Pool Tales and Other Stories by Ace Toscano

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Tuesday, December 05, 2023

The Deadly Truth About Medicare Advantage (A True Story) by Ace Toscano

 



He was an idiot. Every day, as soon as the poolroom opened, he made it his mission to make sure each of the eight televisions that were spaced around the room were tuned to FoxNews, as if he were performing a public service by exposing the other players to the misinformation streaming there. This was during the Obama years when dyed in the wool racists proudly revealed themselves setting the stage for the rise of the deplorable Trumpian hoard now crawling across America like sludge from a busted septic tank. I can imagine the mantras now cascading through his diseased mind – “Fake news,” “Witch Hunt,” “Impeach Biden,” “Lock him up.”

Verifying his credentials as an asshole was the fact that he cheated at pool. I was playing him in a local tournament once when while shooting a ball straight into the side he drew the cueball back into the tip of the cue. I jumped up immediately but he kept on shooting and said the foul never happened. I never forget or forgive a cheat.

But as deplorable as he was known to be in local circles – McNasty was one nickname bestowed upon him – his most serious crime against humanity involved health insurance and his extraordinary effort to get others to sign up for the same Medicare Advantage plan that he had bought into. I don't know if he honestly thought the plan was such a great thing, but I suspect he was getting a kickback from the insurance agent he was steering people to. As I remember, he had a never ending supply of the guy's business cards. And he was relentless. Day after day he would corner a few of the old boys and pound them with the many benefits of Medicare Advantage and urge them to take the plunge.

Now, I'm not going to get into all the details of the plan he was hawking. You've probably heard the commercials – every health insurance company finds these policies beneficial to their bottom line – they offer dental, free prescriptions, money for groceries and dog food, even yearly orthopedic shoes if you happen to be a diabetic. Why do they do that? That's a question I wish my friend Bob would have researched before he signed up. He turned out to be a victim of Medicare Advantage and of the idiot who talked him into signing up for it.

Of course, the answer becomes obvious towards the end. All those little trinkets they hand out to rope you in are nothing in the grand scheme of things. The real threat to those insurance companies' bottom line are hospital stays. Whoa doggie!

The average hospital stay in the U.S. lasts 4.5 days. At an average cost of $2,833 a day, that comes to $12, 974. And that's not considering any procedures that are deemed necessary and the subsequent costs associated with them. Bob didn't realize that the time had come for him to pay for all those so-called benefits of Medicare Advantage. You can have your $50 orthopedic shoes, Bobby, but for them you'll have to sacrifice days in the hospital, whether you need them or not.

When he called me and told me he had had a heart attack and was in the hospital, I headed right to the cardiac unit of the hospital. He was in the midst of explaining to me about his chest pains and his call to 911 when a man identifying himself as Doctor Patel came into the room and explained that Bob would be going to rehab. So, sure enough, he found himself booked into a fly-by-night rehab facility that same evening. No doctors or nurses there, just one young woman who when quizzed proudly proclaimed, “I's a CNA!” Unfortunately, as part of her routine she began giving Bob a high dosage potassium supplement even though his potassium was already high. Oops! So, without any fanfare after a day he was sent home. Predictably, that same night, more than likely because of the elevated potassium levels, Bob suffered another heart attack and wound up in the hospital again. Coincidentally, I was visiting him when the same doctor who had visited him and cut his first hospital stay short came into the room and like before declared that Bob was to be moved to another rehab facility, this one farther away and probably cheaper. Recognizing Dr. Patel from their previous meeting, Bob asked why was he calling the shots. “You aren't my doctor,” he said. 

“I'm here on behalf of _____”, Bob's Medicare Advantage provider.

So, there it was, the ugly truth. Dr. Patel, in order to save his employer, the insurance company, money was charged with cutting Bob's hospital time to the bare minimum whether it was in his best interest or not. Bob's health declined rapidly after that and it was only a matter of weeks before we held a memorial pool tournament in his honor. He was a well-liked member of the local pool community and there was a big turnout. Even the idiot showed up, unwilling to take credit for the part he'd taken in Bobby's demise.

THE END