Claims Department — Affordable Care Act

Hello, welcome to the IRS Health Claims pre-approval hotline.  If you are calling about a prior claim please call our Claims Service Hotline, otherwise for pre-approval,  please enter in your social security number and press # when done.  Someone will be on the line to assist you momentarily.

                                (2 hours later)

“JIM”:   Hello, this is Jim, welcome to the IRS Health Claims Pre-approval hotline.   I see that you have indicated that you will

need approval for the treatment of heart disease.   Reviewing your current information, I see that you have had a heart attack previously,

is that correct?

“GEORGE”;  the patient:   Yes, that is correct.

“JIM”:   What procedure do you need to have approved?

GEORGE” : According to my doctor I need blood work for cardiac enzymes, a stress test, a catheterization, and most likely stents.

“JIM”:   Our records show that you are 58 years old.  Are you planning to return to work after the procedure?

GEORGE” : Why does that matter?

“JIM”:   This information is used to calculate your available lifetime medical benefit under the affordable care act.  Since you already used $256,432 of your maximum benefit we need to calculate how much additional benefit you qualify for.

GEORGE” :  How is that benefit calculated?

“JIM”:   We at the IRS take great care to calculate that benefit from all the information that you provide or which is already in the file we have on you.  It is our goal to make that determination as fairly as possible given all the factors.

GEORGE”: But what are the factors?

“JIM”: Expenses already incurred, the likelihood that more expenses will be incurred, your age, your estimated productive remaining years and such.  Now, please just answer the questions as they are addressed to you. 

“JIM”:  Are you planning to return to work after the procedure?

GEORGE”: yes.

“JIM”:   Do you currently work for a profit or non-profit organization?

GEORGE”: profit

“JIM”:  How many times did you eat fast food last month?

GEORGE”: about 20.

“JIM”:  Do you smoke?

GEORGE”:  Used to.

“JIM”:  Do you vote in presidential elections?

GEORGE”: What?

“JIM”:  Do you vote in presidential elections?

GEORGE”: Why is that pertinent?

“JIM”:  Sir, you need to answer the questions.  These all have statistical correlations.

GEORGE”:  Ok, yes I vote.

“JIM”:  Would you classify yourself a more liberal or conservative?

GEORGE”:  I don’t see….

“JIM”:  Just answer the question sir!

GEORGE”:  Conservative.

“JIM”:  At what age do you plan to retire?

GEORGE”:  65.

“JIM”:  Thank you sir for answering the questions.  The system is reviewing your information. 

Based on the computer’s projection we will approve all the diagnostic tests and procedures.  Should you need stents or some other therapeutic treatment the Affordable Care act will not cover those.   You are already close to your lifetime maximum.

 “GEORGE”:  Are you telling me that if I try to get my heart fixed, you will not pay for  it.

“JIM”:  That is correct.

GEORGE”:  Surely there is some way to appeal this.

“JIM”:  Sir the ACA does not provide for any appeals the decisions of the IRS are final.

GEORGE”:  but….

“JIM”:  Thank you for calling the IRS, have a good day.  CLICK!

 Back at the IRS office Jim speaking to his co-worker says, “There is one more white conservative who won’t be voting next year.  High FIVE!!!!!”

 

 

 

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