Here's one that will go down in the annals of US health care history, and is one, if you know how much contempt I have for our current system, and despite my [unsuccessful] attempt to refrain from such posts, boggles even my mind.
Edie [my wife] becoming eligible for Medicare (due to her disability) signed up for Kaiser Permanente's Senior Advantage Plan. It's a Medicare Advantage plan combining Medicare parts A, B and D, and usually referred to as Part C.
She filled out the application at the end of February, and very recently received a letter in the mail indicating her enrollment in the Senior Advantage plan, along with a new card also showing she was enrolled.
Great! Everything's fine, or so I thought.
It's now time for her to reorder her Lyrica, so the pharmacy calls to let her know there will be an $835 charge [it's a very expensive drug], since she hasn't fulfilled the deductible part of her current plan, which is the plan she was on before she was enrolled in the Senior Advantage plan.
Thinking there is some sort of disconnect, since enrollment was very recent, she calls member services to find out what is wrong.
Now here's where it gets really confusing stupid.
She [actually I did most of the talking] was told by several different people (I spent a good hour on the phone), that since my company didn't remove her from their current plan, which doesn't have a Part D benefit, she's not entitled to the Part D benefit on the Kaiser Permanente Senior Advantage plan, despite still being enrolled in the Senior Advantage plan.
Now keep in mind the plan she was [is] on through the company I work for, is a plan for people not on Medicare, so it can't have Part D, as that is only for Medicare recipients.
I was even told by one Kaiser customer service person, some people want it that way. They want two plans without a prescription drug benefit. In other words they want to pay for a prescription drug plan (Part D is included in the Senior Advantage plan), but not receive the benefit.
I could understand, if my company plan included a drug benefit, Kaiser not providing a duplicate benefit, but not when that plan doesn't include a drug benefit.
It's like we're paying more, my company is paying, and Edie is paying Medicare ($110.50/month), and receiving less.
Now, is my reasoning flawed? Does that make any sense to anyone?
Or is that just the American way? Screw the customer, take their money, and don't give them anything in return.
Edie [my wife] becoming eligible for Medicare (due to her disability) signed up for Kaiser Permanente's Senior Advantage Plan. It's a Medicare Advantage plan combining Medicare parts A, B and D, and usually referred to as Part C.
She filled out the application at the end of February, and very recently received a letter in the mail indicating her enrollment in the Senior Advantage plan, along with a new card also showing she was enrolled.
Great! Everything's fine, or so I thought.
It's now time for her to reorder her Lyrica, so the pharmacy calls to let her know there will be an $835 charge [it's a very expensive drug], since she hasn't fulfilled the deductible part of her current plan, which is the plan she was on before she was enrolled in the Senior Advantage plan.
Thinking there is some sort of disconnect, since enrollment was very recent, she calls member services to find out what is wrong.
Now here's where it gets really confusing stupid.
She [actually I did most of the talking] was told by several different people (I spent a good hour on the phone), that since my company didn't remove her from their current plan, which doesn't have a Part D benefit, she's not entitled to the Part D benefit on the Kaiser Permanente Senior Advantage plan, despite still being enrolled in the Senior Advantage plan.
Now keep in mind the plan she was [is] on through the company I work for, is a plan for people not on Medicare, so it can't have Part D, as that is only for Medicare recipients.
I was even told by one Kaiser customer service person, some people want it that way. They want two plans without a prescription drug benefit. In other words they want to pay for a prescription drug plan (Part D is included in the Senior Advantage plan), but not receive the benefit.
I could understand, if my company plan included a drug benefit, Kaiser not providing a duplicate benefit, but not when that plan doesn't include a drug benefit.
It's like we're paying more, my company is paying, and Edie is paying Medicare ($110.50/month), and receiving less.
Now, is my reasoning flawed? Does that make any sense to anyone?
Or is that just the American way? Screw the customer, take their money, and don't give them anything in return.
Comments
I have retired from a 38-year career with hospitals and health care, but I don't understand hospital and health insurance billing statements or policies any better than the average person. Like, Edie, I am on disability and early retirement for medical reasons with current coverage under COBRA at twice the premium ($1K per month for two people) and a $4,000 annual deductible. So, off the top, we have out of pocket annual expenses of $16,000 for health insurance! We can't wait for the Medicare experience to begin?
Marc: My experience with CSR's of health insurance companies is that they really don't know whats going on either and they make stuff up. I've received some satisfaction in the past when I spoke to a supervisor (they sometimes know what's going on) or more often ask to see where it's written in the contract. At that they usually back down.
I wouldn't give up until they showed you where in the contract it says Edie is not entitled to Part D (even though she's paying for it).
But I do like the idea of asking where that policy is written. Sorry I didn't think of that.
In the mean time, I've got the HR people at work working on it.