Medicare recipient sick of providers

Posted: Friday, July 22, 2005

James Clark has had it.

He's a 67-year-old Anchor Point man with health problems who says he can't get the Medicare benefits to which he's entitled.

"I fired Alaskare in Soldotna. I fired Geneva Woods and now I'm trying to change to Frontier," Clark said in late June about health-care providers with whom he has become frustrated.

"All they do is lie to you," Clark said.

In mid-July, Clark signed on with Pro Care, a health-care provider in Anchorage.

Among Clark's health concerns is a need for supplemental oxygen delivered through a device known as a concentrator.

Medicare, the federal health insurance program for people age 65 and older, will pay for Clark's concentrator if he leases it through an authorized provider.

"They charge $400 a month to lease the concentrator, and I found one on the Internet I can buy outright for $350," he said.

The $350 machine is used. A new concentrator typically costs about $900.

Medicare, however, will not pay for the purchase of the equipment, according to Clark.

He said he was leasing the concentrator through Alaskare from 2000 until he switched to Geneva Woods about a year ago.

The providers are bound by tight Medicare rules as to what they are and are not reimbursed for when providing equipment and supplies to patients.

In May of this year, Clark needed to see a medical specialist in Washington for respiratory problems but said he was denied his request for oxygen during his return drive to Alaska because Geneva Woods told him Medi-care would not cover the expense while he was traveling.

Clark also said face masks he needs for a device called CPAP, which helps him with his sleep apnea condition, frequently wear out, and his providers have been slow to deliver the masks.

Over time, Clark has become frustrated. Now he's mad.

To hear it from the providers, though, Clark himself is responsible for much of his frustration.

"Medicare says traveling is not medically necessary," said Paul Drake, a registered respiratory therapist for Geneva Woods.

"When I told Mr. Clark I couldn't provide it, he swore. He used the 'F' word and hung up the phone," Drake said.

He said Medicare allows $200 per month for the use of a concentrator and Geneva Woods' charge is $395 per month. The provider writes off the difference, Drake said.

Geneva Woods additionally supplies the necessary tubing, humidifier chambers, regulator and oxygen tanks.

"If we provide 10 tanks in a month, our cost is $100," Drake said.

Medicare covers 80 percent of that, so Geneva Woods receives $80.

"When (Clark) went to (Washington) the first time, we set him up for two months — over $400. We did not get paid for that," Drake said.

Drake said he tried to get help for Clark by referring him to an oxygen provider in Oregon, but said Clark "hollered and cussed" at the woman in that office.

"When he got back (to Alaska), he told Frontier he was going to throw our equipment out the window," Drake said.

"I have a problem when a customer turns on me and acts like I owe him," he said.

Drake said he discontinued the relationship with Clark.

"Why would I say I was going to throw their equipment out the window?" Clark asked rhetorically.

"I'd get in trouble if I did that. Why in the world would I cuss them out? I might have told them to kiss my —-," he said.

Clark's wife, Carol, said she is the one who actually spoke with the provider about getting oxygen for the drive back through Canada.

"They said it would cost $150 one time to take oxygen through Canada," Carol Clark said.

"We would have to pay for it ourselves 'cause Medicare won't pay through a foreign country. I said forget it," she said.

When asked about the threat to throw the Geneva Woods equipment out the window, Carol Clark said, "Jim just told them to get their stuff out of here by the end of the day. They picked it up."

Frontier Medical chose to not be Clark's provider, according to manager Mike Tovoli.

"Mr. Clark called wishing to switch to Frontier. We took down his information, but we found out he didn't live up to his Medicare requirements and we declined," Tovoli said.

"He came into the office and became very belligerent to both of the girls in the office.

"They told him to leave and he just kept on. Then he left.

"It was my decision not to serve him," Tovoli said.

Clark said the service providers have lied to him because "they've got a sweetheart deal."

"They've got a gold mine," he said.

"They're leasing concentrators year after year for $400 a month, and I can get one off the Internet for $350.

"They started lying to me and that's when I said, 'Let's go to the newspaper.' Once you write this article, you're going to hear from a lot of people.

"I've got nothing to gain," Clark said.

Geneva Woods' Drake said, "He's doing a lot of the damage himself," referring to the customer service Clark is or is not receiving.

"As a clinician, I feel bad, but I'm not going to take that kind of abuse.

"I feel like we really tried," Drake said.

Drake's wife, Joyce, who is the office manager for the Geneva Woods office in Soldotna, said, "We have to go by Medicare guidelines.

"We try very hard to help people, but when they start using profanities ...," she said, not finishing her sentence.

"I would really like to work with Mr. Clark and help him," she said. "He would have to call us."

She admitted Medicare policies and guidelines are confusing and can be frustrating for clients.

Michelle Crawford, a patient advocate at Central Peninsula General Hospital, said people already receiving Medicare, as well as those wondering if they qualify, can get answers to many of their questions by visiting Medicare's Web site at medi care.gov.

Medicare does not have a customer service office on the Kenai Peninsula.



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