Saturday, January 21, 2006

Singin'Those Ole' Medicare Blues

Most of you have read horror stories relating to the latest mismanagementbungling by our current administration. I am referring to the new Medicare Part D Prescription Drug Plan. Yes, the one that several states and many local pharmacies have had to jump in and bail out so that seniors can obtain the drugs they desperately need. The NY Times today, for example, ran a story on mentally challenged people residing in an assisted living home in FL (not a state that volunteered to bail out seniors) who were unable to obtain prescriptions and therefore had to be hospitalized to treat normally controllable symptoms.

Fortunately, I am one of the luckier ones who recently dabbled in arcane and mysterious drug program facts and foibles. However, I do have a story to tell. Although it has a probable happy ending, it contains an element of mystery, a tinge of shock, and even a touch of humor. Please bear with me as I set the stage and lay out the intricate details necessary to carry the plot forward.

For several months I railed angrily against the new drug plan and stated in front of many witnesses that I would join one "over my dead body"! I had (and still do have) all the usual gripes that it would be the death of the Medicare program, that the bill was voted on unfairly and with much arm-twisting and threatening, and that it would only mean more profits for drug companies and insurance companies. Then my doctor prescribed yet another expensive drug and I was forced to do some quick math (a subject I have always hated!) My drug costs per year had finally surprised the $3000 mark. My pharmacist, quick to notice the bills, also, was good enough to suggest the AARP Medicare RX Drug Plan which he had just researched. So, I went home, clicked on the site and liked what I saw (low premium, no deductible, huge formulary, all my drugs covererd) which brings me to the main body of my tale.

Having a question or two, when I finished with the site, I decided to switch to the telephone. I was simply ecstatic to find that I had to listen to some god-awful non-rock music for only an hour and a half before I got a real person! This kind lady answered all my questions, at which point I offered to enroll. She then took down a few stats that I am always just bursting to share (birthday, age, medicare number!) and at that point she said I was partially enrolled but she would need to switch me over to a licensed insurance rep who would complete the process. Imagine my intense delight when I was again exposed to that same noxious music as before for another hour and a half! Abruptly, a male voice startled me from my trance and proceeded to finalize the enrollment. I remember joyfully calling all my friends and neighbors shortly thereafter and bragging about how easy it was to understand the program and how lucky I was to have found such a great drug plan. Little did I know!

About a week later, I received not one, but TWO letters, each with a different letterhead, telling me that I had successfully enrolled in their drug plans. One letter contained the AARP Medicare RX letterhead, the other, United Medicare Med Advance. I took these letters to my pharmacist who looked them over carefully, noting that United was the insurance company who handled the AARP plan and that my ID numbers were the same on both letters. So, not to worry. I immediately ordered drugs and was delighted to save about $300 compared to what I had been paying for 3 refills. Again, I regaled my friends with platitudes of praise for the drug plan.

Yesterday, the mail contained more than the usual bills. United Medicare MedAdvance sent me a letter in which they informed me that since I had requested to enroll in another drug plan on the same date, I had been removed from their plan (and rightly so. I am not so old, nor so addled that I would believe for a moment that I could belong to two drug plans at once!) However, this left at least one burning question searing my brain. If I was no longer in United's plan, was I in the AARP plan? Or possibly in some other plan which I had never heard of? I called my pharmacy and was told to call the County Department of Aging. Luckily, the woman who answered was extremely knowledgeable and told me that indeed there were two different plans out there both administered by United. The plans have different premiums and different formularies. (that word means a list of drugs covered to all of you younger folks who are well out of this mess for now) but AARP and United Health (the real name of the insurance company) are both in Hot Springs, AK, and both seem to have interchangeable telephone numbers. Not to try topping that, but they both use the same ID numbers for their subscribers (verified by AARP this morning.)

Every story needs a conclusion (this one more than most, being so lengthy!) so here goes. I finally got through to AARP this morning. No, don't even ask how long that took! The rep I spoke to verified that I was now back into the AARP Plan after being removed temporarily to place me into the United Medicare Plan, after which I was bounced back to AARP! I should add that about a week ago I did get a card and packet from AARP and also a letter from Medicare stating that I had successfully enrolled in the AARP Plan. Meanwhile, some or all of my drug bills may or may not have gone to United Medicare, AARP thinks it will reimburse United directly. That would be nice! My stoy, hopefully, will end for sure on Monday when I have an appointment to share all my letters, drug card, drug recepts, ad nauseum, with the pharmacist who probably is as confused as I am at this point! The mystery remains--how did this happen? I can only conclude that somehow I got switched to a rep from United Medicare instead of one from AARP during the finalized enrollment process.

Now to the moral or the point of this story--What if I had been completely addled or totally bedridden? Who would have solved this dilemma and how? People in nursing homes or those unable to speak and decide complicated issues for themselves for other reasons are really at a great disadvantage; in fact, some may be facing a life or death issue, something our present government should have considered BEFORE the drug changes took effect.

1 comment:

Ed said...

Nightmare on Medicare Street part II......

Thanks for telling us about this experience. There are others who are suffering too. What really concerns me is that a lot of seniors don't know that if they sign up for Part D that, in some cases, they can lose all their medicare supplement coverage.

That's scary.