Monday, May 08, 2006

Insurance Doesn't Mean Assurance

I spent over 30 minutes today, arguing on the phone with a patient’s insurance company, then his pharmacy.

The patient has a cough; he is also allergic to codeine. The only effective cough suppressant that doesn’t contain codeine is excluded by Medicare as “a drug we don’t feel like paying for.” Imagine, they paid for Viagra, but cough meds? Those are insignificant, right?

Anyway, I had to call Medicare Part D’s subcontractor (insert long impassioned rant against automated phone answering systems, on hold music, the lack of on hold music, automated reassurances that my call is very important which is ironic since if it were very important I wouldn’t BE ON HOLD!!!!!!), and get them to tell me it was excluded. Then I have to call the pharmacy back and get them to apply for a TAR (I actually have no idea what that stands for. What it means is “we’ll get Medi-Cal to pay”) for the medication. The pharmacy-boy gives me static at this point.

Boy: “Why can’t she just have Robitussin?”
Me: “That’s not a prescription drug.”
Boy: “No, but Medicare pays for it.”
I count to ten, twice, slowly, in French.
Me: “Put in a TAR for the Rx, please, now.”
Boy: “Okay, but…”
Me: “Now.”
Boy: “Okay.”
Me: “Thank you.”

Set phone down with exaggerated care. Pound head against desk until floaty red stars obscure vision. Pick up next chart, repeat.

Actually, the next chart is someone who got the wrong prescription filled, and will now run out twice as fast. The insurance companies dole pills out per day, now, and if your scrip is wrong, you just might end up paying out of pocket, because your insurance company will not cover any deviation from what’s written on the paper. Even if you write them a new prescription, they won’t give the person enough pills to make up the difference for this month.

This isn’t a big deal if your med is cheap. If it’s not, I hope you have a savings account.

Incidentally, on NPR the other morning, I heard the head of some health agency in Seattle say, “In case of natural disaster, everyone should have 90 days of their medications stockpiled.”

Oh, really? So…you’re going to use your position to fight the insurance companies/Medicare who won’t cover “stockpile overrides”? Or are you saying only rich people should be able to have medications during a natural disaster? We should expect a blanket declaration of same to emerge from your office, when? You will lean on your colleagues in other states to enact such policies as well?

This will at some point devolve upon me, of course, because I will have to fill out the inevitable paperwork to apply for the overrides, track them, and solve potential override problems.

It’s like being nibbled to death by worms. Every month, there’s one more piece of paperwork for one more thing, multiplied by X hundred patients. Track this, document that, write this stuff down, keep record of that. Yes, each phone call is less than five minutes. We have over 800 Medicare patients. If I make one five minute call for each of them, that’s 66 hours. Did I mention Medicare doesn’t pay us for phone calls?

I know, everyone’s job sucks. But damn, there are so many enjoyable parts to my job that it makes me sad I don’t enjoy them as much because they are so often overshadowed by Medicare/insurance company shenanigans.

I spent 30 minutes on the phone with an insurance company today…I hope you didn’t.

Monday, May 01, 2006

Where Have All the Comics Gone?

“I am appalled at the latest [insert outrage] out of the Bush Administration!”

Actually, I’m not. It has gotten so bad that my Outrage-ifier broke. The most I can muster now is brief rants followed by long periods of apathy and brownie consumption. I really should buy stock in dairy conglomerates and Hershey.

I mean, really. Mark Russell has taken the red white and blue bunting off his grand piano. He now probably spends his time playing the accordion naked in the French Riviera in midwinter. Political comedy has finally been downsized by Washington.

It’s impossible to satirize what’s going on. You may have wondered why I’d gotten all insipid and introspective. Frankly, contemplating my belly button is far preferable to contemplating the state of politics, today. (Well, it was until now.)

When George Clooney makes more consistent, reasonable, and useful statements than the fracking Vice President, I despair of ever finding another H.L. Mencken. Hell, another Winston Churchill would be nice.

I think we’re too self-righteous a nation, now, for Jonathan Swift’s Irish infantile culinary suggestions. I have yet to see an actual example of an “I escaped from the World Trade Center and all I got was this lousy T-shirt” t-shirt. That’s too “edgy” now. We’re barely dealing with “What Would Jesus Drive?” (And what color wristbands would he wear, of course. Curse you, Lance Armstrong for starting the latest wave of tacky, petroleum product fashion accessory to sweep the globe.)

We can’t live in the middle ground where watching someone’s pain can be funny, because it’s your pain, too. No, we don’t acknowledge that other people have needs anymore. Anything someone else wants that isn’t what I want, is persecution! Of me, naturally. Affirmative action is persecution of whites, education is slanted against boys, and atheists persecute Christians by simply existing, as far as I have been able to tell.

It’s really too bad the phrase “Me Generation” has already been used. I’d vote for the “Solipsistically Me and Only Me (and possibly my dog) Generation” but it’s too long. “Everyone But Me Should Die in a Fire” captures the proper angst, but again, too lengthy.

See how hard it is to do quality comedy with this material? It’s like trying to make nitroglycerin out of crude oil and wet beach sand.

I think the political system in this country is systematically shortchanging its citizens of quality comedians, by appropriating and mishandling the delicate work of satire, sarcasm, and gallows humor.

Okay, now I’m finally appalled. It feels unfamiliar, but good. I think I shall toddle off to explore some other long-unfelt emotions such as schadenfreude, weltschmertz, and Guinness-lieben.