In a Medicare Maze


I used to be horrified at the thought of privatizing Medicare, but now  I am not so sure. How much worse could it get? My experience with the present system has been truly bizarre.

Many moons ago, I belonged to a Medicare Advantage program called Quality Health Plans, and it went belly up. So I joined another program called Physicians United Plan (PUP). It was one of those really cheap plans – no monthly premium, minimal co-pays and so on. It seemed too good to be true, and apparently it was because two months ago it also collapsed.

As soon as I found out, I got on the web and compared various Medicare Advantage providers to see which would offer me the best deal. I settled on Coventry.

That was in mid-June and I couldn’t get enrolled until July 1, but the pharmacy assured me Medicare was paying for my prescriptions until my new plan kicked in.

It turns out that Medicare was doing no such thing. What Medicare did was hand me over to AARP.

(I know, I thought buying and selling human beings was obsolete, but apparently not.)

Imagine my surprise when I received a little coupon book from some United Health Care program. Apparently, I was now committed to paying these folks a monthly premium (I think it was $21).

I got on the phone and yelled at a United Health Care rep, but that didn’t do any good. So I mailed them the $21 under protest and told the rep to cancel my “membership.”

But that was not the end of it.

A couple of weeks ago, I got a letter from Coventry telling me that there was an “adjustment’ of $42 to my account “from my previous provider.” The letter seemed to be in some kind of code, so I was not sure what was being “adjusted” but I was relieved to note that “no payment was beng requested at this time.”

I called Coventry, and their customer service representative figured the adjustment had to do with co-pays I was expected to make during the time I was assigned (unknowingly) to AARP.

Still fuming from this outrage, I went to the pharmacy on Friday to pick up a couple of generic prescriptions. To my horror, I was told there was a co-pay of $12 and some cents.

As soon as I got home, I tried to call Coventry, and spent an hour listening to some really irritating music before I found out their Customer Service Department was closed.

After fuming all weekend, I called them this morning, and got hold of a pleasant young lady. But she couldn’t tell me what was going on. After an extended chat about my date of birth and address and so on, she told me I had to talk to someone in Pharmacy, and asked me to hold. The music was much better this time, the wait was much shorter, and the Pharmacy rep was very polite.

But she had bad news. I was in the doughnut hole.

Already? I don’t usually get in the doughnut hole till November. Where did they get their figures? From PUP?

She didn’t know anything about that. I would have to ask Customer Service. Transfer me, I pleaded.

Back at Customer Service, I talked to a nice young man, who told me that the figures came from Medicare. Coventry had no access to any figures from my previous providers.

So on to Medicare, where I eventually managed to negotiate one of those infuriating machines and get to a human voice. No, the voice said, they did not give any figures to Coventry. They have no record of my pharmacy expenditures. Only PUP would have that. And PUP no longer exists.

I was beginning to feel like the banker in Kafka’snovel.

What could I do? I could speak to a supervisor.

So I did. And the supervisor told me the same story. I was in the doughnut hole based on figures which were no longer available. So there.

Was there nothing I could do to find out more? She would refer my case to Advanced Resolutions. They would call me within two business days.

Perhaps they will be able to solve the mystery of my missing pharmacy expenditures. Or perhaps not.

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