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PART D and ME
Or
There’s Something Rotten in the State of California
I’m a senior with Part D Medicare prescription insurance. This year, my premium has risen by 82% and benefits have gone down by – only God knows how much and, except to George, He or She isn’t talking. Since I take a lot of drugs, I originally chose the most expensive plan that paid for generics in the “doughnut hole”. For those of you under 65, the Part D plans have three periods during the year. The first, or regular zone, has all drugs covered at reasonably good prices. After a certain plateau, there are no co-payments in the “doughnut hole”. After another plateau, the catastrophic zone is entered and co-pays drop to a minimum. In May, I picked up my monthly supply of drugs and was surprised to learn that it cost over
Or
There’s Something Rotten in the State of California
I’m a senior with Part D Medicare prescription insurance. This year, my premium has risen by 82% and benefits have gone down by – only God knows how much and, except to George, He or She isn’t talking. Since I take a lot of drugs, I originally chose the most expensive plan that paid for generics in the “doughnut hole”. For those of you under 65, the Part D plans have three periods during the year. The first, or regular zone, has all drugs covered at reasonably good prices. After a certain plateau, there are no co-payments in the “doughnut hole”. After another plateau, the catastrophic zone is entered and co-pays drop to a minimum. In May, I picked up my monthly supply of drugs and was surprised to learn that it cost over
a $100.00 more than the previous month. I immediately called my insurer and was informed I had indeed entered the dreaded “doughnut hole”. I think it’s more apt to call it the dead zone. It seems like it comes earlier and lasts longer every year. When I pointed out that 3 of the 4 drugs that weren’t covered were generics, the rep told me the government tells them what to pay for and what not to pay for and then laughed at me. I went ballistic!
I’ve never been an activist, but I decided it was time to call in the Federales. I contacted my Federal legislators, the static trio, Boxer, Feinstein and Woolsey. My experiences can best be summed up by the old saying, “They were as useful as teats on a boar”. Of course, I didn’t deal with the actual legislators, but with their minions. I’m sure if I had spoken with any of them directly they would have leapt into action and fixed the problem. I also believe in Santa Claus.
Next, I contacted Medicare and filed a complaint against the insurer. The very next day I was amazed to receive a call from the insurance company and spoke to a very nice and understanding lady who assured me, “That’s just the way it is”. Evidently, that answer was good enough for Medicare since I’ve yet to hear back from them. I called Medicare again the other day and was told the insurance company told them the complaint was closed. It’s good to know they have enough faith in the insurance company that they didn’t need to ask my opinion.
I called the Department of Health and Human Services hotline to report the overcharge and was told they had a special hotline for prescription problems. That line was answered with the phrase, “Medicare Integrity Contractor”. After I stopped laughing, I asked enough questions to determine they simply took down complaints and gave them to Medicare.
Another month rolled by and the drug prices were the same. In July, I picked up my drugs and was surprised to see yet another change in prices. The co-pay for a drug is only supposed to change at the start of the year and when entering and leaving the dead Zone, unless the price changes at the pharmacy. My co-pay for one of the prescriptions went from zero in May and June to $8.17 in July, which was the correct charge. In May and June I paid the entire $43.54 for the drug. The drug is a common blood pressure medication, Metoprolol. Now I had proof that something was indeed wrong. I again called the insurance company and this time was told that they agreed something was amiss and I’d probably get a refund. Next they called and told me I’d definitely get a refund. I’m still waiting for it, but not holding my breath. That apparently solved my problem, but I still wasn’t satisfied.
A good part of my working life was spent writing computer programs, so I have a good idea of how computer systems work. I know that in the type of database system the insurance company uses that a mistake in data entered for the drug would result in a minimum of everyone in the plan I have who purchases that drug being overcharged. (I’m also not vain enough to think they singled me out just to annoy me.) I noticed the overcharge. I made noise. I was at least told I’ll get a refund. The question is, will the people who didn’t notice or didn’t make noise get their refund? My experiences while investigating this matter lead me to conclude they will not. I also believe the overcharge was intentional and the real mistake was that someone corrected the error for July’s purchases when the drug price changed. How can I be so cynical? Read on and I’ll tell you.
When the Part D program was originally set up, the legislation did not provide for oversight of the insurance companies. This is analogous, for those of you familiar with a retail business, to an owner gathering his employees together and telling them that to save his time and effort he will never check the cash register. In other words, it’s a license to steal. I’ve not met many people in life who wouldn’t steal under those circumstances. Why did Congress set the plan up without oversight? There are only two possibilities. They are just plain stupid, like the owner in the example, above, or they are crooks out to line their pockets with money from the drug and insurance companies. You’re absolutely right, nobody could be that stupid.
I checked on my insurance company. A Google search using the words “fines” and “CIGNA” returned articles on the first 2 pages of results that explained the circumstances of just 4 fines that totaled almost $700,000.00. They were for flagrant disregard of the laws and orders by government officials. I do not believe that these practices are limited to my insurance company. Check out yours. I also found that, according to Forbes magazine, H. Edward Hanway, the CEO of CIGNA, made over thirteen million dollars last year from his salary, bonuses, stock gains and “other”, whatever that is. No wonder they’re overcharging me.
My complaint to Medicare didn’t help, so I called the Federal Information Center. They said to call the California Insurance Commissioner. While I didn’t talk to Steve Poizner, the Commissioner, I did talk to a half dozen of his underlings and filed a written Request for Assistance. They were unanimous in saying, “…this matter is not within the jurisdiction of our department…” They recommended that I contact Medicare – spell that Medidon’tcare. I guess it’s legal for these insurance companies to steal from California residents.
I contacted every state and federal office that might be involved with this problem without eliciting so much as an expression of interest. At least Arnold could use his bad knee as an excuse. No one got back to me when I left my name and number and a brief message. That includes the FBI when I left a message telling them that I might have evidence of a crime. A half dozen newspapers that I contacted expressed no interest in the story, nor did a TV station. Even the advocacy groups I contacted either wouldn’t help or didn’t return my calls. Evidently, it’s open season on seniors and nobody cares.
Most seniors, who are smart or fortunate enough to not depend on the social security system, will just loose a few dollars if they don’t check their co-pays at the pharmacy properly. There are many seniors who are dependent on that system and will have to make a choice between drugs and food if they are overcharged. They cannot live without either. They are being deprived of their Constitutional rights by greedy businesses and corrupt politicians. This is not the way the Government of the United States of America should function. Many of you have fought for this Country in time of war. Now we all have to fight for it before it becomes morally and financially bankrupt. Remember seniors, even though we’re old and considered useless, our voices and our votes, when used in unison, are as good as anyone else’s.
I realize that the above account is hard to believe, but all that happened is true. You may argue with my interpretations, but not with my facts as they are easily replicable. If any of you have similar problems with the Medicare Part D insurers, please let me know by posting to this article.
I’ve never been an activist, but I decided it was time to call in the Federales. I contacted my Federal legislators, the static trio, Boxer, Feinstein and Woolsey. My experiences can best be summed up by the old saying, “They were as useful as teats on a boar”. Of course, I didn’t deal with the actual legislators, but with their minions. I’m sure if I had spoken with any of them directly they would have leapt into action and fixed the problem. I also believe in Santa Claus.
Next, I contacted Medicare and filed a complaint against the insurer. The very next day I was amazed to receive a call from the insurance company and spoke to a very nice and understanding lady who assured me, “That’s just the way it is”. Evidently, that answer was good enough for Medicare since I’ve yet to hear back from them. I called Medicare again the other day and was told the insurance company told them the complaint was closed. It’s good to know they have enough faith in the insurance company that they didn’t need to ask my opinion.
I called the Department of Health and Human Services hotline to report the overcharge and was told they had a special hotline for prescription problems. That line was answered with the phrase, “Medicare Integrity Contractor”. After I stopped laughing, I asked enough questions to determine they simply took down complaints and gave them to Medicare.
Another month rolled by and the drug prices were the same. In July, I picked up my drugs and was surprised to see yet another change in prices. The co-pay for a drug is only supposed to change at the start of the year and when entering and leaving the dead Zone, unless the price changes at the pharmacy. My co-pay for one of the prescriptions went from zero in May and June to $8.17 in July, which was the correct charge. In May and June I paid the entire $43.54 for the drug. The drug is a common blood pressure medication, Metoprolol. Now I had proof that something was indeed wrong. I again called the insurance company and this time was told that they agreed something was amiss and I’d probably get a refund. Next they called and told me I’d definitely get a refund. I’m still waiting for it, but not holding my breath. That apparently solved my problem, but I still wasn’t satisfied.
A good part of my working life was spent writing computer programs, so I have a good idea of how computer systems work. I know that in the type of database system the insurance company uses that a mistake in data entered for the drug would result in a minimum of everyone in the plan I have who purchases that drug being overcharged. (I’m also not vain enough to think they singled me out just to annoy me.) I noticed the overcharge. I made noise. I was at least told I’ll get a refund. The question is, will the people who didn’t notice or didn’t make noise get their refund? My experiences while investigating this matter lead me to conclude they will not. I also believe the overcharge was intentional and the real mistake was that someone corrected the error for July’s purchases when the drug price changed. How can I be so cynical? Read on and I’ll tell you.
When the Part D program was originally set up, the legislation did not provide for oversight of the insurance companies. This is analogous, for those of you familiar with a retail business, to an owner gathering his employees together and telling them that to save his time and effort he will never check the cash register. In other words, it’s a license to steal. I’ve not met many people in life who wouldn’t steal under those circumstances. Why did Congress set the plan up without oversight? There are only two possibilities. They are just plain stupid, like the owner in the example, above, or they are crooks out to line their pockets with money from the drug and insurance companies. You’re absolutely right, nobody could be that stupid.
I checked on my insurance company. A Google search using the words “fines” and “CIGNA” returned articles on the first 2 pages of results that explained the circumstances of just 4 fines that totaled almost $700,000.00. They were for flagrant disregard of the laws and orders by government officials. I do not believe that these practices are limited to my insurance company. Check out yours. I also found that, according to Forbes magazine, H. Edward Hanway, the CEO of CIGNA, made over thirteen million dollars last year from his salary, bonuses, stock gains and “other”, whatever that is. No wonder they’re overcharging me.
My complaint to Medicare didn’t help, so I called the Federal Information Center. They said to call the California Insurance Commissioner. While I didn’t talk to Steve Poizner, the Commissioner, I did talk to a half dozen of his underlings and filed a written Request for Assistance. They were unanimous in saying, “…this matter is not within the jurisdiction of our department…” They recommended that I contact Medicare – spell that Medidon’tcare. I guess it’s legal for these insurance companies to steal from California residents.
I contacted every state and federal office that might be involved with this problem without eliciting so much as an expression of interest. At least Arnold could use his bad knee as an excuse. No one got back to me when I left my name and number and a brief message. That includes the FBI when I left a message telling them that I might have evidence of a crime. A half dozen newspapers that I contacted expressed no interest in the story, nor did a TV station. Even the advocacy groups I contacted either wouldn’t help or didn’t return my calls. Evidently, it’s open season on seniors and nobody cares.
Most seniors, who are smart or fortunate enough to not depend on the social security system, will just loose a few dollars if they don’t check their co-pays at the pharmacy properly. There are many seniors who are dependent on that system and will have to make a choice between drugs and food if they are overcharged. They cannot live without either. They are being deprived of their Constitutional rights by greedy businesses and corrupt politicians. This is not the way the Government of the United States of America should function. Many of you have fought for this Country in time of war. Now we all have to fight for it before it becomes morally and financially bankrupt. Remember seniors, even though we’re old and considered useless, our voices and our votes, when used in unison, are as good as anyone else’s.
I realize that the above account is hard to believe, but all that happened is true. You may argue with my interpretations, but not with my facts as they are easily replicable. If any of you have similar problems with the Medicare Part D insurers, please let me know by posting to this article.
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