Just when I thought I could not be surprised at how petty and annoying the insurance companies and Medicare could be, they prove me wrong.
I saw a patient today who has been taking a medications called lisinopril. It is a blood pressure medicine he has used for years. It can not only lower blood pressure, but can also help the heart, and protect the kidney from diabetes. Because he has both diabetes and heart disease, he needs to be on this drug. It has been generic for quite a long time. In our practice, we can get it for about 2 cents per pill. A year’s worth of this medication wholesales for less than $8 per year.
My patient was a bit upset and confused because he had just received a letter from his Medicare Part D insurance carrier, which is responsible for covering his medications. I have read it many times, and I am still not sure what it means. (Please see below). While it does not say that the medication will not be covered by his insurance, it certainly uses language that we usually see in a denial letter. We are not sure what to think. It said that if you have any questions to call 1-800-MEDICARE. We didn’t because we didn’t have 10 hours to waste on hold, only to be given an answer that is probably wrong. (According to a recent study by the Inspector General, they give the wrong advice about their own programs almost half the time.)
We decided to take the matter into our own hands. I provided him with a 90 day supply of the medicine from our stock for less money than he would have paid for it at Walmart. I did something radical. I took care of my patient’s needs in a straightforward manner without asking the government or an insurance company for permission. The dirty secret is that it cost him and the taxpayers a lot less than if we had begged for permission. In fact, I would not be surprised if the whole process of sending out that confusing letter cost more than if they had just filled his prescription in the first place.
Michael A. Ciampi, M.D.
(Disclaimer: Because I have opted out of Medicare, any of my Medicare patients must sign a private contract with me acknowledging that they cannot be reimbursed by the government, but they can use their Medicare for any covered services other than those that I provide. I put this out there just in case Big Brother is reading this.)