Stanley and the Mammogram

Author: 
Lawrence R. Huntoon, MD, PhD
Article Type: 
Medical Ethics and Managed Care
Issue: 
March/April 1998
Volume Number: 
3
Issue Number: 
2

You know, it’s bad enough doctors have to deal with the complexities and pervasive bungling of the HCFA/Medicare bureaucracy, but what do you tell your patients when they ask you to explain an Explanation Of Medicare Benefits (EOMB)? In an attempt to provide you with the skills you will need to rise to such an occasion, I offer the following true story as a test of your “Blue Bungler IQ.”

 

Case History

Stanley is a pleasant 72-year-old gentleman who came into my office one day with his EOMB in hand, and he wanted us to explain something that appeared on his form. In order to fully appreciate this story, you need to get a visual picture of Stanley. Stanley stands about 6’4”, weighs 280 pounds and suffers from something called “Dunlaps Syndrome.” Dunlaps Syndrome, of course, is an acquired disorder whereby his rather substantial beer gut dun laps over his belt. Now, as anyone who has ever tried to decipher an EOMB can tell you, it’s pretty difficult to figure out most of the time. In addition to CPT codes, allowed amounts, site of service reductions, modifiers, deductibles and co-pays, they often contain a myriad of highly cryptic message codes most of which not even the bureaucrats can tell you what they mean. Well, Stanley noticed that his EOMB had a very special message on it that he hadn’t seen before. Most people might just ignore such a thing, but not Stanley. Stanley, you see also has a touch of dementia, and this particular message just happened to stimulate the few functioning neurons he had left controlling curiosity. Stanley read the special message and he wanted to comply with the government’s request printed on his EOMB, but the problem was he wasn’t sure exactly how to do that. You see, the message on Stanley’s EOMB told him to “Get a mammogram” because it was a “picture that could save his life.”

Now, of course, at that point, I could have simply explained the truth to Stanley, that most HCFA and Medicare bureaucrats wouldn’t know their heads from their tails if it bit them, let alone the difference between males and females, but in dealing with Medicare, I always like to go right to the source to get specific, “accurate,” written answers. So, I decided to write to Medicare and ask them just what they meant when they told Stanley to get a mammogram, a picture that could save his life...and, would they cover it if I ordered it?

And, of course, I got a very lovely reply back. All of which brings us to your test. The following represents the single question test I have developed to test the “Blue Bungler IQ” of practicing physicians. You are, of course, on your honor not to cheat, and the test will not be graded on the curve. If you fail the test, however, do not despair, for that probably means you are “normal.”

 

“Blue Bungler IQ” Test

Of the following statements, select the answer you think Medicare provided:

1. “According to section 7525 of the Medicare carrier’s manual, it is recommended that all overweight men obtain a mammogram once every 5 years. They note that breast cancer, although rare, can occur in males.”

2. “The matter has been referred to the HCFA Region II Office to further research the answer to our inquiry, and they will get back to us when the review has been completed” [sometime within the next century if Medicare still exists].

3. “Although it may seem odd for a note concerning mammograms to appear on a man’s statement of benefits, they felt that their message was nonetheless appropriate because it could apply to Stanley’s grandmother” (i.e., Stanley could remind his grandmother to get a mammogram).

4. “Stanley could be a woman’s name. The Medicare computer has no way of knowing if the patient is male or female” — [i.e., perhaps Stanley comes from a place like Lake Wobegon where all of the women are strong and the men are good looking (Garrison Keilor)].

(Correct answer: #3!)

Dr. Huntoon is a neurologist in Jamestown, New York, and a member of the Board of Directors of the AAPS. His address is 560 West Third Street, Jamestown, NY 14701.

Originally published in the Medical Sentinel 1998;3(2):67. Copyright © 1998 Association of American Physicians and Surgeons (AAPS).

 

 

 

 

 

 

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