No brainer

November 25, 1996|By Daniel S. Greenberg

WASHINGTON -- Consultation with fellow seniors confirms the experience: The 65th birthday is a signal event for the telemarketing industry, which, in call after call on behalf of one health-care business or another, promises wondrous protection against the skimpiness of Medicare coverage.

After fielding many of these calls, I was primed for the next one. Following an introductory sales pitch, it went as follows, with Me and Him recorded and presented here virtually verbatim: Me: Do you cover all the medical procedures?

Him: We cover what the Medicare doesn't cover.

Me: We're trying to find out, what about brain transplants?

Him: You're wondering how much we cover of that?

Me: Yeah, how much of a brain transplant do you cover?

Him: We would cover all of what the Medicare doesn't cover.

Me: Does that mean the brain transplant and all?

Him: Yeah, if you had a brain transplant with our plan, you'd use our doctors and our hospitals.

Me: Any one of your hospitals, or do you have a special brain-transplant hospital?

Him: No, you'd use the hospital, wherever they send you. I mean, if they have a hospital where they do brain transplants, you'd use that. If not, whatever hospital was available. But with our plan, you're not going to pay any out-of-pocket expense.

Me: You mean, I can get a complete brain transplant and there's no out-of-pocket?

And you pay nothing

Him: Right. If you use our plan and use our doctors, what you do on our plan, it's an HMO plan. It's going to cover what the Medicare would have covered, but also what the Medicare doesn't, so that you're not paying anything for your hospitalization.

Me: How much do you cover for a brain transplant?

Him: OK. As I said, you wouldn't pay any out-of-pocket expense.

Me: Do they do that on a day basis, or do you have to go into the hospital? For a brain transplant.

Him: Oh, I don't know about the medical procedure, but I would think for a brain transplant that that wouldn't be something -- I mean, that would require a hospital stay.

Me: They don't do that on an outpatient basis?

Him: For what?

Me: For a brain transplant.

Him: I don't think so, sir.

Me: You go into the hospital for a couple of days probably?

Him: Yeah, two, three or four.

Me: And that's all covered, right?

Him: I'm not familiar with brain transplants.

Me: Do you get a private room or do you have to be in a big room with a lot of other people? After a brain transplant, you probably want to get a lot of sleep.

Him: Do you think so?

Me: I guess so. You probably have an awful headache.

Him: Yeah, but aspirin is amazing.

Me: So, what do I have to do?

Him: We're just giving people an opportunity to look at our plan and just compare the coverage.

Literature was sent. It contained no mention of brain transplants.

Daniel S. Greenberg is editor and publisher of the newsletter Science & Government Report.

Pub Date: 11/25/96

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