Outrage? Relief? Medical costs! (Of course political.)

[Spiky Bugger]

MrSue has RAGING psoriasis and psoriatic arthritis. It accompanied his heart attack or the post-attack meds, so an almost 19-year history.

For several years, he and his dermatologist tried to attack it w/various topicals...to no avail. I asked the dermatologist if there were, maybe, more aggressive approaches. There were, but he didn’t like them, so he gave us the names of other doctors.

We went to a really nice doctor who Rx’d a biologic medication, and the games began. Improvement, regression, see-saw...but overall, things were a lot better when he was on Embrel and tanning beds. Then, his body learned to overcome the Embrel and it got worse. So, Humira, but it wasn’t great, so then he changed to Otezla, which didn’t seem to work. So then he added multiple, multiple, multiple twice-a-week laser treatments, which worked, but only for about a week at a time.

But the Otezla hadn’t worked as well as the Humira, so back to Humira.

There are probably other people who have had to deal with this disease. It’s ugly. It’s embarassing. It can—and probably will—show up anywhere on your body. Yup, there, too. And you look like a pink alligator and skin flakes off and you bleed and the skin stuff outside is accompanied by arthritis inside.

Congress does not allow Medicare to negotiate drug prices. Pharmas charge what they want. The current price for MrSue’s Humira is just under $5300 per month. (Just under $64,000/year.)

We are VERY fortunate, in that our insurance covers 95% of the cost, so we pay $264.87 per month. (Just under $3200/year.)

But you know what? Congress DOES allow the VA to negotiate drug prices. So, we two veterans will now re-engage with the VA system, get re-vested, get him re-referred, and (hopefully) get the Rx re-issued, this time through the VA. Why?

Because our cost will be $11 per month. ($132/year.)

REALLY? Yup.

To keep their seats in congress, our representatives think it’s okay that some Americans have to pay $64,000 a year and others pay $132 a year for the SAME DRUG.

As I said above, we are VERY fortunate—480+ times more fortunate than some Americans, many of whom will “go without”—but I’m still outraged.



PS—this goes back way before the Orange Illiterate and his MAGAots, or I’d blame them. But he could have fixed this before the 2018 elections. Now, nobody’s workin’ with nobody.

 

[k9ophile]

No shit. Government is fucked up and WE pay for it, literally and figuratively. I support term limits for both houses, but doubt I'll see it in my lifetime. Why would they do anything that kills their power and benefits?

My B-I-L has more health problems than my sister. Until he got signed up with the VA, they had to very carefully consider which drugs they would get. His income was higher, so she sacrificed her medications to keep him taken care of. It's better for them now, but as you so elegantly phrased it:

To keep their seats in congress, our representatives think it’s okay that some Americans have to pay $64,000 a year and others pay $132 a year for the SAME DRUG.

 

[JackieOnLine]

 

[LizJ]

 

[southernlady]

I ran into stupidity this week.
Okay, first, I am allowed, due to being within 90 days of turning of my 65th birthday month, able to switch to a Medicare Supplement plan. Been on a Medicare Advantage forever, various companies but the latest is Humana.

So, I first had to apply for the Supplement. That went well. Had to get my DISENROLLMENT letter from Humana. Got it and it says, I am disenrolled on 31 May 2019. Supplement starts 1 June. Letter was dated 14 March with the MAY date. I mentioned it two or five times while talking with the disenrollment section to get the letter.

Paid April's payment to Humana in March using our debit card.

Yesterday morning 4/11, dh noticed a credit to the bank account...they returned my payment. Got online, Humana says I have NO ACTIVE policies. It was suppose to remain in force til 31 May. They cancelled my policy on the 31st of MARCH!!! Got on the phone with them at 10AM, turns out, because my disenrollment letter was requested in March, it became effective in March even tho it was mentioned multiple times and states on the letter that it's 31 MAY!!! I told them they should have mentioned that WHEN I REQUESTED the letter.

I was suppose to get called back no less than 24 hours. Hung up about 11:45 AM. It's now 5:30 PM and I have YET to hear from them. Their solution was to get a NEW policy for a month but it won't help the two appointments AND the lab work being done this month.

Lab work was suppose to be done this morning. I got the lab slips and they are good for a year so I will get it done on 1 June. The doctor appts will be covered by Medicare which is what I bounced back to when they cancelled my advantage plan. Messaged my PCP doing the labs that the only lab I need right now is my A1C and will get the rest in June.

I kept trying to get it reinstated since THEY made the fucking mistake but they turned into brick walls. I will be filing a complaint with CMS about this.

 

[LizJ]

 

[JackieOnLine]

OMG it is all so freaking unnecessarily HARD!

 

[k9ophile]

southernlady Good luck. My pessimism combined with my experience with CMS leads me to believe you may get your policy woes taken care of before you get any action out of CMS. Oh, they may make note of your complaint, but actually do something?

 

[southernlady]

southernlady Good luck. My pessimism combined with my experience with CMS leads me to believe you may get your policy woes taken care of before you get any action out of CMS. Oh, they may make note of your complaint, but actually do something?

Oh I know, but at least the complaint will be on record.

 

[Spiky Bugger]

k9ophile
southernlady

We’re too old. That’s the problem. We come from era(s) where things made sense and people were competent.

As mentioned above, we need to get re-“vested” in the VA system. We made appointments:
4/23–10:30 am, his (fasting) labs for his vesting appt. (then we would do lunch)
4/23–12:30 pm, my vesting appt
4/30–10:00 am, his vesting appt

Except, the confirmation postcards arrived yesterday:
4/23- 10:30 am, his labs appt was scheduled at a different clinic, in another county
4/23- 12:30 pm, my vesting appt

When I called and explained that we needed to be at the same clinic, I learned that I no longer had a vesting appointment on 4/23, as the postcard said I did.
Me: Cancelled?
Them: Yes.
Me: How long was that going to be a secret?
Them: Someone should have called.
Me: Well, guess what. So, why was I cancelled and what do I need to do to fix it?
Them: Uhm...no provider available that day.

So all three appts cancelled and we now start over on starting over.

 

[southernlady]

When I called and explained that we needed to be at the same clinic, I learned that I no longer had a vesting appointment on 4/23, as the postcard said I did.
Me: Cancelled?
Them: Yes.
Me: How long was that going to be a secret?
Them: Someone should have called.
Me: Well, guess what. So, why was I cancelled and what do I need to do to fix it?
Them: Uhm...no provider available that day.

So all three appts cancelled and we now start over on starting over.

That's just WRONG.

 

[DianaCox]

We’d both started on Medicare on September 1, 2018. I turned 65 in August, but my work plan-year is September-August. Did the endless paperwork in July - with EXTREME attention the start date. They billed me for August anyway (somehow didn’t bill Charles, with EXACTLY the same paperwork.

We both signed up with the same Part G plan. His worked fine. My doctors started reporting that the supplement payments were not coming or being denied. From October to January I had multiple 1-2 hour long calls with Medicare and BCBSAZ trying to fix it. Problems blamed on 1) my last name being hyphenated, which neither plan could accommodate - either my maiden name was ignored altogether, made into a middle name, or both names were crammed together in a single name, and utterly inconsistently. Then they figured out that my BCBSAZ supplement was not linked to my Medicare account, and BCBSAZ would fix it sometime in the next 2-3 weeks. It was not fixed. Then they figured out that BCBSAZ had my Medicare number transcribed incorrectly - and BCBSAZ would fix it within the next 2-3 weeks. It was not fixed. They finally got it fixed in mid-January.

In the meantime, my therapist didn’t get the supplement payment for 16 appointments from September to January until February. She had resubmitted the claims multiple times, and STILL had to resubmit with my EoBs (or whatever Medicare calls them) after my accounts were connected, which meant sorting through all of her Medicare claims, which come in on one record for all of her patients, and redacting the other patients’ information. I tried requesting a summary statement from Medicare for her three times, which never was sent.

Note: why is it BCBSAZ’s responsibility to connect my account with them to my Medicare account, so they can be billed? What is their motivation to get it right?

 

[southernlady]

In the meantime, my therapist didn’t get the supplement payment for 16 appointments from September to January until February. She had resubmitted the claims multiple times, and STILL had to resubmit with my EoBs (or whatever Medicare calls them) after my accounts were connected, which meant sorting through all of her Medicare claims, which come in on one record for all of her patients, and redacting the other patients’ information. I tried requesting a summary statement from Medicare for her three times, which never was sent.

And we wonder why doctors either limit the number of Medicare patients or avoid them altogether.

 

[Spiky Bugger]

We’d both started on Medicare on September 1, 2018. I turned 65 in August, but my work plan-year is September-August. Did the endless paperwork in July - with EXTREME attention the start date. They billed me for August anyway (somehow didn’t bill Charles, with EXACTLY the same paperwork.

We both signed up with the same Part G plan. His worked fine. My doctors started reporting that the supplement payments were not coming or being denied. From October to January I had multiple 1-2 hour long calls with Medicare and BCBSAZ trying to fix it. Problems blamed on 1) my last name being hyphenated, which neither plan could accommodate - either my maiden name was ignored altogether, made into a middle name, or both names were crammed together in a single name, and utterly inconsistently. Then they figured out that my BCBSAZ supplement was not linked to my Medicare account, and BCBSAZ would fix it sometime in the next 2-3 weeks. It was not fixed. Then they figured out that BCBSAZ had my Medicare number transcribed incorrectly - and BCBSAZ would fix it within the next 2-3 weeks. It was not fixed. They finally got it fixed in mid-January.

In the meantime, my therapist didn’t get the supplement payment for 16 appointments from September to January until February. She had resubmitted the claims multiple times, and STILL had to resubmit with my EoBs (or whatever Medicare calls them) after my accounts were connected, which meant sorting through all of her Medicare claims, which come in on one record for all of her patients, and redacting the other patients’ information. I tried requesting a summary statement from Medicare for her three times, which never was sent.

Note: why is it BCBSAZ’s responsibility to connect my account with them to my Medicare account, so they can be billed? What is their motivation to get it right?

My cousin, let’s call her Mary, married a Mexican with a three word last name...along the lines of “Gabriel del Toro” or “Jose del Campo.”

So, using my first example, various govt agencies say she is:
Mary Gabrieldeltoro
Mary Gabriel Deltoro
Mary G. Deltoro
Mary Gabriel-Del-Toro
Mary Gabrieldel Toro
etc

Some REQUIRE hyphens, some PROHIBIT them

 

[Spiky Bugger]

That's just WRONG.

Indeed.

I was directed to report this at the VA Consumer Advocate, used to be Ombudsman.

The recording said that she had left the position in January 2019, to leave a message and the relief person would return my call.

Sure. That’ll happen.