PAGE 107


Despite difficulties with the Affordable Health Care Act, I have had no problem with Medicare, “big government” medicine.  I have, however, had problems with one private insurance company.  I will call it “X,” to avoid any semblance of libel, although I am not telling an untruth.  Part D was enacted by the Bush administration, and while a step forward, I expected perfection, since Bush was a Republican.  I did not expect a “doughnut hole,” cost overruns, and failure to negotiate with pharmaceutical companies.

Anyway, I signed up online with X and a local pharmacy for my two prescription medications.  I used my Arizona address, because at the time I lived there. I soon discovered that I got what I paid for.

I take Drug “A,” 2 mg, 2 pills twice a day, 240 mg monthly.  Drug A has 3 sizes:  2, 5, and 10 mg.  Representatives from company X told me that Medicare regulations limited the number of pills per month to 90, in order to prevent falls, a potential side effect.  This restriction was not true, I later learned.  Rather than to ask my physician for an emergency authorization to take my usual dosage, I procured a prescription for 5 mg, 60 a month, although I needed to take my daily dosage in a different fashion.  It wasn’t ideal, but I could live with it.  Notice that I could take 300 mg a month.  That was a tipoff that Medicare restrictions were not the issue, private business restrictions were.

I called a special number to X and had a 3-way conversation with their clinical pharmacist and their sales representative.  I had no problem with Medicare’s restriction; I did have an issue with the monthly allowed dose, which made no sense.  Knowing the answer, I asked my next question:  How many 10 mg pills may I take a month?  They both answered: “120”.

I continued:  “So, I can’t take 120 pills of the 2 mg dosage a month, or a total monthly dosage of 240 mg, right?”  They agreed.

“But,” I continued, “I can take 120 pills of the 10 mg dosage a month, 1200 mg total, 6 2/3 times the allowed 2 mg dosage, right?”  I teach high school math; I knew this stuff when I was about 6.

There was sudden silence on the line, then, “we need to talk to our supervisors.”  In other words, apparently somebody at X realized the restriction of dosage for the smaller amount did not obviate the issue of prescribing a larger number of pills for the larger dosage.

That is Part 1.  On 7 March, I went to the pharmacy to get my prescription, only to be told I had been “disenrolled” from X on 28 February.  No reason was given.  Nobody at X answered the telephone on the weekend, so now I was without Part D coverage.  Suppose I were 75, on chemotherapy, needed a key anti-arrhythmic, didn’t have money, and had moderate dementia?  These things occur, even to elderly Republicans.

Becoming concerned about coverage, I called AARP-recommended United Health Care, spoke to a person, and enrolled, effective 1 April.  I will have no coverage during March.  Fortunately, I have enough medication.  If I didn’t, and the medication were expensive, I would be in trouble.

One may change address for coverage of drugs under Part D, and I planned in March to inform X that starting in April, I would be living in Eugene, not Tucson.  I don’t know how X got my Eugene address, except private information is easy to find nowadays.  Amazon, most of West Africa, and every medical organization worldwide appears to have mine.

On 14 March, I received a letter from X, dated 7 March, saying “Your Prescription drug coverage ends soon” .  In fact, when I got the letter, I was already two weeks without coverage; when the letter was written, I was already a week without coverage. Given the letter was written in the future tense, I wonder how X treats the past.

I quote part of the letter, my comments in bold:

“Thank you for letting us know about your change of permanent address”  (I didn’t.  I would have in March, had I not been disenrolled.)

“You now live outside X Prescription Drug Plan service area. To be a member of our plan, you must live in X’s service area, although you may be out of the service area temporarily for up to 12 months. How did you know the address wasn’t temporary? For that reason, we’ll disenroll you from X’s Prescription Drug Plan on 02/28/14.  “Because” is a better word than “for” in this instance.  The tense was wrong, they waited several days to send the letter, it was dated a week after the fact and took 7 days to travel 2000 miles.  

X did nothing illegal.  On page 107 of my coverage document, the wording was quite clear.  It wasn’t in fine print, but I wonder how many people go through these documents word by word, especially elderly folks, who may not understand a lot of these terms.   The individuals involved at X did not appear to know the English language, judging by the tenses; further, they did not mail the letter in a timely fashion, I had no chance to appeal, and without warning, I lost my coverage.  That was not mentioned on page 107.

While the Affordable Health Care Act has become a whipping boy for all that is wrong with medicine, this is an insurance company issue. The one organization that has worked is Medicare.  I suggested two decades ago that we would do well to expand Medicare to cover everybody:  It would be a one page bill, solving many problems. Costly?  Sure.  What cost can one place on not having insurance and being ill?  A lot of people pay that cost, especially the ill person.  Is that what America is about?

Perhaps X is a good company.  In my experience, however, they drop people suddenly, then later use the future tense.  I teach English online to people in 90 different countries and know the difference between the past perfect and future.  Their letter was signed:  “The X Enrollment Team.”  I am old enough to remember the jokes about “the 20 Mule Team.”  This would be funny, if it weren’t so potentially dangerous to the elderly.

I must be careful; “scorn or ridicule” are part of the definition of libel.

 

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