Falling in the donut hole

Posted 4/25/07

My husband and I have wonderful doctors who work hard to keep us healthy and productive. They are not only really good doctors, but they are also caring doctors.

Last year, when my husband rather quickly got into the “donut hole” with his …

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Falling in the donut hole


My husband and I have wonderful doctors who work hard to keep us healthy and productive. They are not only really good doctors, but they are also caring doctors.

Last year, when my husband rather quickly got into the “donut hole” with his Medicare Part D, which pays a portion of his drug costs, I was stunned. How could it have happened so quickly? The answer to that question is that he is taking some rather new and very good drugs that are working wonders but with Part D, once you reach a certain dollar amount, the drug plans begin to pay just 20 percent of the cost until YOU reach an out-of-pocket amount that is considered “catastrophic.” Well, the donut hole was pretty catastrophic for us on our budget.

I was told by more than one pharmacist that they had customers on Part D who were taking their medication one month and skipping the next or taking them every other day because they could not afford them daily.

Last year, when I was in the hospital for three days with severe chest pain, I later got a letter from my health insurance company declaring that they had determined that I only needed to be in the hospital for one day.

The stories go on and on and on. It’s not just people on Medicare who are struggling to pay for insurance and prescriptions. With my health insurance, the highest price I pay is $40 and last year, I was taking quite a few of those. Now, I take only two that are $40 a month, along with my other less expensive prescription drugs. These are primarily to keep me healthy and productive and enjoying some quality of life. I shudder to think if I had a serious problem that required eight or 10 drugs a month, like some people.

Knowing that there was no way we could pay 80 percent of my husband’s prescriptions along with mine, I sat and pondered for a while about what has happened in our country.

Why are people struggling to pay for their medical insurance, struggling to pay co-pays and for hospital stays? Something isn’t right and I personally lay the blame on the medical insurance industry with their record profits and head honcho’s who get salaries and bonuses in the millions.

Profit isn’t a dirty word. Profits are what motivate businesses and the insurance industry is a business, not a charity. But some of the profits enjoyed by insurance companies who are denying needed medical test, drugs and procedures to those they insure are just plane obscene! Do a little research, if you want to be truly shocked.

Not one to sit around and feel helpless, I simply did what I had to do. There was not going to be any more money coming in, so I knew I had to figure a way to get those needed prescriptions. There was a time when we could have signed up with a program and gotten them from the manufacturer, but those programs are no longer available to people who are on Part D., unless they are way, way under the poverty level. Our income is just at the higher end of the poverty level, but still under it. We qualify for nothing at all.

This is where our wonderful doctors proved that they really care about their patients. I called all of my husbands doctors and mine as well (an endocrinologist, an internist, a retina specialist, an ENT and a neurologist). II figured if I could get samples of my prescription drugs, we would have a little more money to spend on his. I asked for samples from all of them and every office that had them cheerfully gave them to me to help us through the donut hole.

Our doctors often don’t deserve the blame that is heaped on them about the problems in our health system. I heard one doctor complain about medical insurance refusing to pay for needed diagnostic procedures and newer drugs for his patients. “They are making it hard for me to do my job,” he lamented.

Some of our fine doctors donate their time to the Alabama Free Clinic that meets Thursday nights at the Health Department building in Bay Minette. As volunteers they care for people who have no health insurance and without that clinic, might get no care at all for life-threatening ailments.

The old family doctor with his black bag who would come to our homes to treat us may be just a memory, but his spirit still lives in the hearts of many of today’s physicians.

Before you blame your physician or the ills of the medical community, take a close look at the insurance providers. THEY are the ones with the busy lobbyists and the huge, huge profits and bonuses — not the doctors.

Barbara Grider is staff writer for The Independent. Contact her at bgrider@gulfcoastnewspapers.com.