A DAY OF RECKONING

I’ve been fighting to get MassAdvantage to work with us rather than against us. We are their customers, people who use their doctors and hospital who they enlisted in this plan.

This isn’t a national or even regional plan. It’s aimed at us, at retired people living in an area where medical plans are limited, doctors are scarce, and you’re lucky if there is a single full-service medical facility available. Despite this, they preyed on us like any common scammer.

Today, I threw in the towel and disenrolled.

Until I called Medicare, I didn’t know I had the option to disenroll. I thought I was stuck with them for the rest of the year. After telling Medicare what they’d done and having them tell me this was a really bad plan with a bad formulary, they said I had until March 31st to dump them and enroll in something better. Which he strongly recommended I do. I’m pretty sure they will never get a recommendation from Medicare.

I didn’t go looking for them. They came to us because we are in their database. They know we use their doctors and hospital. We are linked to them through their medical app. To get me to even talk to them, they had to do some heavy solicitation. Finally, I gave them a call.

A+ for sales pitch. F for the plan.

By joining them, we would be saving $86 per month — the price of the BlueCross plan we had before.

It sounds stupid but I still expect people to do the right thing. Against all odds, I believe most folks are basically decent. I should know better, but I (obviously) don’t. I feel like an idiot. And I feel betrayed

MassAdvantage exceeded my worst expectations. That’s hard to do considering how little I expect.

In the five weeks since I became a client of MassAdvantage, they have made me doubt I could survive a year under their “care.” The amount of money they were going to charge me for each medication vastly exceeds the monthly bill from BlueCross. What was supposed to save us money was going to cost us more. I would, in short order, be one of those people trying to decide whether to eat or get medications I need. No one should be forced to make that choice.

This kind of fighting is exhausting. Today, all I wanted to do was sleep. As I was ready to go back to bed, someone called to tell me one of the medications — something available since I was a child in elementary school — would now be available to me as a TIER 5. Of course, only after I paid a $300 deductible –applicable only to tier 4 and higher medications.

This probably explains why they’ve done it this way. It is, in the end, all about the bottom line. After I mortgaged my soul for the deductible, I could pay another $90 for 90 days for a drug that in December cost me $24 for 90 days. They seemed to feel I should thank them. Wow.

I hung up. Virtual smoke was coming out of my ears.

I called back to try to talk to a supervisor. Every supervisor was in a meeting. Every single supervisor. Okay, then.

I’d had enough. I called Medicare. They took a look at MassAdvantage‘s setup, he said “It’s a bad plan. Also, brand new so there are no reviews. Nothing to go by.” I explained that, stupid though it now sounded, I thought MassAdvantage would make an effort to be a good plan for the often neglected residents of Worcester county. We could use a good locally-based plan.

Instead, they farmed out pharmaceuticals to some Alabama company who took old, generic medications and jacked them up to tiers 4 and 5, way above their actual list prices which are already excessive. This battle to get necessary medicine is cruel and humiliating. NO ONE should have to beg for survival medications. Other countries set maximum costs for drugs, but the U.S., the richest country of all, refuses.

In this country, we don’t protect people. We protect corporations. Does anyone genuinely believe Big Pharma needs protection more than elderly people trying to survive on fixed incomes?

We’re back with BlueCross. It’s not perfect. They are better than anyone else and they understand health and health-related problems, but it’s still an insurance company. We should not be using insurance companies as our only health care option. We need a national health service with the option of joining a plan to get better benefits. Like they do in Israel and Switzerland. The result in both countries is the best of both worlds. As it stands now, we are being held for ransom. People die because of our terrible system. People die because they can’t afford medications or even a trip to the emergency room. Not just old people. Children and working parents too. We all live in peril due to healthcare unavailable to millions of Americans.

Shame on our government, and a special load of shame on Republicans who keep trying their best to make what is already bad even worse. These deaths are on their hands.

 



Categories: Anecdote, Customer Service, Health, Heart, Medical, Medicare, medication

Tags: , , , , ,

15 replies

  1. I said I’d/we’d try it for a year, and if we don’t die at their hands by open enrollment in the Fall of 2022, we’re going back to Blue Cross.

    I called their alleged “customer service” for weeks and everyone was so kind, as was I. MassAdvantage was not paying claims for my husband’s Continuous Glucose Monitor and insulin pump supplies because the suppliers were not on MassAdvantage’s “preferred” list. I got no where for 2 weeks until I finally spoke to a supervisor who really tried to help. On the eve of Memorial Day weekend, their VP of Clinical Operations called at 8:45 PM. By the time our story got kicked up to her, they thought we couldn’t get insulin and she was calling to avoid a neglect complaint.

    I’m writing this on 4th of July weekend. We have yet to receive CGM or pump components. To no one’s surprise we’re not renewing.

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    • They were really bad. All my generic drugs costs at least twice as much and often, more than list price and they didn’t cover anything. Absolutely the WORST provider I’ve ever had — even worse than Fallon and that’s saying something!

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  2. I’m sorry you had to go through this but I hope by sharing your experience others will avoid this company. Whenever I read something like this I am more grateful than ever for our wonderful National Health Service. It’s not perfect (waiting lists for non-urgent procedures are horrendous right now) but it’s free so no one has to chose between essential drugs and food! Yes, those who afford it can opt out and pay for private treatments, or take out insurance to cover the costs of those, but no one is forced to pay other than a few pounds per prescription (a standard fee regardless of the cost the drug). And retired people like me get their prescriptions for free.

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    • I don’t understand how we don’t have a sensible medical system. It’s embarrassing from a national point of view and it’s lethal to many people who get lost in the system. Considering how many problems I have navigating it, I can’t begin to imagine how bad this is for someone who is just a wee bit more confused about computers and telephones — and long, long hold times.

      We absolutely SHOULD have a system. No one has ever been able to give me a sensible answer as to why we don’t.

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  3. The world is such now; as I had heard somewhere the K curve, rich getting richer and poor getting poorer. All over the world it is the corporations that are being protected and not the citizens. It is a shame.

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  4. I am relieved that you were able to get out of a bad plan but sorry you had to suffer so much at their hands. You would think that your local hospital group would be able to do better than that for those that need affordable health care. They obviously make their money by nickel and diming all the things that were included in your old plan.

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    • They farmed out the pharmaceutical portion of the plan to some group down south which is obviously run by accountants, not medical people. The funny part of this — if you could call it funny — is that I’m betting the hospital isn’t making any money from the pharma area. It’s all going to that group in Alabama.

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  5. I think you did right. I hope these people give you less trouble.

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    • Blue Cross is fine. We were with them for four years. I just thought it would be nice to get a good group working that’s local. All our doctors are associated with UMass (University of Massachusetts Hospital and Medical Campus) and we aren’t going to change any of our doctors. Just going back to the plan we had before. There are better ways to deal with medical stuff, but we just can’t afford it. BlueCross is the best of the affordable plans.

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