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Paul Gross

Halloween Horrors

Paul Gross

One October evening last year, I went to our local pharmacy to pick up a prescription for my daughter. I made sure to bring Cara’s insurance card because my employer had switched us to a new health plan.

I wasn’t sorry about the change. Our prior plan had been operated by incompetents–although they might only have been crooks, I couldn’t be sure–who also managed our flexible spending accounts. These accounts, you may recall, collect pre-tax income from your pay and then return it to you to pay for out-of-pocket medical expenses.

With that plan, nothing ever worked as advertised. I would submit a dental bill for reimbursement and the company would review it for three months before sending me a denial notice, stating that my health plan had no dental coverage.

“I know that I have no dental coverage,” I’d tell the representative on the phone. “That’s why I put a big X in the box labeled Flexible Spending Account.”

“You sure did!” she’d say cheerfully. “I don’t know why they did that. You’ll have to submit it again. This time, put my name on it….”

Or I’d submit a claim for a medical expense that was covered, » Continue Reading.

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A Brush With the Beast

It all begins one Sunday morning when Mrs. Morris, a 75-year-old retiree with a heart condition, trips on her way out of church. She falls flat on the sidewalk, can’t get up, and ends up in our Bronx emergency room. A CT scan shows a pelvic fracture, and she’s admitted to our inpatient team.

When I join the family medicine residents to see Mrs. Morris the following day, she can’t get out of bed. She’s got short, unruly white hair and a gee-whiz expression that charms us. “What a pain!” she says. Given how close she lives to the brink–terrible circulation has cost her one heart attack and several toe amputations–I’m impressed with her good cheer.

Things looks promising. Follow-up studies confirm that the fracture won’t require surgery, and in the afternoon a physical therapist pilots her through a few wobbly steps.

The next morning we come to Mrs. Morris’s room and find her peering at a novel. “I think it would be great fun to be a secret agent, don’t you?” she says to me.

We make arrangements to transfer her to a rehabilitation facility, where therapy will get her walking again.

All goes smoothly until a hospital

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