 0.3 on a reference range of 0.0 - 4.0 ng/mL.
• HIV-1/2 antibody to test for AIDS. (I can hardly believe that this is not mandatory given the huge issue this is around the world. Many issues prevent this from being mandatory, most of which do not make sense to me personally.)
RESULT: I had "nonreactive" results from this testing, as expected.
• Lipid Panel to check my cholesterol level, among other things.
RESULT: My cholesterol level is 133, HDL cholesterol is 53, and LDL cholesterol is 70.
4.) To pay for this exam, I was told that my doctor's office just needed to send the claim to Medicare. That's it. This can only be done once, but this exam is covered by Medicare in this once instance. After this, secondary insurance would have to pick up the tab.
5.) The actual report needs to be sent to a location based upon my zip code. I got that address and passed it along to my doctor's office. They said they had the address somewhere, but I gave it to them directly, just to be on the safe side. We both agreed that was the safe thing to do.
What else?
The last thing I did was really geeky. I just put a reminder in my Palm Pilot to follow up with my doctor in a month to make sure this task has been completed and to request a copy of their transcribed letter. This will help ensure that everything is complete. And I will not consider it done until I talk with a representative at Medicare and they tell me in person that this important item is completed to their satisfaction.
Abnormal Rhythm EKG/ECG
There is one test that had unusual results. I was diagnosed with Atrial Bradycardia when I had an Abnormal Rhythm ECG (electrocardiogram). An ECG, also known as an EKG, is a test used to measure the electrical activity of the heart.
Atrial Bradycardia is defined as follows:
A slow rhythm, known as bradycardia (less than 60 beats/min), is usually not life threatening, but may cause symptoms. It may be caused by reversible causes (low oxygen, electrolyte abnormalities), or be more permanent (heart block). When it causes symptoms implantation of a permanent pacemaker may be needed. Either dysrhythmia requires medical attention to evaluate the risks associated with the arrhythmia.
So this seems to be telling me that my slow pulse reveals a bit more when I undergo an ECG/EKG. I don't know how much of a concern this is, but I know we have a family history of the opposite -- tachycardia, where an adult has a heart rate faster than 100 beats/minute. This will be an interesting thing to ask about.
Final thoughts
Well, I certainly got some more information that is helpful. That's good. So the benefit of having a "Welcome to Medicare Physical Exam" has certainly been fulfilled. But I am still confused about whether this physical exam was altruistic or a measure to protect against fraudulent use of Medicare.
Both are good reasons for requiring a physical exam within the first 6 months of getting Medicare Part B. I just don't know the real answer to the above question. Perhaps it's a bit of both. It would take a Medicare expert to explain the real answer.
Either way, this activity is just about off my plate. Amen. My list need of health care insurance items needs to get shorter every day during the month of October. I have a full plate, without doubt.
