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Wednesday, January 28, 2015 |  Madison, WI: 31.0° F  Overcast
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Unprofitable = undesirable
Provider seized its chance to terminate coverage
Mark Nowacki
Mark Nowacki

Editor's note: Michael Moore's Sicko argues that the nation's health-care crisis affects not just the uninsured but also the insured, who are subject to the predations of for-profit companies. Our invitation to readers to share their personal experiences with these companies yielded a number of replies. Here is one.

I have had AIDS since Oct. 10, 1994, and been disabled since Aug. 1, 1996. I have received my health care at UW Hospitals and Clinics the entire time. I have Medicare and Medicaid health insurance. I could talk for hours on the subject of health care, for I am truly an expert. For the purpose of this letter, I will limit myself to one example.

Medicare Part D, the prescription drug plan, is an insurance policy by itself. There is a premium and a co-payment. Medicaid (the state of Wisconsin) will pay the insurance premium up to a certain dollar limit. Federal law allows the providers to raise the premium price.

Wisconsin Physicians Service (WPS), based here in Madison, was my provider since the beginning of Medicare Part D. During the last week of April, I received a letter from WPS Medicare RX. The envelope really stood out, so I opened it immediately. It was a final bill for my Medicare Part D premium for January and February. I called the next day and was told that I had been terminated for nonpayment.

I argued that I had never received a bill before and that the state paid my premium anyway. They explained that the state only pays to a certain amount and WPS had raised the premium past that amount in January. The notice I received was the last notice before collections.

WPS also explained that since I had not paid my portion of the premium, all prescriptions I had received since Jan. 1 would be reversed. With the cost of AIDS medications, I was instantly in debt for tens of thousands of dollars. Incidentally, the bill was for $7.60.

I involved my case manager at AIDS Network and the director of the state's Medicaid purchase plan. They explained that insurance companies don't want to be in the Medicare Part D loop. The big money isn't there.

WPS will say it sent me notices and bills. But I know the final bill was the only piece of mail I ever received from WPS Medicare RX. After the state and my case manager intervened, I was allowed to give WPS a money order for $38. That is $7.60 for the months of January, February, March, April and May. I was then reinstated.

On May 1, I enrolled in Dean Health Care's prescription drug program and canceled WPS effective June 1. WPS had effectively rid itself of an unprofitable client.

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