Obama-care: A Ball of Confusion

So, back in the Springtime, I got a letter, known by diabetics as "The Letter," from the nice folks at Medicare informing that starting July 1, 2013, regardless of who I'd been dealing with previously and regardless of how smooth things had been going up to then, I would have to get my diabetes testing supplies from a vender who was on the new Medicare approved list. They even supplied a url for the web page from which I would be able to launch my search for a new supplier: medicare.gov/SupplierDirectory

Up to now I have been getting my testing supplies in the mail, so, first, I figured I'd try to hook up with another mail order company. I went to the list and started to call the mail order suppliers. Of the venders on the two pages comprising the list, not one supplied the Accu-Chek Softclix Lancets and the Accu-Chek Aviva Plus test strips that I've been using. You might think that someone who was in the business of selling diabetic testing supplies might keep an inventory of a number of different brands, but no, these venders had a very narrow selection to choose from. I'm sort of partial to my Aviva meter because it requires less blood and when I go to my doctor she can plug it into her computer and get a readout of all my tests since the last time she saw me. I don't want to change equipment at this juncture.

In addition, some of the suppliers on the Medicare list informed me that they did not offer diabetic testing supplies and they couldn't imagine how they wound up on the list. I was forced to move on to the local pharmacies.

First, I thought I'd give CVS a try. They were only a mile down the road. I went there with my prescriptions and was immediately told by the young lady working the counter, who was pecking away at her keyboard like one of Skinners pigeons, that I was not eligible for Medicare. I let her know that she and her computer were sadly mistaken since I'd been on Medicare and receiving benefits for more than a year. Nope, she affirmed, I was not qualified.

She sought the help of another worker who determined that she had entered my Medicare account number incorrectly. Finally, we were making progress. Next, she wanted my drug provider's card. I explained that that wasn't necessary because testing supplies were not considered a drug, they were covered under Medicare B the balance to be picked up by my supplemental insurance. No, she wanted my drug card. So, though she didn't really need it, I gave it to her. She was ready to roll.

I watched as she came out from behind the counter went to the shelf where the lancets were kept and pulled out a box of 50. My prescription called for 400, a 90 day supply, but 50's a start. Unfortunately, as I pointed out to her, the lancets she had chosen were not the kind I required. She was under the impression that all lancets were the same. No, I said, not hardly.

I didn't want to sound like a broken record, but I thought it important to convey to these people, and by now I'd drawn the attention of several including the rotund and bespectacled pharmacist that these supplies were covered by Medicare Part B and my supplemental. I did note also that according to the information on the Medicare site CVS accepted the Medicare payment as payment in full so no supplemental would be required. They knew better.

Their lack of understanding about how Medicare worked especially in regard to testing supplies was very frustrating. I couldn't believe they had never had to deal with this issue before, but evidently they hadn't or, if they had, they'd been dealing with it improperly.

Fat boy, the pharmacist, started getting feisty. "Can’t you see?” he sneered. “This takes time.”

"Can’t you see?" I responded. "I want my prescriptions back." They were not quick to comply, forcing me to add, "Now!"

There was a Walgreen's across the street, but fearing that employees there might have succumbed to the same environmental factors that had rendered the CVS crew stupid, I decided to cruise down the road to the Publix where, according to the website, they also accepted the Medicare allotment as payment in full. The girl working the counter at Publix was not appreciably more informed than her counterpart at CVS. Fortunately for me, though, the pharmacist, Adrienne was a gem. What she didn't know already, she took the time to find out and in due course I was phoned a few days later and told that I could pick up my supplies the next day after 2 PM.

I got there around two thirty and saw that Adrienne wasn't on duty. This wasn't immediately alarming, but when the girl asked for my insurance card I knew I was in trouble. Once again I tried to explain to these health professionals, the substitute pharmacist included, that testing supplies were taken care of by Medicare Part B. When they wanted to charge me twenty bucks, I informed them that my supplemental insurance would pick up the balance. They refused to consider this possibility, implying that I was confused. The pharmacist was particularly adamant, insinuating that I didn't know what I was talking about.

So, I paid the money and got out of there with my supplies before they changed their mind. By this time I was almost out of test strips and couldn't start all over again with another drugstore.

Subsequently, I called Medicare, and Florida Blue, my supplemental, and both affirmed that I was right. Big deal, being right hadn't done me much good so far. A rep from Florida Blue called Publix and tried to explain to them how these transactions are supposed to go down with Medicare paying most and my supplemental picking up the rest. I don't know who he talked to, and I don't know if they believed him. But, I'm still waiting to hear back. He suggested that if Publix didn't straighten out the problem and give me my money back, I should seek out another vender. Easier said than done, I say.

Which brings me back to where I started. Why were these changes made? Whose bright idea were they? Why am I now forced to deal with a bunch of people who don't know the first thing about  Medicare, when the people at the mail order house had been thoroughly schooled in the proper procedures? Do any of the geniuses in Washington actually think this is better? For who? That's what I want to know. For who?

From Your Friends At Humana-Medicare

I usually manage to tune out or fast forward past TV commercials, but a promo for Humana-Medicare popped up during the Emmy Award broadcast the other night and, since I hadn’t noticed it before, I watched it with interest. I don’t recall the particular content, but suffice it to say they were trying to get people to sign up for their program. A blurb on their website makes this promise: “At age 65, you may qualify for Medicare. Enroll in a Humana Medicare plan with additional benefits and more coverage than Original Medicare.”

Thing is, a friend of mine is in their program - specifically, their Medicare Advantage plan. Recently, he had a heart attack. The ambulance took him to the closest hospital in New Port Richey, Morgan Plant North Bay Hospital. I visited him several times there and, quite frankly, he wasn’t looking to good. That’s why I was surprised when he told me one day that a doctor, not his cardiologist, who had just been in his room had told him he was being sent to a rehab facility.

Well, though he participated in rehab at Orchard Ridge Rehab, also in NPR, his condition continued to decline. He felt miserable. Finally, I said to him, “Bobby, these people don’t give a shit about you. You’ve got to see your own doctor over at the VA. They don’t even know what’s been going on with you.” So, since he had a regular appointment at the VA coming up, I made arrangements to take him there.

Well, on the fateful day, the VA ran some blood work on my buddy and found, among other things, that his potassium was at a dangerously high level. This condition was no doubt exacerbated by the potassium supplements the folks at Orchard Ridge had been feeding him. The people at the VA encouraged him not to return to the rehab site and made arrangements for him to be admitted to the Cardiac Unit at Bayonet Point Hospital.

He was there a few days when the very same doctor who had released him from Morgan Plant to Orchard Ridge Rehab appeared in his room. Having become familiar with the doctors who were tending to him, he asked the doctor what he was doing there. That’s when the doctor informed him “I work for Humana.”

That explains a lot about my friend’s deteriorating condition and the basics of Humana-Medicare. This doctor had only one interest – keeping down charges to Humana. He wasn’t interested at all in my friend’s welfare.

I hope that the next time you see the ad for Humana Medicare, this story comes to mind. We know that insurance companies are sleazy outfits, but some are sleazier than others.