How to [legally] extort almost USD$170,000 from your company and yet keep your job...

by Michael S. Kaplan, published on 2013/02/05 07:01 -05:00, original URI: http://blogs.msdn.com/b/michkap/archive/2013/02/05/10391102.aspx

Now step 1 is to be a full time employee of Microsoft.

And step 2 is to break your hip.

You see, Microsoft is the payee of health insurance. They just have Premera Blue Cross administer the plan. This is important since Microsoft is much more generous than Premera is on its own.

I used to think insurance companies were evil, it turns out they're just greedy. Their sin is clearly a venal one, not a mortal one (a distinction my catholic readers will appreciate!).

So, in October, I spent almost USD$50,000 of Microsoft's money to get my left hip fixed in a hemihip replacement (the doctor replaced the ball, kept the socket).

In November, I spent almost USD$20,000 of Microsoft's money in a SNF (pronounced "sniff"), a skilled nursing facility known as Crista Senior Living in Shoreline, until I was kicked out.

I had started at the UWMC Rehab Unit (on an outpatient basis), since the SNF was unable to help with forward progress.

This was not soon enough for Joseph Palermo JR DO (a man I think of as "Palermo the Douche™") had me kicked out, after one 3 minute visit billed to my insurance as a full consult (USD$195), something I would call insurance fraud if an investigator from Premera Blue Cross ever asked me. And I really really hope they ask me at some point.

Now the whole SNF thing is described by Kathy Quan, R.N., B.S.N., P.H.N. in this article:

Skilled nursing facilities are also known as a SNF (pronounced “sniff”), or nursing home. They provide two basic levels of care: custodial and skilled care. Residents may be temporary or long term. Temporary stays are usually for rehabilitation purposes after a major surgery, injury, or illness. Long-term stays are usually for those who can no longer live alone and require a higher level of care than can be provided at home or in assisted-living facilities or board-and-care homes.

Skilled care in a SNF is usually short term and continuous only so long as measurable gains are made. However, some circumstances require ongoing skilled care such as those who require a ventilator or other tubes or mechanical means for nutrition and life support. An episode of illness or injury may also be cause for skilled care on a temporary basis in a SNF for those who usually just require custodial care.

Custodial care in a SNF is also supervised by the licensed physician and a registered nurse, but it is usually provided by nursing assistants. An RN or LP/VN manages and dispenses medications. Custodial care consists of activities such as bathing, dressing, feeding, grooming, transferring and assistance with ambulation, and toileting or incontinence care. If the resident needs some skilled care as a result of illness or injury, or develops a decubitus or bedsore due to immobility, skilled care will be ordered and provided.

Who Pays for Skilled Care?

Skilled care is covered by Medicare and most private insurance using Medicare's guidelines. Under Medicare's guidelines, the skilled care must be preceded by a minimum qualifying hospital stay of three days. Admission to the SNF must be within thirty days of the qualifying hospitalization. The first twenty days are paid at 100 percent; after that, there is a daily deductible. (This may be covered by Medigap insurance.) There is a maximum of 100 SNF days for a qualifying hospitalization and diagnosis.

The patient must show measurable gains, also known as rehab potential, toward independence in the documentation by the RN or therapist. If at any time before the 100-day maximum stay the measurable gains or skilled-care need ceases, reimbursement will end. Custodial care will be included and covered during a skilled-care stay.

Now the physical therapist there (Ashley Nicole Dennis) did document rehab potential, and had a documented plan to unblock progress, but despite all that Palermo the Douche™ (who in his 3 minute consult said he was in my corner) told the insurance company that I had no further rehab potential and despite the fact that I disagreed believed I should be discharged from my private room.

After a few days at home seeing UWMC PT on an outpatient, upon the recommendation of B. Jane Distad MD I made it from an ER visit as an inpatient on the Neuro service in 6SE to eventually the Rehab Service in 8N.

In December, I spent almost USD$100,000 of Microsoft's money in that inpatient service. Because they did see rehab potential, even though Palermo the Douche™ did not.

Now some might wonder whether Palermo the Douche™ is guilty of insurance fraud and medical malpractice for his laughingly bad care of me while I was in the SNF.

I think so.

And I think Premera Blue Cross should make him pay the entire USD$170,000 they paid for my care, or at the very least the USD$100,000 that they had to pay out because of his awful medical decisions about me in Crista Senior Living, peraps minus the USD$25,000 (SNF plus outpatient PT), perhaps not.

But since Microsoft ultimately paid the bill, it probably won't happen.

In the end, I predict that Palermo the Douche™ will never be made to pay, financially or otherwise, for his role here.

Despite being quit guilty of the crime.

Since the outpatient care may not have been as successful...

Thus in a weird way, I might owe the crappy care of Palermo the Douche™ for me ultimately getting the best care from UWMC Rehab.

All funded by Microsoft, the company that continues to employ me despite how expensive it seems to do so.

Note they also paid USD$26,100 for 100% of the cost of my iBot 4000!

Perhaps they should go after Palermo the Douche™ to help defray the cost of employing me? :-)

Peter Lake on 5 Feb 2013 8:55 AM:

cheong00 on 5 Feb 2013 6:07 PM:

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