Wow! Is the Medical Community Totally Insane?

It is truly remarkable how many hours, weeks, months I spent on trying to sort through items related to my husband’s medical condition. Because my husband Jim cannot talk or use his hands easily, I am the person who needs to answer questions, fill out forms, call (endlessly) for help, clarification, follow-up, etc. etc. Every time there is a new bill or form that comes in the mail, my heart sinks. Not only is it depressing, but it is so daunting, energy-draining, and frustrating (to say the least). My latest months-long adventure has been so unbelievable that I needed to share it with you.

 
To make a very long story short, when Jim went on long-term disability we were forced to go on Medicare. We still have our private insurance, which now is considered secondary, and we still pay the same amount of money for the policy (it hasn’t gone done even though we now have Medicare as primary). Well, the complications, pains, and frustrations that come with this change of status is mind-blowing. Everything takes forever and the rules with what “you didn’t have to pay for before” and “sorry, you now have to pay for” make no sense (and it is always changing so I can’t even try to figure it out).

 
A year ago Jim was rushed to the emergency room – a scary time that fortunately turned out to be only a scare. While Jim was there, he had a chest x-ray, received some medication for anxiety, got rehydrated and took some Combivent – basically the inhalers that many people take who have breathing problems such as asthma. After the visit, the bills came, the explanation of benefits, the names of physicians on forms that we never met, items to be tended to in general.  Back and forth things went with the hospital, us, Medicare, the private insurance company. I never knew what was happening, had to make countless phone calls, and wait on things to be mailed to me. Medicare couldn’t send things directly to the hospital or the insurance company because apparently they had done it already and the rule says “only to the patient” after that. So more weeks went by, more months…

 
A year later (yes, a YEAR!) I am finally thinking I have things figured out – got my new letters from Medicare, etc. – and I called the hospital. Speaking to a very kind woman, she tells me the balance on our account is now $0. I was so relieved. I still didn’t really understand what had happened, but I decided not to press my luck and just go with it. Then she tells me the problem was over Medicare’s new rules about self-administered drugs. Anything that is placed in your eyes, nose, mouth, or ears is considered self-administered and Medicare won’t pay for it (and by default, our private secondary insurance doesn’t pick it up either).

 
My obvious next question was “What did Jim get that was self-administered?” She told me she couldn’t tell me on the phone, but that she could mail me the summary sheet of all the expenses Jim tallied up on that visit. The itemized summary came days later (something I had never seen in the year of trying to sort this out – point interesting in and of itself). The price day of the self-administered drug was $1,559. When I looked to see what it was it said “ipratropium albuterol sulfate”. I googled this and was absolutely, totally, and completed stunned. It is Combivent (“puffers” or “inhalers” as many people call it). I have a copay of $60 on this when I pick it up at the pharmacy. The hospital was charging close to $1600 for the two or three puffs they gave Jim when he was in the hospital.

 
Unfortunately this is not an isolated event.  I continue to be amazed at the illogical, constantly changing the rules, and “make it as hard for the patient as possible” attitude that I encounter.  I do believe the healthcare industry has gone completely mad. How can a $1600 two puff inhaler charge be justified or explained? It is not logical. It is definitely crazy.

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3 responses to this post.

  1. Posted by Tessa McCall on April 29, 2013 at 9:42 pm

    And completely a scam invented by the new main stay of American Economy. This is what keeps this country alive – Medical. Just drive down one street and count how many doctors’ offices there are. Then comes lyme disease. The big fat lie that noone wants to admit is true because …. you guessed it MONEY. Disgusting and sickening all in one.

    Reply

  2. I can never understand the US Medicare…*sigh*. It seemed to be adding up more stress to already stressed out patients and their family. Greatly admire the health care of Canada. My friend, who lives there says it’s a blessing.
    I pray that all goes well for you and your family.

    Reply

  3. It does seem very confusing in general. I always wonder why things can’t be simplified. Perhaps my ever optimistic view on things?

    Reply

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