I have a friend on Medicare. She cannot afford a supplemental policy. Consequently, she’s lived for the past several years with the reality that without the extra 20% upfront, many (perhaps most) practitioners are not going to provide services. That is certainly true when it comes to testing associated to diagnosis and treatment. In addition, folks with insurance get a disconnected rate because of the insurance. Folks without insurance get billed the total amount. At some level, you’ve got to concur that under some circumstances, the poor pay more.
The Affordable Health Care Act was touted as being the panacea for what ails the health care system. I don’t know enough about the legislation to pass judgment. Allegedly, those who passed the bill didn’t either. However, I’m not rendering an opinion on that either since I actually don’t know. I also don’t know if members of Congress are exempt from the provision. Rumor has it that it is so, but fact or fiction, I do not know. At some level, I’m inclined to think, “What’s good for the goose is good for the gander.”
According to the American Heritage Dictionary, the aforementioned statement means: “What is good for a man is equally good for a woman; or, what a man can have or do, so can a woman have or do. The original proverb simple stated: “What’s sauce for the goose is sauce for the gander.”
At some level, I guess you could say that I’m now a double dipper. I have been since the age of sixty-five. I don’t always make good decisions, but when I left employment with the State of Texas, I opted not to withdraw my State retirement. Consequently, at the age of 65, I was entitled to free health care insurance for life. It, too, comes with a prescription card.
My current employer also provides both those benefits. Since I’m still working, the insurance through the State Employees Retirement System chooses to opt out of being primary, but the secondary benefits coupled with the primary benefits normally cover most of my out-of-pocket expenses. The same is true for my prescriptions. Generally, I don’t incur a co-pay because the secondary insurance covers the differential. Every time I get a prescription, I’m grateful for the 17 ½ years I worked with the State. It always puts a smile on my face. In addition, I had a really good experience associated to State employment and still maintain friendships with many of the people I worked with over half a lifetime ago.
In Monday’s mail, I received a notice from the new prescription drug carrier for the Employees Retirement System that my coverage had been denied because I had not provided the requested information. The General had already opened the mail and she predicted that would set me off. She knows me pretty well. I was furious.
One of my first orders of business yesterday morning was to get that error corrected. I remembered the conversation I’d had with the insurance company initially. First they wanted to get my Medicare number. I knew it was my Social Security number plus a letter. I was clueless as to the letter, so I had to call the General to locate my Medicare Card and provide the number.
I won’t even begin to describe the wait in getting someone “live” to talk with when I called the insurance company, but I was subsequently placed on hold several times while the person I eventually provided the requested information to was ensuring it had been captured properly. From my perspective, it was a big-to-do about nothing. They only asked three questions: (1) What is your Medicare Number”? (2) What is your mailing address? (3) What is your street address? That is all they asked? How dare they suggest I had not provided the requested information? The thing I found puzzling is that I just received a new prescription drug card. I haven’t even used it yet. How could I be denied and at the same time be issued a card?
Miracle of miracles, the insurance company discovered I had an active account. Just to cover my bases, I telephoned the State Employees Retirement System. You guessed it. They had no confirmation that I was enrolled in the new plan. Consequently, they’d have to contact their representative with the insurance company to determine if my account was active or not. They couldn’t take my word for it. They telephoned me back later to confirm the new coverage has been in place since July 1.
I guess the litmus test of whether it works is: “Did it work?” The eye doctor I saw yesterday morning prescribed an anti-inflammatory medication for my eye. He said, “This medication is expensive. I’m giving you a coupon for $50.00 off. I thanked him for the coupon, but told him I probably wouldn’t need it since I’ve got two forms of insurance.
I stopped by the pharmacy on my way home from work. I presented the coupon the doctor had given me to the pharmacy tech. She said, “Good, you’re probably going to want to use this.” I was startled when the pharmacy tech told me my co-pay was $100. I asked, “What about the secondary insurance. Did you bill it to two carriers? She had not.
After she completed the transaction, she told me my co-pay was now $70. I asked about the coupon. She responded, “Your prescription card is through Medicare. Consequently, the government prohibits us from using redeemable coupons with any purchases associated to Medicare”. The pharmacy even provided the information to me in writing on my receipt: “The government payer of this prescription does not allow reward programs at this time.”
It was more about the principal, but I suggested “Wouldn’t I be better off not using my Medicare prescription card? I could then take advantage of the $50 coupon. That would cut my co-pay by an additional $20.” The pharmacist overheard the conversation. She added, “I know it make no sense, but since you have a Medicare prescription card, you don’t have an option. You have to use it”.
I smiled and said, “If this medication accomplishes what it is intended to accomplish, I’d more than gladly purchase it without the insurance”. My visit with the cornea specialist on Tuesday morning went well. He didn’t make any absolute promises, but he is confident over the next several weeks my vision will improve.
All My Best!
Don