by Dick Hall-Sizemore
I just had an experience that illustrates the bewildering complexity of the finances of the American health care system.
Yesterday, I had a colonoscopy. I’m a veteran of this procedure, having had several because there is a history of colon cancer in my family. (No polyps this time, by the way.)
The protocol for the dreaded “prep” time has changed. No longer does the patient have to consume a gallon or two of sickening sweet liquid (others who have had this procedure know what I am talking about). Now, one has to take 24 pills in two stages between 6 p.m. the night before and 6 a.m. the day of the procedure, along with a lot of water.
Under my Medicare Part D prescription drug coverage, the pills would have cost me about $150. However, my doctor gave me a coupon from the pharmaceutical company, with which the pills cost me $40. To use this coupon, I had to go online and activate it. As part of the activation, I had to certify that I had Medicare Part D insurance, agree not to seek reimbursement from Medicare or a Medicare Advantage prescription plan for any out-of-pocket expenses in purchasing the drug, agree not to count the cost of the drug toward my deductible, and notify my prescription plan that I have purchased the drug outside of my plan benefit.
In summary, I was eligible for the reduced cost if had Medicare and a prescription plan, but I could not use that prescription plan to get the lower cost. In what world is this a sane way to run a health care system?