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Medicare Part D Doughnut Hole Patience

A retired pharmacist transferred his wife's prescriptions to my pharmacy and became a new customer. It took about two weeks, thanks to the Medicare Part D "doughnut hole," to make him an unhappy customer. He told us she was in the Medicare Part D "doughnut hole," the gap in the Medicare prescription drug plan where members are responsible for 100% of the cost of their drugs. I added his wife's medical info into her profile, and the pharmacist called the other pharmacy to transfer the prescriptions.

To soften the financial blow of the doughnut hole, the customer split the timing of his wife's prescription refills to be two weeks apart. So, he refilled half at the beginning of the month, and the other half at mid-month. This really distressed me. This guy was a pharmacist, so I knew he had lived a comfortable lifestyle, and now in retirement, he was struggling to keep the cost of his wife's medicines within budget. I can only imagine what seniors go through who have to take expensive medicines and didn't have pharmacists' salaries.

Before the customer left, I told him some Medicare Part D plans didn't have a doughnut hole because they charged higher monthly premiums. In all the confusion when the program was new and no one understood the details very well, a lot of folks didn't understand what a godsend a plan without a doughnut hole could be. So, since he knew his wife would hit the doughnut hole every year, it might be to their advantage to pay higher premiums and spread the cost over the entire year to avoid the financial shock of paying full price in the doughnut hole. He seemed to understand this, thanked me, and said he would call 1-800-MEDICARE to price out the available plans.

Since the Medicare Part D doughnut hole is complicated, this is an aside to briefly explain it. The doughnut hole begins when total cost of drugs reaches $2,250 and ends when the member has paid $3,600 out-of-pocket costs in any year. Depending on co-pays, the doughtnut hole could theoretically last for as long as $3,600 (if the patient had no co-pays) or as little as $1,350 (if the patient paid full cost for drugs, which isn't a realistic example, because with a full cost co-pay, such a patient would always be in the doughnut hole)

The customer returned last week for the second half of his wife's prescriptions. Despite knowing his wife was in the doughnut hole, the sticker shock caught him by surprise... over $200. But what can you do? What he paid was actually a price his Part D provider had contracted with the pharmacy. In other words, the full price for his wife's medicines was even higher than what he paid, probably $300, but the insurance company had contracted a "volume discount" price for its patients, and this reduced price is what patients in the doughnut hole actually pay. He sighed on his way out, and said, "I know, I need to find a plan without a doughnut hole, like you told me the other day."

He returned a couple days ago with his $200+ receipt, complaining we hadn't given him the 10% senior citizen discount on his wife's medicine. We do have a 10% discount program for seniors, which does include cash price prescriptions, but since he pays a contracted price set by his insurance company, we can't give him the 10% discount, because that doughnut hole price is technically his co-pay, and discounting or waiving prescription co-pays is insurance fraud. So...

There was nothing we could do for this customer, except show him what the full cash price would have been without the contracted price, explain this contract price was greater than the 10% discount he would have received without a Part D plan, and explain we legally could not discount the price. The customer grumbled about hogwash and having to deal with insurance companies as a pharmacist for 50 years, and still having them stick it to him in his pocketbook after he had retired.

But at least he understood and calmed down after blowing off steam. That's a big challenge -- it's not easy to distinguish who just needs to blow off a little steam and will calm down once they know you sympathize with their situation, and who will continue to escalate to the point of making a scene by screaming in front of other patients and scaring them away, insulting you personally, and being escorted out by security. That's the hardest part of the job.

:: Bryan Travis :: 08/13/2006 @ 10:19 :: [link] ::

The 10 Dimensions

It's mind-boggling to comprehend the insignificance of your own existence with the incomprehensible vastness of not just the universe, but the multiverse. This very concept was used as capital punishment in Douglas Adams' Hitchhiker's Guide to the Galaxy, in a machine called the "Total Perspective Vortex." It was a punishment so hideous only one person survived to tell about it, and even then, he cheated.

Imagining the Tenth Dimension is a website to accompany a book of the same name by Rob Bryanton. It presents a short and engaging audiovisual of our 10 dimensional multiverse as described by Superstring Theory.

When I realize myself for what I am, a miniscule fleck lasting for but a flicker in the entire timeline of the universe, there are no words to describe the sense of humbleness and disappointment I feel. Comparing one's own existence in the universe to sitting in a huge, dimly lit stadium for 10 years and barely noticing a tiny flash of light in the far distance out of the corner of your eye late some night on day 218 of year 4, and not being sure if it was really there or your eyes playing tricks on you, is a poor metaphor because it still doesn't come close to conveying the insignificance of you compared to the immensity of everything there is, ever was, and ever will be.

What kind of an existence is that? Seriously, we're nothing man! Even a star, a million times the mass of the Earth, which is itself is at least 70 sextillion(70,000,000,000,000,000,000,000 -- typed out since hardly anyone knows what a sextillion is) times more massive than you or me... even that massive star is insignificant in the universe. It's one of a hundred billion other stars in a galaxy, which is one of anywhere from hundreds of billions to an infinite number of galaxies.

Now, imagine our entire universe, from beginning to end, as one possible timeline. Then imagine all the other possible timelines for our universe, an infinite number of them branching from each point in an endless timeline. Finally, imagine all the infinite, different manifestations of the Big Bang, each with different constants for the fundamental forces of nature (gravity, electromagnetism, and strong and weak nuclear forces), amount of mass in the universe, speed of light... and each of these "starter recipes" for the universe would have its own infinite number of possible timelines.

Okay, so this infinite number of Big Bangs followed by an infinite number of possible timelines defines the grand total of all there is, all there ever was, all there will ever be, all there could have been, and all there ever could be. It's everything, and it's represented by a single point in the 10th dimension. We're left wondering, "what comes next?"

What comes next, indeed?

Maybe this is a better metaphor: it's like comparing all those possible universes (what is known as the multiverse) to a single proton in our universe, and all the other protons in our universe are each their own multiverse. And you and me? You and I are a rather miniscule bit of the energy that forms a single proton for a trillion trillion trillion trillion trillionth of a second in the entire lifetime of the universe.

All this might give some insight to my struggle with the existence of a God, because the multiverse is so vast, the concept of God I formed as a child is incompatible with the perception of reality I have today. I'm sorry, but my mind struggles with the concept of a God who demanded animal sacrifices, assumed a human form for a brief 30 years, and requires an unquestioned belief in Itself as price of admission to immortality. If God did exist, it seems extremely improbable such an entity would even notice us, much less take an interest.

But on the flipside, supposedly our entire multiverse, and all the subatomic particles in it, is comprised of a single Superstring that vibrates, folds, and interacts with itself to form the universe we see. That's one busy string! Well, maybe I shouldn't anthropomorphize our great big Granddaddy Superstring and suggest it has self-awareness of everything that occurs within itself... and maybe if it were self-aware, it wouldn't necessary mean it was aware of things at every level of detail. For example, humans are self-aware, but our self-awareness isn't detailed enough to include every cell or every molecule in our bodies. But to suggest the nature of God's existence is somehow related or equivalent to the Superstring is fascinating, but ungraspable by our brains. I just don't know.

:: Bryan Travis :: 08/08/2006 @ 19:48 :: [link] ::

For Posterity's Sake!

All 1,202 pieces of evidence from United States v. Zacarias Moussaoui. For posterity's sake!

Quick tricks to speed up mental math.

Vanity Fair's special report on NORAD's operations during the September 11, 2001 terrorist attacks. It's an excellent article featuring key excerpts from NORAD's conversations with FAA air traffic control operation centers, itself, and the military. It highlights the confusion and communication weaknesses the folks at NEADS (NORAD's Northeast Air Defense Sector) faced during the 2 hour crisis.

:: Bryan Travis :: 08/06/2006 @ 11:04 :: [link] ::