Friday, December 18, 2009

My experience with socialized medicine

My regular readers have heard me ramble on and on for months concerning health care reform. Today, I'm gonna do something I don't really want to do by telling of my personal experience with socialized medicine - Medicare. Why ?? Because the U.S. Senate is promising a vote on ObamaCare by Christmas, and I want everyone to know what you may get because this plan will be very similar to Medicare. As you read today, forget about all of my previous writing on the issue, all the news reports and rumors of rationing, so-called death panels, and inferior care, and think about one thing only - customer service.

Shortly before my heart transplant, I went on disability making me eligible for Medicare. I enrolled in the COBRA plan of my employer when I quit work due to heart disease and stayed on that through July 2008. On August 1, 2008, I went onto a Medicare Advantage Plan administered by Humana. At that time, Humana told me that my anti-rejection medications, Gengraft and Cellcept, would be covered under Medicare Part B. A few months later I went to my pharmacy to pick up a Cellcept refill and was told it was over $600. When I asked why, I was told that I was in the coverage gap a.k.a. the donut hole. I did not understand how that could be. So, when I got home, I called Humana to find out. They told that yes I was in the donut hole because of the high cost of the anti-rejection drugs. However, when meds are covered under Part B, they do not count toward your total annual drug costs, but apparently Humana had put them under Part D so they did count. Therefore, I hit the donut hole pre-maturely leaving me with no drug coverage the rest of the year.

I hit the roof and filed an appeal because Humana had not covered the anti-rejections meds the way they told me they would. On November 17, 2008, I received a letter from Humana granting my appeal and putting my anti-rejection meds under Part B where they said they would be processed originally. It also said they had to re-work the claims and then issue a refund to me for my overpayments. It amounted to almost $1000. I called the appeals representative the next week to find out how long this would take, because I now had a monstrous credit card bill to pay because of their screw-up. Finally, nearly three weeks later, she returned the call and said it would take 4-6 weeks to get everything cleared up. So, I'm thinking that by the end of January 2009, it should be settled. Man, was I wrong.

January came and went. Then February - then March - then April - then May, June, and July. Finally, in late August of 2009, my overpayment was refunded. It didn't take 4-6 weeks - it took almost 8 months (32 weeks) !! During this time, I'm called the Humana rep at least every two weeks and sometimes every week. I either got no answers or had to wait a week for a return phone telling me that they don't know when it's gonna be finalized. I was considering a lawsuit. How long do you think they would have waited to stop my benefits if I hadn't paid my premiums ?? Heck, they would have stopped them quicker than a Democrat can vote "yea" on a tax increase. But, I had to wait for what they owed me. Typical government bureacracy.

After I got my refund, it still wasn't over. I had to get new "prior authorization" done by my doctor to get the anti-rejection meds paid for even though I was told the previous ones were good "indefinitely." I learned that "indefinitely" in socialized medicine speak could mean anywhere from a day, to a week, to a year. Basically, it's until they change their mind. Whereas, anyone with common sense knows for that for a transplant patient it means for the rest of your life. You can't stop taking your meds or you'll die.

Then, in November 2009, I get a phone call from Humana at 7:30 one morning telling me that effective January 1, 2010 my anti-rejection meds are gonna be switched back to Medicare Part D from Part B. All the time spent getting the mess fixed was for naught. They were screwing it up again !! Once again, Humana told me they were gonna cover them one way and then said, "No. Sorry. We've decided to do it this way." They've done me that way on doctor's visits, too. I'm sick of it.

I've been told that many people on Medicare love it and that everyone doesn't have experiences like mine. That is probably true, but let's think about something. We Americans like everything fast. We want fast food, cars, internet, and don't want to wait on service. Depending on who you listen to, there are currently anywhere from 20-40 million Americans without health insurance. So, let's say that ObamCare is passed and to be conservative, let's go with 20 million uninsured that will all join the ObamaCare rolls. Also, let's say 5% of them have a bad customer service experience like me. That's 1 million hacked off Americans. Furthermore, let's say the pessimistic pundits are right and that the plan is to eventually get ALL Americans on government run health care. That's over 300 million people. What if 5% of them have a bad experience. Know how many people that is ? Try 15 million !! If 15 million Americans, who want everything fast get the same kind of lousy customer service from ObamaCare that I have received from Medicare, can you imagine the riots and the weeping, waling , and gnashing of teeth ? It will be ugly. If the politicians in D.C. think people are pissed now, they ain't seen nothing yet.

I know very well that our health care system in the U.S. is not perfect but it's the best in the world. Too many people, including me, with pre-existing conditions are discriminated against daily trying to purchase health insurance. Private insurance companies will NOT sell us a policy and that's wrong. So, how do we fix it ?? The only way to end this is to update our anti-discrimination laws to prohibit insurance companies from discriminating against people with pre-existing conditions. Insurance companies would then be required to sell a policy to anyone who wants it and can pay for it. However, if that's done they will simply charge enormous premiums that we can't afford to cover their increased costs. To fix that, the law would also need to set a cap on the premiums the insurance companies can charge or require that everyone be charged the same amount. As someone who believes in free enterprise, I've got a problem with this solution because healthy people would get charged the same as the sick or more than they should to make up for the extra costs incurred because of the sick. That's not fair either. Plus, we'd be forcing a unconstitutional government mandate on privately owned insurance companies. So, the question is - what'll we do ?? We're in a catch-22 because neither of these is gonna fly in a free country and to be honest with you - they probably shouldn't.

Two quick things and I'm done. One - if you do NOT want to have this kind of lousy customer service experience with your health care in the future, you better take the time to contact your Senators (click here) and tell them that today. Two - next week there will be no politics on the blog. In honor of our Savior's, Jesus Christ, birthday, they'll be a couple of "Christmassy" posts, but that's all.
Enhanced by Zemanta


Hannah Baskets said...

I can relate, the same thing has happened to me, but now that my antirejection drugs are suppose to be covered under Medicare Part D, they are telling me if medicare paid for my transplant they DO NOT have to cover them, that they have to be billed under Medicare Part B which only pays 80% and now medicaid does not cover anything if you have medicrare Part D (which will not pay anything anyway). I have now not taken my pills for 7 days due to not being able to afford them and my Kidney will most likely fail as my creatnine is not at 6.3. I guess the good news is, Medicrae will pay for the three times a week I will have to spend on dialysis again and possibly another transplant!

The Second Chance Sheepdog said...


I'm so sorry to hear that. That is horrible.

They kept telling me that the reason they changed how mine were covered was because my transplant was paid for by the insurance I had through my employer Medicare would not pay under Part B since they did not pay for the transplant. If mine would have been covered under Part B, I was gonna be able to manage the 20% each month. However, as high as the drugs are, I was gonna be in the donut hole in February or March if they were under Par D and then I had to pay 100%. That was what I could not afford.

Have you tried contacting the manufacturer of your anti-rejection drugs to see if you qualify for their drug assistance program ?? They might be able to help. Or, your transplant center might have some ideas.

Don't give up. Keep looking for an answer. Let me know what you're taking and I've probably got a link or other contact info I can send you. Let me know if I can help. I'll be praying for you.