When my brother passed away four years ago today, I knew that he would have wanted my parents to come live with me and my family in the Bay Area.
That naturally meant we had to figure their healthcare insurance. My parents are green card holders and I knew that up until they are residents for five years, there would be no way to get them on Medicare even though at 75 and 80, they more than qualify for the federal government’s health benefit.
They once had Obamacare before they give up their green card but going the exchange route was going to be difficult again. If I said they had no income in the U.S., which is true, then they would be put on Medi-Cal, which wasn’t my preference. If they wanted a subsidy for the premium payments from the ACA, they would have to show a lot of paperwork showing Indian income, which would be a nightmare for me to deal with.
Luckily, my brother lived the proverbial immigrant’s American dream and so my inheritance was the pot I relied on to get coverage for them. Kaiser was my obvious choice — having been a healthcare journalist for ages and living where I do, the integrated health system was my top choice.
And all has been well. My parents love Kaiser. I love Kaiser. Their care coordination is excellent – if the primary care doctor makes a referral to say physical therapy, a call comes immediately to schedule an appointment. Their efficiency is without parallel – rarely are there wait times when you go in person to the clinic. Kaiser’s vaccination distribution process was also for the most part, smooth, for my parents that is. Pharmacy delivery of medication occurs three-four days after my parents order on the app. Everything’s peachy.
The biggest asset of course are the physicians. Dr. Albert Lau is their primary care physician. He is very thorough and self-assured based on the appointments that I have attended. My dad, mom and I absolutely loved his radiation oncologist, Dr. Lawrence Scala. He spent basically spent an hour explaining our radiation options when my dad was diagnosed with moderate rate prostate cancer in 2020. This was discovered in India in late 2019 but given the relatively earlier stage of cancer and the general outlook for prostate cancer patients, I decided to wait to have it treated after their arrival in January 2020.
Dr. Scala shepherded us through the pandemic, delaying my dad’s treatment in early 2020 deeming that my father’s risk of dying from Covid-19 was higher than his risk of dying from cancer. I am happy to report that my dad is now effectively cured.
So you get the picture – I love Kaiser.
Well up until last week. My parents haven’t been back to their home in Kolkata, India since January 2020. They are due to leave on Nov. 21. I asked my dad if he could write to his primary care physician asking if the doctor could approve getting his medication ahead of time so that he would have enough to last until his return in early May. Dr. Lau tried helping us by approving additional three months after his medications run out in January.
But when I called the pharmacy, it didn’t matter that the man in charge of his patients had decided that this was an appropriate request and approved it. The pharmacy operator basically told me I had to call the insurance side of Kaiser because the benefit says you can only order 3 months at a time.
Yes, but we are not consuming the medications early, I countered. It’s not as if my dad will consume pills like a man addicted and then we will then ask Kaiser for more medications, which would be costly for them to cover. Dad would be mad to do so — these are for hypertension and other chronic conditions and are perfectly titrated.
Anyway, I dutifully called the claims side. And well, let’s say the man answering the phone call ruled that nothing could be done – if you want to get more, you would have to pay out of pocket because every 3 months is the benefit.
Benefit? The irony of it.
Benefit for whom? What kind of “benefit” doesn’t take into account a life situation following a once-in-a-century pandemic? Why is it that even after paying $30,000 in premiums just this year alone, my parents cannot get the medication they absolutely need?
Journalists are supposed to stay neutral, never insert themselves in a story and just report the facts. Healthcare, however, is too personal and my frustration and concern for my parents is a fact I cannot ignore. I recently returned from the HLTH conference in Boston where MedCity News hosted a track on patient engagement with a big focus on “patient-centric” care.
Alas, the lofty ideals have yet to reform base reality.
Photo: poshfoto, Getty Images