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post #1 of 15 (permalink) Old 12-11-2006, 05:36 PM Thread Starter
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Medicare Part D

Anyone out there eligible or do you have elderly parents who are? The Part D prescription drug benefit is a classic example of what results when our politicians get their fingers out of their noses long enough to hold a microphone and shuffle papers (but leave their heads somewhere it's too dark to read). I used to practice law and while my specialty involved statutory law and regulations, Part D remains a befuddled mess.

One of my favorite parts: if you didn't sign up in time, you're penalized -- forever -- when you do sign up.

For those of you who think socialized medicine is the answer in the US, I say just look at what a complete mess medicare/medicaid are and then imagine similiar rules and regs for 4 times as many people.

Of course, if you come to this country illegally you can go to an emergency room and get treated for free. The worst that might happen is you'd be deported, but even that is unlikely, and you can always return illegally.

Attached is a pretty good cartoon, however...
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Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy; its inherent virtue is the equal sharing of misery. (Winston Churchill)
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post #2 of 15 (permalink) Old 12-11-2006, 05:40 PM
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Well, you can catch your death in that cold, cold river. If we set up a ferry service, maybe they wouldn't get so sick.....DUH!

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post #3 of 15 (permalink) Old 12-11-2006, 05:41 PM
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Well, you can catch your death in that cold, cold river.

Rio Grande ain't that cold. I should know.
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post #4 of 15 (permalink) Old 12-11-2006, 05:48 PM
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Oh, god--don't get me started. The hell we go through at work trying to get coverage for Part D patients! It's just about useless for most of the participants because of that big black hole and it doesn't pay for supplies, so if the patient needs IV meds, they have to foot the bill for all the tubing, dressing changes, gloves, valves, etc. The worst part is that companies give patients with no coverage the shaft when it comes to billing. Example: an IV pole costs my employer $6 who then charges a private pay patient $65.
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post #5 of 15 (permalink) Old 12-11-2006, 05:51 PM Thread Starter
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Originally Posted by Jillian80
Oh, god--don't get me started. The hell we go through at work trying to get coverage for Part D patients! It's just about useless for most of the participants because of that big black hole and it doesn't pay for supplies, so if the patient needs IV meds, they have to foot the bill for all the tubing, dressing changes, gloves, valves, etc. The worst part is that companies give patients with no coverage the shaft when it comes to billing. Example: an IV pole costs my employer $6 who then charges a private pay patient $65.
Uh, oh.

Now we know two things about Jilly... (1) What she does for a living and (2) why she's so easily able to get medical "hemp".

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post #6 of 15 (permalink) Old 12-11-2006, 06:00 PM
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Originally Posted by Jillian80
The worst part is that companies give patients with no coverage the shaft when it comes to billing. Example: an IV pole costs my employer $6 who then charges a private pay patient $65.
That has REALLY pissed me off for years. What I don't get is seeing as the insurance companies do not pay those prices but instead wheel and deal on a final cost, why doesn't the industry just reduce their insanely overinflated prices to accommodate those with no insurance? Their whining about losing money on the indigent has become banal and tiresome.

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post #7 of 15 (permalink) Old 12-11-2006, 06:02 PM
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Uh, oh.

why she's so easily able to get medical "hemp".
I wish....uh....for my cataracts, you know.
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post #8 of 15 (permalink) Old 12-11-2006, 06:04 PM
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Angry

I was selling Medicare last year during the initial breakout of the Part D. I'd never heard so many seniors swear and call me names like I invented it.

Even worse is what's called Medi-Medi - those who are on Medical and Medicaid.

If people take medication that the retail cost exceeds $5600 annually, the Part D works for them. Most - it just sucks.

Although this is a simplified diagram, it's the basic outline of how it works.

Let's say someone has 4 prescriptions (2 Generic and 2 Brand Name)
The Brand RX cost $250.00 Retail each, with a $20 co-pay
The Generic cost $125.00 Retail each, with a $5 co-pay

We would pay $50 a month for the meds. The insurance company is tracking the retail cost. Once that cost reaches $2000, we're on our own. So in this example, after 2.6 months, we've hit our $2000 limit, even though we've only spent about $120 in co-pay.

Now, we're on our own for the following $3600.00 (warning - people are being told that it's $1600 (3600 minus the initial 2000) which is wrong. So, we take our $3600 out of pocket obligation, minus the initial co-pays and are left with an obligation of $3480 worth of meds. After that (even though most people never exceed that number), the insurance kicks in again and we're back to co-pays.

yes... it almost requires a slide rule. This is a very simplified explanation. Most insurance brokers don't fully understand. When I was being trained in this, even the government appointed instructor had to double check the math.

I had one woman in her 90's actually say "I wish someone would assassinate that bastard". Part D is on the same anger scale as closing the all-you-can-eat buffet. I always recommended that when they're in the black out period, go to Costco. You don't have to be a member and the prices are cheaper than anywhere else. Stores set the price - not the pharmaceutical companies.
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post #9 of 15 (permalink) Old 12-11-2006, 06:11 PM
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Originally Posted by ThrillKill
That has REALLY pissed me off for years. What I don't get is seeing as the insurance companies do not pay those prices but instead wheel and deal on a final cost, why doesn't the industry just reduce their insanely overinflated prices to accommodate those with no insurance? Their whining about losing money on the indigent has become banal and tiresome.
Our contracted rates are really shitty sometimes, though. We might get average wholesale price (AWP) minus 15% for a drug and a low per diem for supplies from the insurance company, but have to pay our distributor AWP minus 17%, so the margin is really tight. Add packaging and delivery costs, etc. to that and you don't end up with much. Maybe that's why they try to squeeze so much extra from the private pay folks.

It really is shameful.


But it keeps my wage up.
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post #10 of 15 (permalink) Old 12-11-2006, 07:00 PM
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I'm gonna put an initiative on the ballot to allow British Columbia to annex Warshington State. We desperately need a functioning healthcare system up here.

Bye bye, suckers!
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