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  • Writer's pictureJane Rubin

My Medicare Nightmare

Updated: Mar 8, 2023

It’s taken six months for me to write this episode. By far, it was my most mind-blowing, nerve-wracking misadventure this year. Once resolved, I had to put it out of my mind because it made me physically sick to relive it. I could barely tell others because it stirred up so much anxiety that I hated to torture myself and friends over and over again. But, with open enrollment around the corner, I know I need to tell my story.

Like all virgin Medicare subscribers who chose not to use professional assistance, I consulted my friends who had traveled the road before me and listened carefully to their advice. There are many choices to make and it is critically important to be very careful. Remember that line, “be very careful” - should serve as a word of caution.

At first, I did just that. I signed up for my three plans: Medicare, the Part B Supplement and the Pharmacy Supplement. I did this all on line. Medicare, unable to handle all of the insurance matters in-house, has relationships with private insurers to handle the day to day matters - and they must follow Medicare’s guidelines for reimbursement etc. So, the supplements are frequently handled by an intermediary - in my case, United Healthcare.

Each plan mailed its respective paperwork to me with options to have the insurer take money from my account or pay with a voucher book. My personal preference was to program my online banking account to pay my monthly premiums, leaving the control in my hands. Having worked for a big organization, I was terribly spoiled as they did all of this for me and also deducted my premium contribution from my biweekly paycheck. As a retiree, we all handle this insurance on an individual basis - it can be a dizzying amount of paperwork especially if you regularly rely on medical care.

It is important to share at this point, that I have ovarian cancer. Luckily, it has been successfully managed as a chronic condition. I take a drug with a retail price of over $12,000/month. Of course, this is not what it actually costs to manufacture, but with so many different contracts the manufacturer has with Medicare and other private insurance companies, this is what they charge if you try to purchase it on an individual basis (with prescription of course).

Back to the saga and to the killer part of the story.

Both my Part B supplement and Prescription supplement were handled by United Healthcare. At first, I put both payers into my online checking, but somehow, before I switched to autopay, I began paying both premiums to the Part B box number - my error. I received a letter from United that they had not received my payment. I went back and checked and saw the payments in my checking history and assumed it was a timing error. A few weeks later, they discontinued my prescription plan.

Numerous phone calls were made, United stood behind their so-called policy that if the payment is made to the incorrect box number, it did not count toward the correct box even within their own company. The Part B agent was aghast that the prescription side would refuse to accept her transfer as proper payment, she had never heard of such a thing. I could not believe that the different divisions could not simply transfer the on time payments into the correct account and reinstate the plan - the United representative was willing to take the transfer but would not count it as a timely payment and would not permit me to either speak to a manager or file an appeal. Subsequent calls led to the same results. I was shut out. And I even called the mediator at Medicare who was entirely unhelpful.

I began looking for an attorney to represent me and also reached out to the manufacturer to see if I qualified for a discount, but with my husband working, our household income exceeded the cost of a full year of retail cost - we did not qualify. I began considering martyrdom as a better option than shelling out that kind of dough! At least I would die making a stand. I’d show them!

In the meantime, my husband, a much more level headed soul, suggested I reach back into my many healthcare contacts to see if anyone could help me connect with a more senior level decision maker. Long story short, that did the trick. I have now resolved the issue (with effusive apologies from the United Healthcare appeals department who reviewed the documented interactions with the front line individuals and firmly stated that they were not following United’s procedure), my policy was reinstated, and now I scrupulously make my payments each month two weeks ahead of their due date. I have a feeling deep down, that the front line was thrown under the bus and United simply did not want to shell out the dough for such an expensive drug. But, I am a bit jaded and will never really know the truth.

Fixing this awful nightmare came down to connections. I believe if I had proceeded with an attorney, I may have gotten this resolved and it would have made an interesting 6:00 News story as well. But the emotional capital to do all that overwhelmed my fragile spirit. The best news of all, is that I did not have to die on that hill - and the drug still seems to work for me. I also probably had a few more bourbons that I ordinarily would have during those two and one half months.

So take my experience as a cautionary tale and be very careful to select what you need and make sure that your payments are solidly in order.

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