Summer has finally arrived

 Edie, Health Care, My MCL, Politics  No Responses »
Sep 272010
 

When I first sat down this morning, I had every intention of writing a political rant.

I was pissed off because I believe Kaiser overcharged Edie for a prescription. I find it so amazing, that after 7+ years of dealing with the Medicare Part D prescription drug plan, Kaiser still can’t get it right. [Fortunately the quality of care they provide is better than their financial and billing prowess.]

This last prescription put Edie $200.50 into the donut hole, but instead of charging her only $200.50 for the prescription, Kaiser charged her $270.50. I assumed, and later confirmed, the extra $70 was the copay for the 3 month prescription for Lyrica. So why was she charged the copay? After all, if she had been within $1 of the donut hole (instead of $721.61), they wouldn’t have charged her $995.61 (the drugs only cost $926.61) for the prescription. They would have only charged her $925.61. [At least logic tells me that would be the case.]

So why are they charging her the copay in this case?

Of course the customer service people, didn’t seem to grasp that concept, and were adamant about charging the copay.  So now I’m forced to write a letter to the Appeals Board to file a grievance. Hopefully they are a little more intelligent than the customer service representative(s).

Then I saw the following article at Marketwatch.com “Real Estate 101: How to buy property in college towns“, and wondered when did the US stop making stuff? When did investing become such a huge part of the economy to the point companies are no longer concerned with their products or employees, but only their bottom line? When did the financial industry become an industry? They don’t make anything. All they do is move money around, and then charge you for doing just that.

What ever happened to hard work as a way of making money? My father did it, and I’ve done it for the past 35 years.

But then I thought, what’s the point? Who’s going to pay attention to me anyways? There are a lot smarter, and more influential people trying to get the same point across, without much success, so what makes me think I can accomplish what they can’t?

So rather than dwell on the perverseness of the US health care system, or a national psyche that favors greed and profits over hard work, fairness and moral principles, I decided I would find something more uplifting to write about.

I decided to complain about celebrate the fact summer has finally arrived. It only took 3 months, but it may actually be here now. I know that because it’s been hotter the last two days than it has been this entire year, and today is not supposed to be any different.

These are the first days this year, I’ve been able to go without arm warmers, or a long sleeve shirt at the start of a bike ride, and sitting at the coffee shop afterwards has actually been very comfortable.

Oh, and then I just realized, yesterday marked my 8½ year anniversary of dealing with my MCL, and not needing treatment.

I guess those are two things I can celebrate.

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 Posted by Marc at 6:10 am  Tagged with: , , , ,

The lunacy we call our health care system

 Health Care  4 Responses »
Mar 182010
 

Here’s one that will go down in the annals of US health care history, and is one, if you know how much contempt I have for our current system, and despite my [unsuccessful] attempt to refrain from such posts, boggles even my mind.

Edie [my wife] becoming eligible for Medicare (due to her disability) signed up for Kaiser Permanente’s Senior Advantage Plan. It’s a Medicare Advantage plan combining Medicare parts A, B and D, and usually referred to as Part C.

She filled out the application at the end of February, and very recently received a letter in the mail indicating her enrollment in the Senior Advantage plan, along with a new card also showing she was enrolled.

Great! Everything’s fine, or so I thought.

It’s now time for her to reorder her Lyrica, so the pharmacy calls to let her know there will be an $835 charge [it's a very expensive drug], since she hasn’t fulfilled the deductible part of her current plan, which is the plan she was on before she was enrolled in the Senior Advantage plan.

Thinking there is some sort of disconnect, since enrollment was very recent, she calls member services to find out what is wrong.

Now here’s where it gets really confusing stupid.

She [actually I did most of the talking] was told by several different people (I spent a good hour on the phone), that since my company didn’t remove her from their current plan, which doesn’t have a Part D benefit, she’s not entitled to the Part D benefit on the Kaiser Permanente Senior Advantage plan, despite still being enrolled in the Senior Advantage plan.

Now keep in mind the plan she was [is] on through the company I work for, is a plan for people not on Medicare, so it can’t have Part D, as that is only for Medicare recipients.

I was even told by one Kaiser customer service person, some people want it that way. They want two plans without a prescription drug benefit. In other words they want to pay for a prescription drug plan (Part D is included in the Senior Advantage plan), but not receive the benefit.

I could understand, if my company plan included a drug benefit, Kaiser not providing a duplicate benefit, but not when that plan doesn’t include a drug benefit.

It’s like we’re paying more, my company is paying, and Edie is paying Medicare ($110.50/month), and receiving less.

Now, is my reasoning flawed? Does that make any sense to anyone?

Or is that just the American way? Screw the customer, take their money, and don’t give them anything in return.

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 Posted by Marc at 4:38 am  Tagged with: , ,

Everything is better at the VA

 Diagnosis, My MCL  No Responses »
Nov 072009
 

I find it very interesting when comparing results of tests performed at Kaiser and the VA, all the results are better [higher] at the VA.

After receiving the latest blood test results (taken with 24 hours of each other) At the VA, my hemoglobin was 12.7 g/dl vs 11.5 g/dl at Kaiser, and my platelets were 212 thou/cumm at the VA vs 178 thou/cumm at Kaiser (both with the same reference range). Even my blood pressure was higher [not better]. At Kaiser, and when I check at home, my blood pressure always ranges from 110/60 to 120/70, but at the VA, it’s always about 130/80 or higher.

I can certainly understand blood pressure being higher due to the environment, and a shorter wait to have my blood pressure taken at the VA (little time to relax after a brisk walk to the doctors office), but why the hemoglobin and platelets?

Oh well, I guess that just goes to show you how much variability there is in the equipment and/or the technicians interpreting the results, and a good reason not to focus on the results of just one test. You have to look at trends.

Fortunately though, my total lymphocyte counts were about the same at 90 thou/cumm, which is good.

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 Posted by Marc at 6:55 am  Tagged with: ,

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