New Insurance.....

When Babygirl turned 18, we applied for disability for her.  Now, most people under are turned down as a matter of course on the first try, but...If you fail the vision test, and add in all the rest of her struggles, I guess you qualify.  Because she is over 18, this gets her a small income of her own, and, because she is over 18, it makes her officially "poor."  So, after some difficulty with the system, she qualified for Medicaid, supplementing our private insurance.  The problem is, Medicaid is state-based, so it covered anything here in OUR state, but not her out-of-state care, which was, until recently, the majority of what really cost the most.  Even her transplant medications, since they were written by out-of-state providers, were only covered on OUR insurance, not her Medicaid, so her co-payments and deductables remained unchanged, and high.  If it had been all on her, it would have taken half or more of her disability income to pay for it.

But, after two years on disability, one becomes eligable for Medicare (we "Aid" the poor, we "Care" for the elderly and disabled).  So, suddenly, she got a Medicare card (which we had, temporarily, when she was on dialysis.  We apparently also "Care" for those in renal failure.)  But when you qualify for both Medicare AND Medicaid, interesting things happen. 

First, let me explain Medicare. Medicare has 4 parts.  Part A covers 80% of your hospital stays, and everybody over 65 automatically gets this.  This is, by itself, crappy insurance.  It won't pay your doctor, or your medications, and, if you are in the hospital for 2 days and get a $10,000 hospital bill you will owe $2000.  Multiply THAT times a few more days. 

Part B covers doctor's visits, or at least part of them.

Part C covers home health care/PT/ and some other miscellaneous things.

Part D covers prescriptions, or part of them.

Parts B, C, and D have to be purchased by the consumer.   Yes, YOU have to pay for them.

Now, there are some reasonable plans out there, and there are price breaks based on income.  And if you qualify for Medicaid, then Medicaid will buy your B and D plans (although they may cut a deal with the cheapest, meanest most Satanic insurance company ever to make a dime off your Granny's back, but hey, poor people shouldn't complain, right?).

So, Babygirl has new insurance, and we didn't get an up-front choice as to which Satanic flavor she got. And by some clerical error, we never got a prescription card.  So we just kept going to our pharmacy and using my insurance, until I our pharmacy about her new plan.  Horrified faces.  Apparently we've been committing some sort of fraud.....

So we finally got ahold of the new plan. And it turns out, according to the witless wonder that we spoke to, that her transplant medications are considered a hospital benefit and not a prescription benefit so we have to change pharmacies, because ours doesn't bill Medicare B, only D.

So, we have the new transplant team send new prescriptions to CVS, who have assured us that they bill Medicare B.  We have 5 transplant related prescriptions.  I get a call from the new pharmacy that 2 need to be ordered and they will let us know when they are in.  A few days later I get a text that 2 prescriptions are ready.  This repeats a couple days later.  But since I'm waiting on 5 prescriptions, I just sit tight.

Then, a phone call:  "Are you coming to pick up those 2 prescriptions or do you want them delivered?" I asked about the others, and the woman said, "Oh, look, there are more, but they were filed. I can get those filled in 15 minutes." 

Babygirl and I put a dog on a leash and walked a mile to the pharmacy.  She waited outside. And waited.  And WAITED. 

One prescription was ready, 90 day supply. One of the ones that needed to be ordered STILL needed to be ordered, would tomorrow be okay? The other one that needed to be ordered ALSO still needed to be ordered, but was out of stock, so they couldn't order it. They had 70 out of 90  days available, if they used 3 different manufacturers. Was that okay? The fourth had a 22 day supply in it, for no reason that anyone could determine, and they had to re-do it to make a full 90 day supply, would I mind waiting?  I completely forgot at that point that there was supposed to be a 5th medication.  I have to check on that when I go to pick  up the remaining bottle. 

What. A. Cluster.  We are in the middle of the Zombie Apocolypse. Avoiding people is the name of the game here. I was the only person in the store when I got there, and FIVE sets of people came and went for prescriptions while all this was going on.  If I had accepted home delivery, the whole order would have arrived a complete mess with no explanation, and ...... do I stick with these yahoos or start over somewhere else???? Oh my dear Lord.

Oh, and despite the fact that I was assured by Babygirls's Medicare D plan that they DO NOT cover her transplant meds, THEY FRICKIN paid for them.  Not the B, but the D.  So, does that mean I can go back to my regular pharmacy???????

And Babygirl's response to all this was classic, polite, optimistic Babygirl:  "Well, they got ONE of them right!"

That's a low bar, Babygirl.  A really LOW bar. LOL

DeeDee