Part D Insurer Passive-Aggressive Behavior?

Imagine this. On your way to an important appointment. you drive down a busy 40 mile per hour street behind a car moving no faster than 27 mph. You can't pass. There's no way to get around this driver. And then the light changes and that car drives right through the changing light, giving you the "finger", leaving you late, stopped and angry.

A psychoanalyst friend uses this scenario to illustrate passive aggressive behavior. The driver ahead of you deliberately and consciously roadblocked and provoked you, and then sped through the light.

My wife and I recently encountered a passive-aggressive situation with respect to a Medicare Part D drug. In the late Fall of 2008 we were reminded by our Part D insurer that we didn't have to do anything to renew for 2009. Late in December, just before the time had expired to renew, the insurer sent us its complex revised formulary which tripled our copayment for Zetia by raising the copayment and moving Zetia into a higher tier and threatened to non-renew our Zetia prescriptions. My wife made a number of calls to the "customer service" desks at that insurer, was given different stories by each of the persons she talked with, and was sent numerous differing forms to "appeal" the tripled Zetia copayment and non-renewal threat. Our physician sent a letter to the insurer. The company responded, indicating that it would provide us with Zetia for the next 20 years and then charged us the full augmented copay (which, having no other choice, we paid), as if our appeal had been denied.

More days of calling brought conflicting responses and forms until my wife finally learned that the company had agreed to grandfather us to the extent that it would provide us with Zetia, but had not considered restoring our copayment to what it had been before January 1, 2009 leaving us with the prospect of paying about $2000 a year for this one, of many, prescriptions. However, after almost two months of frequent calling, for the first time the company acknowledged that our physician could submit an appeal letter to roll-back the copayment.

Since I spent years negotiating contracts with HMO, PPO and other insurers, I am familiar with their tactics. The confusing, conflicting and opaque behavior of our Part D insurer was neither the result of incompetence nor accident. It was a calculated stall to block, or at least discourage, customers from getting the drugs they need. The insurer's calculation was for its financial benefit: mislead, block, delay and use secret administrative policies, not clearly disclosed to the Medicare customers brought to it under Part D, for its own profit.

When the driver ahead of you is passive-aggressive, you may become angry, but for the mature driver, there is no lasting injury. When Part D pharmaceutical insurers' policies are passive aggressive, mature Medicare beneficiaries will die.

I hope that the Obama administration will not fill health care reform posts with people (including board members) connected with health/pharmaceutical insurer policies of secret administrative regulations, deliberate misleading of Part D beneficiaries, blocking and stalling the provision of needed drugs, and other obstructive health insurer profit-enhancing behavior. Persistence of these policies will generate public frustration and anger. And people will die.