Warren Scheible fought his way across Europe as a combat engineer with General Patton in World War II in an outfit known as "Patton's Troubleshooters." But the Hamilton, N.J., veteran never saw a skirmish like the one he is now waging with a drug company.
Hobbling around his home with a diabetic wound in his foot, the still sharp 91-year-old former financial planner is rummaging through a box of bills, totaling nearly $2,000, which Warren believes he shouldn't have to pay.
"Why charge me one price for a shot one time and seven times the price for the same shot three days later?" he asks. "And why does Medicare pay the bill this time but not the next? They tell me to call, so I keep calling. But I can't get a straight answer."
'D' for effort
At the heart of Warren's problem is the complex law known as Medicare prescription drug coverage (Part D), which took effect in 2006. It arguably benefits the pharmaceutical companies more than consumers, since it was engineered by then Louisiana Rep. Billy Tauzin, who left Congress to become president of the Pharmaceutical Researchers and Manufacturers of America, a powerful lobbying group.
Older Americans like Warren usually require more drugs, which tend to be costly. Scheible, for instance, has diabetes and needs 14 medications.
So anyone who thinks that their health insurance problems are over with the onset of Medicare at age 65 should think again. Warren pays for Medicare Part B (medical insurance), Part C (supplemental insurance) and Part D himself on a limited income.
Unfortunately Warren has been in and out of nursing homes for rehabilitation all too frequently, according to Medicare. There are strict rules: first go to a hospital for three days and then you can be discharged to a rehab facility for up to 100 days.
But if you leave nursing care, you have to stay out for 60 days before you can be readmitted for the same procedure. Otherwise you pay the tab. And, as Warren found out after his last two-month stay, it ain't cheap.
And there were other problems. His most recent facility wouldn't allow his own doctor to see him. Instead the "house doctor," with minimal knowledge of his case, prescribed a variety of medications, some of which Warren didn't even know he was getting until afterwards. A single injection cost him $487.25. "What was in it, gold?" he asks. "Nobody tells you anything in a nursing home. They just say, 'Take these.'”
This nursing home had a special arrangement with a pharmaceutical supply service that provided medication, but not at a reduced cost. Even after Medicare Part D paid, Avodart, which he could get at the local Rite-Aid for $26.31, cost him $150.81, and blood pressure medication Prandin set him back $167.98 as compared to $27.26 at Rite-Aid.
Just get it right
Calls to the nursing home's drug provider proved ineffective. He first spoke to a man who asked, "What's Medicare?" The next two women were sympathetic when he told them that he just wanted the right bill so he could pay. But they kept sending him the same bill over and over. He thinks part of the problem is that they are unable to spell his name correctly.
As a veteran, Scheible could have gone to a veteran's hospital or rehab facility for care. The catch, he says, is that if you signed up as a veteran you had to use veteran's hospitals. The closest veteran's facility is in Philadelphia and he didn't want to be that far away from family.
So Warren soldiers on. Armed with a telephone, calculator and his box of bills he continues to fight the faceless pharmaceutical company.
But he has another box, too -- with World War II memorabilia that help him remember when his unit came to the relief of the 101st Airborne at Bastogne. He recalls his buddy Tony from Brooklyn, and the day Tony died from a German sniper's bullet.
As bad as it may seem, with the bureaucracy, the bills, the diabetes and the hole in his foot, Warren still says, "I'm lucky to be here."