This article actually is an appeal to a Medicare Part D provider who thought I should have to pay double the co-payment on a medication I had been taking for years because of it’s high expense. (It’s somewhere around $555.00 for a month’s supply.) But I knew trying other medications would be at best an exercise in futility. At worst, it is not an easy thing to find the correct balance of medications and to remove one will cause suffering. So here is my appeal to my provider:

Think of a factory and your brain as a network of factories, all committed to keeping bodily functions and the mind itself in well -oiled condition. Each network of factores is

owned by a one person, in this case myself. All the workers have assigned jobs. However, for the owner there is trouble in Mood City.

The facility, which we will call Mood Central, not only does not perform at optimum rate, but it is also indeed grinding to a halt due to the fact the workers are not doing their assigned jobs. Everybody’s brain has a Mood Central factory. When we say “mood,” I am not referring to the PMS women experience, although it’s not a bad comparison in some respects. PMS, however, is hormonal and related to the monthly cycle in a woman. After a few days she regains equilibrium with or without medication. The bipolar

brain, however, is ever present, expressing itself in mood swings we call episodes, from the heights of mania to the depths of often suicidal depression. While it is normal for us all to experience some highs and lows, for the normal person, these things tie in to circumstances, whereas the bipolar person can and often will experience crushing depression when things are going very well. When we look at circumstances through the filter of depression, we do not see things as they really are. In a real sense, it is not the person we hear, but the bipolar brain which speaks.

In an art therapy session I once drew a house on fire. People were gathered around chatting, oblivious to

the fire. One person, myself, is screaming while another person observes this and says, “What is she so upset about?” You see they cannot see the fire. For a bipolar person the house may always be on fire. And they react accordingly based on what they see, not what is. So when people say, “Why can’t she just get her act together?” they are essentially saying to the owner, me, “Can’t you put a stop to the devastation, close it down for repairs, and get this running better?” The problem is that to the biplar mind, it is impossible to change her brain chemistry without the aid of medications. It is impossible to run the factory without first a manager,represented by the doctor, and secondly, foremen, represented by the medications, to go in and restore order. The owner realizes he can’t do it by himself, so he makes an appointment with the doctor, who will now be the new manager.

The owner explains the problem. There are workers who job is receiving, and there are workers whose function is to send things down to the shipping area, but the receivers would rather send it all one whether or not there is anyone down at the dock. Not only that, but debris is overflowing the wastebaskets and dumpsters, and no one is carrying this out. Picture a factory where the trash isn’t being carried out. But the foremen

begin to restore the receivers to their proper funtion and to remove the debris. The result is a smooth running factory. But just as there are formen who work out, there are those who do not, and it is really a process of trial and error. Formen who worked very well at other Mood Central’s may not work out at all at this place. And one who failed at another factory now works very well at Mood Central. And the moods begin to regulate themselves.

Enter the treasurer, a person who knows absolutely nothing about Mood Central because his job is only to see that costs are kept down at the expense of the manager and the owner, me. The

owner is being penalized for keeping a high salary foreman who is doing an excellent job just because the treasury does not want to pay the higher salary. They saddle some of that responsibility on the owner, who can scarcely afford it. The obvious question seems to me, “Why mess with what works/” It is a sad day indeed when the treasury dictates who works there rather than the managers. It reminds me of a comic showing an HMO exectutive in the operating room saying, “We have a saying in the front office that a dead patient is a cost effective patient, so therefore I will be taking over the nursing duties.” The caption reads, “Your HMO, with you to the end.” Thery’re with me to the end alright. The end of Mood Central.

Sadly, the insurance industry does dictate what the owners get to their detriment and really that of sociey. Think of the homeless mentally ill street people. People’s welfare lies in the hands of big industy, whose bottom line is cost, rather than with the doctor, whose bottom line is the health of his patient. It’s time to put an end to that. I have written to my senators and representatives to Congress with no response. Evidently, the little guy’s plight does not conern them.

Even more egregious, when I filed a grievance last year against my provider for using a technicality to excuse themselves rom paying

a lowered copay got themselves out of having to do that by using a technicality to charge me retail price, emptyng my bank account, doing this without warning. I sent 4 prescriptions down to a mail order facility in late December. They filled the other medications at agreed upon co-pays but not the lowered co-pay drug. That, they charged me retail price, citing I was not covered in January. They made a mistake, they said, on the other three. Well, if that is true, why not make a ‘mistake” on the other drug. They didn’t want to pay for the non-preferred drug, so with retail price, they ended up getting what they would have gotten if the price had not been lowered.. The sad news is, for filing a grievance, there is no law requiring them to issue an appeal. You have none with the provider or Medicare, making it possible for these guys to do what they want without any accountability. The exectutive I talked with was arrogant and slick. Under the law, I would win a lawsuit but they know it isn’t worth my time or hige amount of money I would have to pay so I could take them to court.

It would be my privilege to go before Congress and stand up the little people, for myself, for justice and respect for those with brain disorders. Please, if you are in federal government, please listen to

my pleas and stand up for my rights under the constitutional law if not Medicare. Make the insurance industry pay when appropriate.

The good news in the latter case is that the part D provider sent the appeal on to Medicare, who ruled in my favor. You can appeal a decision but not a grievance. That’s the end of the line. But what of those who cannot write an appeal? What happens to them? This is an issue that needs to be addressed. My own governor made a promise that no one would work harder for the benefit of people with brain disorders (which is the proper name for mental illness,) than he would, and yet he vetoed

a bill that would let Medicaid people have access to more expensive drugs. What was he thinking? He has written no response back to me. We need to hold these people accountable.