Through the “Donut Hole”

 Edie, Health Care  2 Responses »
Apr 302012
 

So Edie’s free lights are continuing their upward trend, and her doctor has recommended adding Vorinostat (Zolinza) to the mix (4 – 100 mg tablets per day for two weeks, then off a week). A recently completed clinical trial has shown it to be efficacious when combined with Velcade, and since the Velcade alone hasn’t been doing the trick, this seemed like the logical alternative.

The only problem with Vorinostat is it’s given in pill form. That means it comes under the Medicare Part D Prescription drug plan, and this drug is not cheap. $4,945 for a 14 day supply. Fortunately we were only on the hook for about $2,300, but it could have been a lot worse.

We would have been on the hook for the entire amount, if it weren’t for the Affordable Care Act [AKA ObamaCare], which mandated a 50% discount once you enter the donut hole. In addition, thanks to the Affordable Care Act (ACA), the amount of the discount provided by the manufacturer is also counted towards the Out-of-Pocket cost, and gets Edie to within $300 of the catastrophic coverage portion of Medicare Part D, where the cost of drugs is reduced dramatically.

Fortunately we’re able to afford the $2,000, but I can’t help but think about those who don’t have an extra $2,000 ($4,000 if it weren’t for the ACA) laying around? What do they do? Go without? Yeah, there are programs, but just how poor do you have to be before you qualify?

I never did understand the reasoning behind the “donut hole in the first place? What kind of mind(s) comes up with such a concept? I just hope it’s not the same minds that want to destroy the Affordable Care Act, and along with it many of the inequities it tries to correct in an otherwise dysfunctional health care system often working in a manner irrespective of patient needs.

Isn’t it enough having to endure a debilitating or life threatening disease? Do most people in the US really think it’s moral to make those same people also suffer the indignity and humiliation of financial ruin just because they had the misfortune of getting sick?

Wouldn’t it be nice if everyone in the US thought of health care as a right, rather than a privilege provided only to those that can afford it?

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.

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.