A letter came in the mail from Humana, my Part D Medicare Drug Plan,stating my medication, 2 mg pills, was “excessive;” while I would be given a 30 day supply, I would need a letter from my doctor to get more.  I take 2 pills twice daily.  That is 4 *30, or 120 pills per month.

Getting a hardship letter from a physician is difficult. When I practiced, this sort of stuff was the norm.  Some of us did it as part of the job, others charged for it, still others ignored it.  I realize we live in different times.  I wrote off $30,000 annually for bad debts and poor people. In 1984, when Arizona went on the “successful” non-Medicare AHCCCS program, it worked, because we didn’t get paid for “AHCCCS Noncert” patients, but we saw them anyway.  You’re welcome.

I was not going to fight the doctor’s office staff.  I had a better idea.  I went on Humana’s Web Site and found the problem: only 90 pills were allowed a month.  I thought that odd, but Medicare is interested in preventing falls in the elderly.  Being Medicare, they set rules in stone.  Had my colleagues fixed the problem, we wouldn’t need government regulation, but I’ve been saying that for decades and would have had better luck saying it to the wall.  At least, the wall wouldn’t have yelled back at me.  But I digress.

I discovered that the 5 mg pills were restricted to 90 as well, odd, but I could buy them, use a pill cutter and do just as well with 1 1/2 a day.  That would be easy.  So, I went to my doctor’s office and asked for a prescription for 1 pill twice a day, 70 a month, to have a few extra.  I would do the cutting, and I didn’t want the staff to deal with fractions, for people don’t understand fractions and don’t like them, mostly because they were not taught how to deal with them. I should quit digressing.

Two weeks later, I got another letter from Humana stating the same thing, this time about the 5 mg pill.  I was annoyed.  I called their number, and entered a loop that sent me back to where I started.  At least I didn’t hear “Your call is important to us.”

Non-plussed, I called the line for those wanting to contest a denial. While on hold, I called another pharmacy to find I could get what I wanted off Medicare if I paid for it.  Good.  I had Plan B. I wasn’t really contesting the denial, but I soon learn to find the right number to talk to a real person.  I got a guy from Tampa on the line and told my story.  He explained the 90 pills was a precaution against falling.  I knew that. He then said that the pharmacy had given me an 18 day supply of the 5 mg pill, because it was the prescription was written for 4 a day.  I didn’t thank him for the extra pills: 18*4=72, and there is really an easy way to do that in one’s head. I was polite.  I know that, because after the call, my wife agreed.

In other words, I concluded, either the pharmacy or the doctor’s office made an error.  I wasn’t done.  I asked him to look up how many pills I could get of the 10 mg size.  I knew, because when I deal with irrational thinking I ask questions I already know the answer to.  Jeesh, I’m sounding like a lawyer.  That’s worse than digressing.

There was a pause, and then I heard, “120”.  I asked him what he thought about the number.

“I think I better get the clinical pharmacist on the line.”  Good answer. Now I’m having fun.

A few minutes later, I was speaking to the clinical pharmacist and the operator.  Wow, this is great.  I outlined the problem in simple math, since I am after all both a mathematician and a substitute math teacher.  In my last post, I said I was better than average with dealing numbers.  No, I am far better than average in dealing with numbers.  I always counted things; I still have a 1957 diary wherein I counted license plate tabs I saw.  Yeah, I did that stuff when I was 8.

I outlined my issue in simple math I thought an 8 year-old would understand:

“I can get 90  2 mg pills a month, right?”  Both agreed. “So,” I added, “I can take 180 mg a month.”  The pharmacist started saying something about Medicare, but I interrupted her.  Yes, I shouldn’t interrupt; the German verb for it translating literally to “under break”.  Gotta love the Germans for that.

“I know what Medicare says,” I continued.  “I can get 120 of the 10 mg pills a month, right?

The pharmacist and the operator agreed.  I then lay down my royal flush:  “That is 1200 mg a month, right?”

There was dead silence on the line.

I started arranging the Ace, King, Queen, Jack, and Ten spot and said, “So Medicare says I can only take 180 mg a month of the 2 mg size but 1200 mg a month if I take the 10 mg size.  Does that make sense to you?”

The silence continued a little longer.  Almost in unison, I heard, “I think we need to talk to our supervisors.”

I thought that was reasonable.  I doubt anything will happen.  It seldom does.  But once in a while there is real thinking about numbers at high levels of business, numbers that don’t have parentheses around them and lie at the bottom of the page.  Somebody might actually say, “Hey, some old codger from Arizona called and said he could get 1200 mg of this medication if he took one size pill, but only 180 mg if he took the smaller size.  We need to change that.”

“That can’t be true,” will be the reply.  “The codger doesn’t know what he is talking about.”

“But he said that was 6 2/3 x the lower dose.  He did that without pausing.”  Man, I’d pay a C note to be present at that conversation.

That was easy.  Been doing that since I was 8.

The harder part was multiplying the two, just for fun.  The product is 216,000.  It is meaningless, but I did it in my head.  It is not difficult to teach…..should you want to learn the technique.  It’s not like directing Swan Lake, for heaven’s sake.  It’s just working with numbers.  I gave the link.  We read left to right.  Learn to multiply left to right.  You may not have born with mathematical ability, but you can learn this.  I wasn’t born with musical ability, but I sure love to listen to Swan Lake.

Math really matters.

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