EDIT-New info-First failure of the new Medicare Drug "benefit".

[techs]

EDIT for follow up:
Still no prescription filled. Went with the guy to Social Services. I was told by his worker that Vermont Medicaid is estimating that only 20 percent of prescriptions are being filled for Vermont Medicare and Medicaid recipients. No figures for people who only have Medicare drug coverage.
This is criminal. No other way to put it. People on Medicare and Medicaid are the least likely to be able to purchase their meds out of pocket in an emergency.
I am still trying to find out what is going on at his Medicare provider. Now the phone says we are experiencing higher than normal volume please call back. So there is no way to get thru to them. The pharmacist can't get thru on the number reserved fro pharmacists.
Finally got a call from Vermont Social Services. They set up an emergency plan to get life saving meds paid for out of state money. They will cover one month of meds. Unfortunately the pharmacist can't get thru to state Medicaid to get an authorization. He just gets a busy signal.
The pharmacist, the social worker both say the Medicare drug plan was done in the absolute worst way possible.

There's guy in my building, maybe 80 years old. He has been on disability his whole life. He is not the brightest guy, if you get my meaning. He can't drive. Nicest guy in the world. Despite being on disability he bagged groceries at the supermarket for 10 years.
At the beginning of every month I drive him to the drug store to fill his prescriptions.
He is also on Medicaid which charges him a co-payment of like 5 dollars per prescriptions.
But now he had to sign up for the Medicare drug plan. I worked in health insurance for years but could not figure out which plan was the best. I hope we made the right choice.
Anyway he couldn't get his prescription filled. Seems his new provider is doing a computer upgrade(?) on the FIRST DAY THE PLAN IS IN EFFECT (ok, the second day but yesterday everything was closed). Their recording says try back in a day or so.
A DAY OR SO? HE NEEDS THIS MEDICATION FOR A HEART PROBLEM.
We asked how much to buy the medication. 367.00 for a month!
Sorry no meds. Go home and die.
Anyway I am standing there thinking I have to pay for the meds. So I ask if I will get reimbursed. The pharmacist doesn't know, but he suspects not.
So before I pay the money I get an idea. We drive over to the health center he goes to. I know the director personally. She talks to a doctor and they give him a weeks supply from the freebies the doctors get.
Now I wonder if people have any recourse when their provider does not provide reasonable service? Is it to just change providers the next year? What about this year?

 

[Pabster]

Ok...so because a provider is doing a system upgrade, the drug benefit plan is a failure?

And yes, you always have a choice of providers. Just like Doctors, Surgeons, etc. You don't like the first one, keep on going until you find one that you do.

 

[Moonbeam]

Originally posted by: Pabster
Ok...so because a provider is doing a system upgrade, the drug benefit plan is a failure?

And yes, you always have a choice of providers. Just like Doctors, Surgeons, etc. You don't like the first one, keep on going until you find one that you do.

Yup, not to mention they may have some in the emergency room when the haul you in after your heart attack. Alwaqys look on the bright side.

 

[techs]

Originally posted by: Pabster
Ok...so because a provider is doing a system upgrade, the drug benefit plan is a failure?

And yes, you always have a choice of providers. Just like Doctors, Surgeons, etc. You don't like the first one, keep on going until you find one that you do.

Not saying its a complete failure. Just pointing out the first of many failures of a fatally flawed plan.
Also, as for provider I mean drug insurance provider, not doctors, etc. One of the really bad parts of the plan is your drug insurance provider has, I believe, "got" you for a year even if they decide at any point to not cover any medications at all. They literally can decide to take your money for the year and not give you anything.

 

[catnap1972]

Going to be more of these stories...my mother should've been auto-enrolled in a Part D plan (since she has Medicare A+B and Medicaid), but it turns out she isn't ("hmm--no idea what happened" was the insurer's answer--they all seem to be clueless). She hasn't received a new card, nor a "magic letter" (evidence of coverage) that's being touted as the temporary solution when there's no card.

Office that handles this is closed today so she has to go through the whole thing on the phone again tomorrow with the clueless CSRs.

 

[Whoozyerdaddy]

I guess I don't see how this is a failure in the Drug Benefit Plan. The pharmacy was updating their computers. What does that have to do with the new Medicare plan?

 

[catnap1972]

Originally posted by: Whoozyerdaddy
I guess I don't see how this is a failure in the Drug Benefit Plan. The pharmacy was updating their computers. What does that have to do with the new Medicare plan?

Should they or should they not have been prepared for this (before it took effect)? They've only known about it for months

 

[techs]

Originally posted by: catnap1972

Originally posted by: Whoozyerdaddy
I guess I don't see how this is a failure in the Drug Benefit Plan. The pharmacy was updating their computers. What does that have to do with the new Medicare plan?

Should they or should they not have been prepared for this (before it took effect)? They've only known about it for months

I guess when you have been given a license to abuse you use it fully.

 

[zendari]

A company is upgrading a computer system and has some downtime? Ohnoes, who would have thought?

 

[slyedog]

i have the plan D drug plan. could not be more simple to understand. when you buy the plan it tells you what medicine it will supply. if it does not cover your medicine, go to another plan. if you buy a plan, and the plan decides to quit, they have to give you a 90 day notice so you can get another plan. and the next provider has to take you. when you get to be 65 you will appreciate it

 

[Corn]

Originally posted by: zendari
A company is upgrading a computer system and has some downtime? Ohnoes, who would have thought?

...and its gonna cause that poor old codger to have a heart attack!!


Although if I required medication to ensure I didn't croak if I missed a dose, I wouldn't wait until I ran out prior to attempting to purchase more. This isn't a failure of the drug plan, it's a failure to plan ahead--for both the geezer and the pharmacy.

 

[EatSpam]

What are you talking about? The Medicare drug plan is a rousing success....for the Big Pharma, the middlemen between Medicare and the profit **ahem** patient, and the politicians that ran the bill through.

Who else was the plan supposed to benefit? Seniors? :laugh::laugh::laugh::laugh::laugh:

 

[charrison]

Originally posted by: techs

Originally posted by: Pabster
Ok...so because a provider is doing a system upgrade, the drug benefit plan is a failure?

And yes, you always have a choice of providers. Just like Doctors, Surgeons, etc. You don't like the first one, keep on going until you find one that you do.

Not saying its a complete failure. Just pointing out the first of many failures of a fatally flawed plan.
Also, as for provider I mean drug insurance provider, not doctors, etc. One of the really bad parts of the plan is your drug insurance provider has, I believe, "got" you for a year even if they decide at any point to not cover any medications at all. They literally can decide to take your money for the year and not give you anything.

So you want a drug plan for million of american to be executed without any problems> That is of course an idealistic idea to hold, but however it is completely unrealistic. There will be problems and they will be ironed out.

 

[techs]

Originally posted by: slyedog
i have the plan D drug plan. could not be more simple to understand. when you buy the plan it tells you what medicine it will supply. if it does not cover your medicine, go to another plan. if you buy a plan, and the plan decides to quit, they have to give you a 90 day notice so you can get another plan. and the next provider has to take you. when you get to be 65 you will appreciate it

Actually you fail to mention that things on the formulary can be changed without notice. Nor how you can know what drugs you MIGHT need in the coming year. Nor any of the plans complicated benefits that change as you pay out of pocket which doesn't roll into your new plan if you change it mid year.

 

[Lemon law]

Medical services are just too vital to run on a for profit basis.

Why are we in so much trouble with the budgit---and the only major industrialised nation to
have such a for profit plan?------is this telling us something?

 

[EatSpam]

Originally posted by: Lemon law
Medical services are just too vital to run on a for profit basis.

Why are we in so much trouble with the budgit---and the only major industrialised nation to
have such a for profit plan?------is this telling us something?

America has its priorities:

#1. Invading nations in the defense of Israel and providing military contractors with major payouts.
#2. Banning gay marriage.
#3. Banning science, except when it involves bombs.
#4: Health care programs that benefit big business and generate big profits.
#1,001,311: Health care programs that benefit non-wealthy people.

 

[zendari]

Originally posted by: Lemon law
Medical services are just too vital to run on a for profit basis.

Why are we in so much trouble with the budgit---and the only major industrialised nation to
have such a for profit plan?------is this telling us something?

On the contrary. Something done for profit is something done well.

 

[Hayabusa Rider]

Originally posted by: Corn

Originally posted by: zendari
A company is upgrading a computer system and has some downtime? Ohnoes, who would have thought?

...and its gonna cause that poor old codger to have a heart attack!!


Although if I required medication to ensure I didn't croak if I missed a dose, I wouldn't wait until I ran out prior to attempting to purchase more. This isn't a failure of the drug plan, it's a failure to plan ahead--for both the geezer and the pharmacy.

The Geezer is confronted with a plan that provider's cannot fully comprehend. Pharmacists CANNOT even know what their reimbursment rate will be. No one will tell them.

And yes, this is a failure of the PROVIDER, not the pharmacy. Their site is down, and the pharmacist can't bill them anymore than you can get on OT if the servers go. It's the same thing.

If it's so simple, then why does no one here know WTF they are talking about?

 

[EatSpam]

Originally posted by: zendari

Originally posted by: Lemon law
Medical services are just too vital to run on a for profit basis.

Why are we in so much trouble with the budgit---and the only major industrialised nation to
have such a for profit plan?------is this telling us something?

On the contrary. Something done for profit is something done well.

Like Enron, and Tyco, right? And lets not forget the bang-up job that the private power companies did a couple years ago...blackout?

Drug dealers operate on a for-profit basis and you would jail them for "something done well."

 

[Hayabusa Rider]

Originally posted by: EatSpam

Originally posted by: zendari

Originally posted by: Lemon law
Medical services are just too vital to run on a for profit basis.

Why are we in so much trouble with the budgit---and the only major industrialised nation to
have such a for profit plan?------is this telling us something?

On the contrary. Something done for profit is something done well.

Like Enron, and Tyco, right? And lets not forget the bang-up job that the private power companies did a couple years ago...blackout?

Drug dealers operate on a for-profit basis and you would jail them for "something done well."

Zendari is wrong as usual, but on the other hand this Medicare plan is the result of "Govt. universal health care".

If Uncle Sam provided truely universal health care, it would be 10 times worse than the OP's post. IMO something needs be done, but to toss it to Congress means chaos.

 

[EatSpam]

Originally posted by: Hayabusa Rider

Originally posted by: EatSpam

Originally posted by: zendari

Originally posted by: Lemon law
Medical services are just too vital to run on a for profit basis.

Why are we in so much trouble with the budgit---and the only major industrialised nation to
have such a for profit plan?------is this telling us something?

On the contrary. Something done for profit is something done well.

Like Enron, and Tyco, right? And lets not forget the bang-up job that the private power companies did a couple years ago...blackout?

Drug dealers operate on a for-profit basis and you would jail them for "something done well."

Zendari is wrong as usual, but on the other hand this Medicare plan is the result of "Govt. universal health care".

If Uncle Sam provided truely universal health care, it would be 10 times worse than the OP's post. IMO something needs be done, but to toss it to Congress means chaos.

Sadly, you're right. I believe universal health care is the way to go, but I wouldn't expect those clowns in congress to come up with anything decent - or at least anything better than the for-profit mess we have now.

 

[zephyrprime]

Signing up my father for one of those medicare part D plans has been quite a problem.
1. Takes forever to get mailed the forms. I advise relying solely on the net because it's the only timely solution.
2. Never got the proof of coverage letter. But He did receive the a membership card 1 month after applying.
3. Impossible to talk to anyone on the phone. One customer service rep told me that the division that handles my dad's plan doesn't even have a phone number in the company directory.

 

[nihilaxiom]

You think its bad now trying to get through to a 'representitive" of your health care company and getting someone who understands their own policies, just wait intill those for-profit health care companies start shipping those jobs over to India ( or wherever they can find cheaper (slave) labor) and talking to someone without a full grasp of the language about your health care.

 

[EatSpam]

Originally posted by: nihilaxiom
You think its bad now trying to get through to a 'representitive" of your health care company and getting someone who understands their own policies, just wait intill those for-profit health care companies start shipping those jobs over to India ( or wherever they can find cheaper (slave) labor) and talking to someone without a full grasp of the language about your health care.

I'm honestly surprised that hasn't been the story from day 1.

 

[ericlp]

Much of the roughly $11 billion in cuts over five years proposed by the Senate for Medicaid, a health care program for the poor that many elderly use to pay nursing home costs, were recommended by state governors. They contend the program is becoming burdensome for the states, which must come up with money to match federal funding. Democrats have portrayed the reduction in the growth of Medicaid spending as dire, but even liberal analysts concede they are not severe. One provision would increase co-payments from $3 to $5, and another would allow elderly nursing home residents to shield $750,000 in home equity, raised from $500,000 after Republican moderates objected.

"It's less about the magnitude and more about why should you be asking poor people to pay anything more for health care at the same time that you're giving brand-new tax cuts to the most fortunate," Furman said. "That is what is just completely wrong with this picture.

Hmmm, tell me this isn't a failure?