April 10, 2012: Time To Make the Donut Holes

            Today I was yet again reminded that American health care is mostly a pile of steaming crap that places profit ahead of the well-being of withering old women and men.

            This morning I stopped at the pharmacy on my way to my folks’ to pick up this week’s pile of prescriptions, and the bill, which is usually about 50 bucks, was $936.77. That’s because one of my mother’s pills costs about a thousand dollars for a one-month supply. Periodically, my parents’ Medicare Plan B, the part of their insurance that covers prescriptive drugs, goes into what’s called “a coverage gap” or, more commonly, a “donut hole.” (Yes, really.) That means their insurance stops paying the co-pay on drugs for several weeks, until Mom and Dad have spent a couple thousands of dollars in cash. Then the insurance magically resumes its job of paying for stuff again.

            They do this to be mean, the insurance companies. And because they can. We’re at their mercy, and they like giving us the finger every once in awhile. But, hey! Don’t think for a minute that we need health care reform in this country! What are you, a Communist?

            After getting my parents dressed and fed, I phoned AstraZeneca, which sounds like a character in a Godzilla film but is in fact the manufacturer of Seroquel, the super-expensive medicine my Mom takes. Last year, I jumped through a couple hundred fiery hoops in order to qualify Mom for AstraZeneca’s one-time freebie program, which pays for Seroquel while patients are in a donut hole. It took several weeks to get all the forms filled out and the half-dozen medical reports collected and the social worker’s mental health assessment completed, and once I did and got them all faxed over to Astrazenaca, my mother was no longer in a donut hole and didn’t need the free pills anymore.

            “That’s okay,” the guy at Astrazenaca told me when I called to complain last year. “Now that your mother has qualified for our program, you can just call us next time she goes into a donut hole, and we’ll send her a voucher for free Seroquel.”

            So I did, this morning. And a man named Dave looked up my mother’s account and said, “Yes, she qualified last year, in March. But it’s April, and so her qualification has expired.”

“You mean,” I said to Dave, “that I’ll have to fill out the paperwork, and get a new mental health assessment, and drive around collecting medical records, all over again? Because by the time I complete all this horse crap, which I’ve already done once, it’ll be just like last year: She won’t need your free pills anymore, because she’ll be out of her coverage gap.”

Dave sounded sympathetic. “I know,” he said. “We get that a lot.”

It was barely 9:30 in the morning, and I’d already had a full day—already spent 45 minutes explaining to my mother that she did not, in fact, have to meet with the Canasta club she’d quit five years ago; already cleaned up shit off the bathroom floor and juice off the kitchen floor and argued with the daycare secretary about the dosing of my mother’s daytime pills and phoned the cardiologist about the fact that he did, in fact, have to call the phlebotomist to get the results of my dad’s bloodwork, because I’d just called the phlebotomist and she reminded me that she doesn’t give out test results, the doctor does.

And so, despite the fact that Dave sounded nice and although I knew it wasn’t his fault that health care is a fucked-up racket designed to rob sick people and piss off already-exhausted caregivers, I told him exactly how I felt.

“Dave,” I said to him, “blow it out your goddam donut hole.”

And then I hung up.

I got mine, though. A few minutes later, my father brought me yesterday’s mail. Among the Fingerhut catalogs and AARP circulars was a fat manila envelope from my parents’ extended care insurance policy, with which I recently opened a claim for some home health care services. Inside the envelope were two 16-page questionnaires to fill out, one for each of my parents.

“Please attach the patient’s most recent mental health assessment,” the cover letter read. “Also copies of your most recent physical examinations from your general practitioner, including chest x-ray and/or TB test results.”

In other words: “Blow it out your donut hole, Pela.”

 Thing I Hate Today: Dull knives


5 Responses

  1. Mr Pela,
    The LA Times recently did a story on the benefits of meditation on people with dementia/Alzheimers and their caregivers, in particular the one I have been doing since January 1st; Kirtan Kriya. You should look it up.

  2. Sucks. Balls. Or holes, I suppose.

  3. I have such major sympathy for you that I can’t even stand it. I don’t know if the above commentor is serious, but in this case, I don’t think meditation is going to cut it.

  4. Unfair – grossly unfair circumstances, dear author. I attend to my kids and all of their medical, mental health and poop cleaning needs — but I brought all that on my self and believe accordingly that I have some parameters on bitching rights. Parental care obligations are a bonus for which we did not sign up. I am, therefore, in awe of your having directed your completely justifiable frustrations into merely blasting one “fucked up racket” representative and channelling the rest of your pissed off energy into this blog instead of any number of far worse emotional explosions. Congratulations on rising to the occasion with your folks. I hope I can be as present, helpful, and constructive with my own parents’ care as they become idiots in diapers (not calling your parents idiots, mind you, just acknowledging the possibility in my own family).

  5. I never truely appreciated health care coverage until I didn’t have any! That lasted for 2 years. At 65, I am giddy with the delight of visiting a doctor!

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