Medigap Woes

Scrolling through Facebook there’s often a good looking “senior citizen” earnestly addressing the rest of us senior citizens on Medicare that we’re tired of the recent increases in the cost of our Medigap policies. And they even mention Medigap Plan G—the plan I’m on—as the target of these price gouges. For those of you who aren’t senior citizens, Medigap means the private insurers—United Health Care, Blue Cross and Blue Shield, Humana—who cover the gaps in Medicare medical payments. Yes, Medicare has many gaps that need to be filled in if you don’t want to end up paying a lot of money after a hospitalization or a doctor’s visit.

Let’s quit lobbying for “Medicare for all!” Let’s call out, “Single payer health care for all!”

I clicked on one of those posts, worrying that I’d be sent to a sales person hawking an insurance company, but instead I ended up with Mitch, a friendly senior citizen himself in Florida who works for a company helps you apply for a different Medigap provider. My United Health Care monthly premium just got raised to $325. Remembering back 16 years I think the price was about $175. Mitch went through his list looking for companies that charged significantly less than $325.

My first choice was HealthSpring—formerly Cigna—whose monthly premium was in the low $200s. Mitch walked me through the company’s evaluation form, asking me about any illnesses, surgeries, and medical conditions that ran the gamut from heart disease to diabetes to cancer, none of which, other than arthritis, I answered in the affirmative. Mitch and I were pretty confident that I’d get approved quickly. He said he’d call me as soon as he heard back.

I waited a week with no response from Mitch but I did get a call from a HealthSpring person who asked me a few more questions and the one that stuck out was Sjögren’s. It’s an autoimmune condition where the immune system attacks the moisture producing glands. It primarily causes dry mouth and dry eyes but can sometimes affect internal organs. I was diagnosed with secondary Sjögren’s 40 years ago: My rheumatologist used to check me out for any underlying conditions but nothing has ever manifest except the dry eyes and dry mouth, which I treat with eye drops, water, and lots of sugar free lozenges.

I decided to call the Medigap company again and this time I got Melissa, who told me that Mitch no longer worked for the company. I thought that was odd, wondering what happened to Mitch, but Melissa took over and told me that HealthSpring had denied my application. I asked why. She said they told her Sjögren’s. She’d never heard of it. I was dumb struck. The only treatment I’d ever received in 40 years was dental (dry mouth causes tooth decay), which Medicare doesn’t cover.

Melissa then put in an application for Omaha of Nebraska, which has a monthly premium in the $200s. She asked them straight out of Sjögren’s was a disqualifier. They said no, not a problem. An examiner called me right away and asked some questions, never mentioning Sjögren’s or any autoimmune disease. Again, I didn’t have any of the conditions on their list. The next day they called Melissa and said I’d been rejected. When she asked why, they said it was based on the phone evaluation. Melissa then sent an application to another provider, I think it was Aetna, and they also turned me down.

In the meantime, I got a letter from HealthSpring notifying me that I was ineligible for coverage based on my “medical history of Sjögren’s Syndrome,” which use was obtained from the rx database.

Did you know that there is an rx database, which is a consumer report, like a credit rating report, that contains all of your medical history? I certainly didn’t. HealthSpring said the consumer reporting agency didn’t make HealthSpring’s decision to reject me and told me how to obtain a copy of my rx report, which I then requested, and that I had 60 days to dispute the accuracy of the rx database. HealthSpring also told me I could appeal their decision to refuse me with a signed letter from the treating physician “ruling out any declinable conditions.”

I’ve got an appointment with my primary doc next week who I’ll ask to write the letter. He’s not the rheumatologist who I’ve seen only twice since my longtime one quit, but he knows everything there is to know about my medical history and health and will probably write the letter (he’s a good guy).

All of this has taken almost a month so my next payment of $325 will be due shortly. Is it worth going through all this bureaucratic bullshit with greedy, corrupt insurance companies to save a hundred dollars a month? I don’t know the answer to that question yet. I’ll follow through with the appeal and if I miraculously succeed in eliminating Sjorgren’s as my declinable condition, I still won’t know why the other companies denied my applications.

Remember, it was the CEO of United Health Care who got shot down on the streets of New York. Unfortunately, there’ll be another United Health Care CEO who steps right up and decides that next year $325 a month isn’t return enough for the stockholders and decides to shoot (pun unintended) for $375, or maybe $400. As our beloved Kurt Vonnegut would say, “So it goes.”