my jaundiced eye

the absurdities of life

Category: health insurance companies

medicare/rx sux

medicare:rx sux

I just received, via the failing us postal service, my most recent medicare/rx supplemental insurance statement which shows that my plan has paid precisely zero toward any of my prescriptions this year. Yet this coverage is, according to the incessant anxiety inducing advertisements, the only thing standing between me and the monstrous vortex of the dreaded “prescription donut hole” that will suck my bank account dry and leave me lying destitute and infirm on the side of the road clutching a tattered cardboard sign that reads “will work for plavix if I don’t stroke out first.”

So, I pay about $600 a year in premiums, with a $405 annual deductible…so just from the get go MJE is out a cool thousand bucks. As any typical overmedicated boomer, I ingest at least five prescription meds daily, as well as a few almost certainly useless nutritional supplements primarily to offset the results of ingrained unhealthy lifestyle choices, which I have no intention of changing.

So in order to try to sort out the vexing question of why am I spending money on supplemental insurance, which does not appear to supplement anything, I went in search of some answers, However, the federal government, which administers medicare has, in the interest of cutting government spending, deleted customer service entirely. This move, in addition to reducing governmental employee salaries and benefits, offers the added benefit of hastening the demise of legions of doddering lowlifes living off the government’s pharmaceutical tit. But my third party insurance provider, recommended by none other than the esteemed aarp, still employs customer service agents who do ultimately pick up the phone, but not before subjecting callers to a muzak loop obviously intended to force them to hang up and speed dial dr kevorkian instead.

However, MJE don’t scare that easy…I finally got connected to j joey who assured me most heartily that he could without a doubt answer any and all of my questions to my full and complete satisfaction. And true to his word he provided a lengthy and intricate explanation of exactly how each perceived expense had actually been a benefit that actively reduced my deductible, which currently stands at $35.97 thanks to my having spent $369.03 in cold hard cash.  I then got an unsolicited tutorial on the pricing tiers of various medications should the elusive deductible ever be realized: tier 1 for example would only cost $1 for a 30 day supply, tier 2 would cost $3 for a 30 day supply and so forth. As the tiers get higher the formulas revert to random percentage coverages, which are then sliced into tranches, bundled with other medication pricing structures and sold as derivatives on the big pharma futures markets.

So according to the gospel of joey, two of my meds are tier 1, (theoretically cheap), one med was tier 2 (less cheap theoretically) should I ever meet my deductible, which unfortunately lies somewhere between the end of the rainbow and my shallow grave. My three other widely prescribed medications are not covered at all. The good news is that the pharmacy I use is not a preferred vendor so my costs are much higher. Why is that good news…because in the through the looking glass reality of insuranceland the more expensive the drug the faster I will be able to claw my way to the top of mount deductible!

When I suggested that perhaps I should look for another rx supplement provider, joey patronizingly advised me to simply take different meds. Well, that was the pill that broke this camel’s back. MJE’s response was as follows, “You sound as though you are about 22 years old and since you’re working the graveyard shift (in whatever your time zone is) at an insurance company customer service desk I’m gonna guess that you haven’t been to either pharmacy or medical school. And furthermore you are most likely not suffering from high blood pressure, high cholesterol, anxiety, depression, arthritis, bursitis, fallen arches, bleeding gums, tingling in your hands and feet, dry skin, memory loss, or swollen ankles, just to name a few common afflictions of your client base. So please leave the prescribing to the professionals and stick to convincing your pathetic geriatric medicare dependent customers that they are not being taken to the cleaners by your employer, you little prick.”

To which he replied “Thank you ma’am for that excellent feedback which I will certainly pass on to my supervisor, and have a wonderful rest of your day.”



oh no! bama care


MJE is going to take a quick commercial break from politics and tackle another topic just this once. Obama care.

This program is in the headlines right now because it has been announced that premiums may go up as much as twenty five percent in the coming year…. AAAAGGGGHHH….zombies are on the front porch, help me! They’re eating my dog and tromping on my landscaping!

I’m not sure where people get their health insurance but from a lifetime of paying premiums to BC/BS I can state without fear of contradiction that my premiums rose about 20% on average every year. And hello, did I hear anyone screaming about it, no I didn’t because the fact of the matter is that insurance companies of every stripe have you by the short hairs. What are you going to do, say screw you and get insurance somewhere else…oops, then you get into the whole pre-existing condition fun house, or the you’re pretty old to be shopping around septic tank, or whatever other excuse they can haul out to either deny you coverage or to charge you ten times what your current provider does. Better the devil you know than the one you don’t. And when they get tired of you because you actually filed a claim, you’re dropped like one of the conald’s wives…I was lucky enough to get sick when I was 64, maxed out my annual and lifetime deductions and finally got a portion of my pound of flesh out of my long and costly association with BC/BS…and the best part of it was that as of 1/1/16 I was on medicare and they couldn’t drop me…and people don’t believe in karma?

But BTW, medicare ain’t no picnic either, lower premiums, really? Single payer!!!! Woo hoo!!!! By the time I pay the regular (income adjusted) premium, add the extra part Z to cover the dreaded “donut hole” and the prescription add-on I am at about 140% of what I was paying BC/BS. Which unbeknownst to me is not even available to those of us who have survived long enough to enjoy our golden years unless we are covered by a major corporate insurance plan. You’re in, like it or not. Wanna contest a claim denial, opt for an IRS audit instead, it’s far less labor intensive and stressful.

So the conald (commercial break is over kids) is touting (or trouting in the vernacular) the tired repeal and replace trope. Part of his plan is to offer health savings accounts. Yo, dono! head’s up, HSA’s have been around for decades…and they are great. You sign up for a high deductible health insurance plan and you sock away $5K or so a year into an account that is untaxed as long as you pay medical bills with the funds. But, just so you know, that $5K doesn’t arrive on your doorstep like a publisher’s clearinghouse sweepstakes check, you actually have to have the money to put in there. So say you’re living on $50K a year before taxes, does it seem likely that you might have a spare 10% of your gross income to put in an HSA? Thanks for the thoughtful and incisive input conald.

Then there is the “erasing of state lines” thing…not sure about other providers but BC/BS seems to cover medical expenses incurred over state lines without a problem as long as your doctor is within the BC/BS network. Admittedly, coverage expenses can vary greatly from state to state so MJE is going to give the conald a passing grade for that, although he get’s an f for originality.

I can’t actually remember what the other parts of his plan were because when he reads from the teleprompter it’s like watching a hostage video, and I have to turn it off and lie down.

But the upshot of the conald’s plan is that everyone is going to have great, really great medical care for a low, really low price and we’re all going to beat the house at black jack. Speaking of which, how does a casino lose money…seriously, how does that happen? Maybe we’ll find out if the conald gets his hands on the us treasury’s checkbook…

well done

well done

Okay, so after eleven months, the medical industrial complex has finally wrung MJE dry and kicked me to the curb…my right hooter has been mammogrammed, programmed, pajamagrammed, MRI’d, FYI’d, DIY’d, x-rayed, blue rayed, inspected, bisected, dissected, irrigated, oxygenated and irradiated. Every doc, nurse, orderly, lab tech and passerby in several states has felt it, held it, fracked it, hacked it and packed it. I’ve been cooked to medium-well and am sporting a Boehner tan headlamp with a permanent smirk. Oh, that and a head of holocaust hair.

So, what did MJE learn from this experience? First off and a tad bit late for me, that the kind of cancer with which I was diagnosed is a form that many in the forefront of oncology now believe may be best left alone and monitored closely. No rush to surgery. Treated more like a polyp in your bottom than a bombshell in your bosom. Also that a surgeon never met a piece of meat he didn’t want to carve up and will never admit when he doesn’t know what he doesn’t know. I also realized that many doctors are as resistant to change as the most stagnant civil servants and that a patient needs to do her homework, sharply question a treatment plan, or lack thereof, and to over ride it without feeling guilty about changing docs or getting another opinion. My health and yours are more important than some doc’s inflated ego. I also think that being a tattle-tale is a good thing for the general betterment of the afflicted. I’m not talking about going to the medical board, but if a specialist has been referred by your primary doc and you have valid complaints, you should let the referring doc know before he sends another hapless victim over.

I also discovered that nurses and technicians can literally be your best friends and are entirely under-appreciated in the medical universe. I found that getting their take on what’s really going on is invaluable. They are in the trenches all day every day while most docs pop in when required, having read the notes (or as is sometimes the case not even that) give you a cursory once over and waft out the door without so much as a by your leave. That said, MJE was treated by a couple of exemplary docs who were more than willing to put away their stop watches and take whatever time was necessary, so all is not lost, yet.

Finally MJE was extremely gratified to find that it is actually possible to get your money’s worth out of the godless health insurance companies if you: meet your horrendous deductible, then get some really crappy diagnosis, have months of complications, endless (often unnecessary) tests and a tediously lengthy treatment plan. MJE totally ate BC/BS’s lunch in 2015! Admittedly it was an extremely long and unappetizing meal , but in the end the dessert was delicious. And for once it was on the house.