I just can't wait to get on Medicare (Dis)advantage with the issues I've been having with Emblem GHI the last month or so. BTW, that was sarcasm.

About a year ago I was waking up, as well as recurring throughout the day, with pins and needles in my left (dominant) hand and fingers. I assumed it was because of a pinched nerve in my neck and went to a chiropractor (Didn't need a referral and I recall when chiropractors weren't covered). I went for about a month and stopped due to it was getting better and I didn't have time anymore. 

But around late October, early November,  the symptoms came back. Worse. There was pain with the pins and needles. It would wake me up in the middle of the night. The numbness would take an hour to go away. So this time I went to a spine surgeon that I know of, Dr Jonathan Oren (The ABSOLUTE best! If you have spine issues, he can work miracles. Mention me to him and get a free glass of wine compliments of Lenox Hill Hospital) (He deals with. REAL spine issues, not fantastical spine issues. And, his office isn't in a storefront or a strip mall). Again, no referral was necessary. Good.

I was examined and x-rayed. Dr Oren not being some gonoff doctor saw nothing abnormal in my spine and suggested I see a hand specialist and also to have an EMG. Since I already have a hand surgeon due to an arthritis issue my left thumb that part was taken care of. I also made an appointment for the EMG.

So far so good. Notice I am in control of my healthcare. 

I went to the hand doctor. He gave me a diagnosis of Carpal Tunnel and Cubital Tunnel Syndromes. I was also directed to start PT at once. Better, I knew the place where I wanted to go! The same PT where I went when I had my shoulder replaced three years ago. 

I called and was told that they don't take GHI for hand therapy. Say what? Yep, that was true. In fact when I looked closer at the script, the doctor wrote I was referred for "occupational therapy." I found out a few days later that anything from the elbow to the hand is considered occupational, not physical, therapy. 

Reluctantly I reached out to several other PT centers and heard the same. None took GHI for occupational therapy.

But I got a surprise with my last phone call. 

It was not that PT centers did not wish to take GHI. They couldn't. Why? Because GHI does not cover occupational therapy. Yeah. It doesn't. I found out after speaking with the hand therapists where I am going now that GHI is the only plan they know of which doesn't cover occupational therapy. 

How am I rehabbing the hand? I was told by a hand therapist where I am now to have the doctor  re-write the script to "physical therapy." Instead of a hand (occupational) therapist working on me it will be a physical therapist. The PT I have now is fantastic and he gets his instructions for the hand people. How does this make sense?

I understand how complicated the hand is. I nearly sliced my thumb off cutting open a roll at Grand Union in 1984. I severed the tendon and nerve in my thumb and hand therapy helped quite a bit. It is proven science. But who knows how the powers that be think at GHI. I mean, who do we even bring this up or complain to?

Overall I have been happy with GHI. This story is like a gnat flying in front of my face at a picnic. But with Mulgrewcare it won't be a little gnat fucking around with our healthcare. It'll be a flying Mulgrewsosaurus right in front of us with it's hairy and pimply ass right in our faces.

I'm grateful that at no point have I had to get clearance to see a specialist, receive a test, or go to PT (though with PT one needs to re-certify after 16 visits). I am grateful that I spoke with someone who told me how to get around the system. 

But to deny occupational therapy for whatever reason is mind boggling! What happens is someone else didn't have the resourcefulness, guile, or perseverance I have? That person just might wind up with an atrophied, useless hand. This is one of the inherent dangers of Mulgrewcare. How many will be told "no" and just accept that? 

Seven months after total shoulder replacement I was swinging a golf club again. Eight months after I was playing a round of golf. Will I, or anyone else, be able to have access to world class physical therapy on Mulgrewcare? Or even the surgeon who operated on me?

If I have to have surgery on my hand, I'll be damned if I won't be out of a golf course no more than six weeks after surgery. Again, I'll have top notch PT and a surgeon.

Fix the healthcare. Give us occupational therapy. Give us what we want. Don't fix what is broken. 

JOE NAMATH IS A SELLOUT!!!!

 I haven't really been paying too much attention to the change over, as well as the fight over, the switch for retirees from Medicare to the new Medicare Advantage. I've basically reduced myself to reading both James Eterno's blog and Norm Scott's blog for great information. I'm also getting some information from my step-mom who is a retired CSA member. She's not craxy about my proclivity for rabble rousing so she doesn't share much with me. 

Heck, this is going to effect me in 6 1/2 years, and I should pay more attention. From what I have read I don't like the co-payments, the referrals, and more importantly the "Trust us, it's going to be great" rhetoric coming from Mulgrew. But one thing really is bugging me.

What's the rush to sign everyone up by October 31? 

To the best of my recollection, the deal was done around July, maybe a little sooner (Please correct me if I'm incorrect). As far as I can tell, retirees are going into this blindly. They don't know which doctors, which hospitals or any other providers will be available. All they get is: "Trust us, it's going to be great."

Which brings me to two personal stories. In 1995 when I started with the DOE, I signed up with Physician Health Services. The only reason I signed up for PHS was all of our doctors were on it. I paid for it, unlike GHI which then and now is free. But eventually GHI got more of our doctors on it and we went to GHI. The key was doctors, a wide selection of doctors, and hospitals and providers.

Just recently I was looking at changing out from our top notch, world renowned UFT dental plan (SARCASM). I wanted to switch to the DENTCARE HMO. I researched it and found that not only are there very few providers, but the customer service sucks as well. It wasn't worth it. 

So, back to the Medicare Advantage. Retirees are walking blind into higgedly piggdly of a plan. There is not a list of doctors and providers. No one knows if their doctors that they have had a relationship with for years will be on this plan. No one knows if God forbid they are in treatment for a chronic condition they will be able to continue receiving the same treatment. This is where the UFT and other unions screwed up.

Why the rush? If as Mulgrew claims, "Trust us, it's going to be great," why not how all how great it is. This implementation should have started with NEXT October of 2022 for the sign ins or sign outs. This way, an educated choice of knowing ALL the providers will give those a basis to make a choice.

And beforehand why not have a true year to test out the new Medicare Advantage program. Incentivize retirees to sign up now in October 2021 and this way the kinks can and will be worked out. This way when others start opting in or out in October 2022 not one retiree will be going into this blind. 

Let's not forget the retirees who live where there re a dearth of providers. What of the retiree who has retired to North Dakota? Or the Alaska? What about where there are plenty of providers such as Florida but very few providers will be on the Medicare Advantage. Would the retiree who lives in Tampa have to schlep across the state to West Palm Beach for a prostate exam?

Something smells fishy here. This rush to get everyone in just leaves a bad taste in my mouth. Yes, there are plenty of retirees who can afford the out of pocket expense of paying into regular Medicare, but there are plenty of others who can't. And we are only stronger as people, as teachers, as retirees, and as UFT members as our weakest link. These are the people we should fight for. 

The UFT rammed this through. This should have been better explained and had much more input from retirees. This change should have been voted on as a whole by the union. Too often this happens. That some change is just shoved down our throats which the very few decide for several hundred thousand. 

Too bad chapter elections have come and gone. It's time to vote out the leadership of the retiree's chapter. Perhaps a recall is due?

The Westchester Journal News has reported that New York State has stopped collecting
agency fees from 31,000 state workers. As far as I am concerned that is 31k freeloaders and rats.

I am getting tired of this whining from UFT "members" who are threatening to withhold dues in light of Janus. Yes, as I ahve said in the past, I empathize with them. But a dysfunctional union is better than no union or not being in a union.

I have been reading a lot of the comments on James Eterno's blog. Yes, the grievances and feelings are real. But the one question I brought up and could not be answered to the complainers is, "What have you ever done for 'the cause'"? The question has been met with silence. Instead of cursing the darkness light a god damn candle.

I ask those that are thinking of freeloading that are reading this, what have you done? Where have you been? And please, anonymous comments on blogs don't count.

Even under the best of circumstances if the UFT was strong and proactive there would be people complaining and kvetching. Nothing is perfect. Too many are looking for a perfect fit on an off the rack world.

Yeah, our working conditions and the way we have been treated pretty much sucks. But we make more than most teachers in the country, let alone New York State. We have solid pensions awaiting us. We have rights that are bargained for. And, we have great health benefits.

Yeah, Mulgrew got stupid again about saying health benefits can be bargained. Would you rather have no health benefits? Crappier health benefits? A friend of mine that teaches in Armonk NY told me that he has a family deductible of about $6k on his health plan and pays into it 10% (or a little less) or so of his pay. If you have GHI you pay $0 and with the out of network rider (which I have) $16 a month.

I have been without insurance and on insurance. Guess which I prefer? Thirty years ago I dislocated my right shoulder (I am a lefty). It was popped back in never saw a doctor because I had no way to pay for it. I have developed horrible arthritis, I have bone grinding against bone, I'm in pain, can't golf, and I will need a shoulder replacement eventually.

In January my wife had almost her entire back fused. We saw the hospital bill. It cames to about $550k, with about $200k for the hardware in her back. Maybe another $95k for the bed. We owe $200.

This is what you can give up if you fail to join the union and other things as well. Under law freeloaders are covered by the CBA. Well, what happens if the next CBA there are provisions for freeloaders to be own their own? Too bad.

Remember, how the UFT got the family leave (Yes, it's not parental, stop bitching.). And something that was just shared with me. Family leave was negotiated outside of the contract so we would not have to do a quid pro quo. Yeah, sometimes the UFT gets it right.

But the worst thing, aside from being a freeloader, for not paying dues is that you will hurt each and every member staying in the union (I've been to a union meeting already. The anger at the freeloaders is just beginning), in negotiations, in solidarity, in advancing our needs, and more importantly, the needs and wants of the communities we teach in.

Being angry and frustrated is fine. Acting out on being angry and frustrated impulsively and for spite will hurt others and worse, yourself.