I know that the government can’t help but be the quagmire where bureaucracy goes to die… in triplicate. But.
Why is it that, if you’re physically/mentally unable to work they think you are somehow able to navigate a complex bureaucracy of paperwork, programs and running back and forth between the pharmacy and Medicare?
Short form: This is my fault. I let my old prescription coverage (Plan D) lapse. The old plan kept sending me warnings that I needed to change my plan now that I had moved. But there were always a few dozen other fires to put out.
So then I get a prescription card from Humana. Apparently, Medicare automatically enrolled me, so I’m covered — as of July 1st. Did I mention my other coverage ran out April 30th?
It’s not too bad, though, because I’d finally gotten my act together enough to get enrolled in a new prescription plan, which will start June 1st. Only problem is that my very expensive ($400+ a month) antidepressants run out on 5/21.
So I call Medicare to find out why it bothered to automatically enroll me with a two-month gap and whether there was anything that could be done in the meanwhile.
Despite my asking repeatedly and in various forms, the question about the gap is never actually answered. But, the good news: There’s a program called LI_NET which will cover my prescriptions during the lapse. I just need to tell the pharmacist that I’m eligible.
Yet, when I do just that, I get a blank look, then something of condescension. She essentially insists she’s never heard of it, doesn’t know what it is and can only bill a specific Plan D. And when I suggest she call Medicare to ask them directly, I’m told they get all their information online. Maybe WalMart forbids 1-800 numbers?
I go back home and get on the phone with Medicare, rather panicked because I’m completely out of my meds.
Apparently, it’s a relatively new program, which is why some people won’t have heard of it. (Actually, I’ve yet to find anyone who has, and I’ve called several different pharmacies.) But the agent gives me the various numbers and information to give to WalMart.
I call that in, and quickly receive a call back that those numbers don’t work. Oh, and the phone number I was given if they had any questions? Yeah, that goes back to Humana, the plan that doesn’t start until July. Oh, and it’s the weekend so no one is in the office to offer help.
They suggest I try again on Monday and just buy a few days’ pills. I send Tim since, at this point, I’m on the verge of Effexor-lessness induced dizziness (every eye movement makes the world spin horribly) and he comes back with a four day supply. And a bill for $75.
Somehow, Monday is over in the blink of an eye without my calling WalMart. I think part of it was my utter disbelief that they’d be able to help me after all the stuff we’ve already been through.
Tuesday, I manage to call Medicare again, at least, and find out why it is the Humana info was given to me. Which, like so many other questions, never gets completely answered. But I do come away with more information on the plan.
It’s bureaucracy at its finest:
- Not all pharmacies accept LI_NET. Oh, and there’s no list of ones that do.
- If I can’t find a pharmacy that takes LI_NET, can I pay out of pocket and submit a claim? Sure… once I’m enrolled in LI_NET.
- How do I enroll in LI_NET? By getting a pharmacist to fill a prescription.
(The sound you hear is me banging my head against my desk.)
I call around, and, at CVS, find someone who takes pity on me. I think she could hear the hysteria that was creeping into my voice. She asks more about the program — which prompts me to start crying somewhere around the “I can’t put in a claim until I’m enrolled” point.
She assures me that there’s no reason to cry — clearly, she’s never been a depressive without her meds — and tells me we’ll work together. It takes a few attempts but, sure enough, she gets it to work. And in about 90 minutes or so, I should be able to pick up my prescriptions.
All it took was three 20-minute calls to Medicare, two trips and a phone call to WalMart, $75 in meds to tide me over, calls to three other pharmacies and a 10-minute call to CVS walking a pharmacist through the information. (And a partridge in a pear tree.)