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I Have An Angus Rib-Eye Steak

February 29, 2012

…that would be “I Have A Beef,” MA-style

I’ve been a consumer in the MA system for three years now and some parts are still mysterious to me. The price of special-needs medical goods is one of them.

Take diapers. After flirting with cloth twelve years ago, I switched to disposables. I tried a few different brands and was happy to discover that my favorites –the Sam’s Club generic –were also the least expensive. So Joy wore those until she turned four and became eligible to receive diapers shipped to our home for free as a Medical Assistance (MA) benefit.

I dialed up the supplier recommended by our public health nurse, and requested enrollment in diaper delivery.

They asked which brand I wanted.

I asked what they carrried.

They named three premium brands.

I said I had no idea; we used generics.

They offered to ship me free samples so I could see which size and brand fit best.

The answer was Pampers, size 3, delivered to my front porch once per month in the quantity I specify –as long as that quantity is in full-sleeve increments. So every few months I have to remember to reduce my order to one or zero or we end up with a super-abundance of free diapers.

These are not really free because we pay into the system to get them. But the system gives me no choice but to consume diapers that would cost me 20-25% more off the shelf at the store than generics. And I’m sure the mark-up is higher than that with MA because somebody has to pay the helpful customer service reps; the warehouse person who removes one sleeve of diapers from a case to give me the requested amount before taping the case up for shipping; and the friendly UPS guy who monthly braves the barks of Daisy the Menace to drop the diapers at my front door.

Joy’s new car seat is another example. The invoice informs me MA was billed $749.00. Figured at cost per year over 10-12 years until she outgrows it, that isn’t bad. But when I first priced the SnugSeat Traveller last fall, I found it for sale direct to the consumer at $450. Today the lowest direct price I could find was $550. Then, as now, there’s about a $100 premium for the identical seat with “by Britax” on the label. Our medical supplier ordered the “by Britax” seat.

I may be missing something here; maybe there are behind-the-scenes mechanism designed to save money. But compared to the consumer support grant (CSG) option we used on MA before this, I can’t see any. The CSG used a formula to compute a yearly grant amount. To access the allotted funds, we had to have therapists write letters justifying equipment purchases. But I purchased the supplies/equipment directly. So I price shopped to make the most of my granted funds.

It became clear very quickly that most prices for adaptive equipment are inflated.

Like I bought this Kekaroo Height Right chair and cushion combination for $219.90 on Amazon. But it is priced at $677.36 by the cushion manufacturer, Special Tomato.

Cost-savings might not be on my radar if we were not buying into the system. That’s why I price shopped on the car seat I knew MA would pay for. I’m thinking ahead to the day we may opt out of the MA system for Joy and use the budget money allotted to our pay-in for out-of-pocket expenses instead. So I don’t want to underestimate the value of MA to our family economy.

Yet it is almost impossible to tell the real value of MA –despite the handy monthly and yearly expense summaries they supply –because the prices MA is willing to pay for goods and services is so high. That keeps us in the dark about our actual costs.

That’s my beef: in the MA system who price shops on behalf of taxpayers? I’m glad Joy can help keep so many people employed. But unlike some users, we are not house-bound. Do I really need customer service, shipping and delivery to significantly mark up the cost of a case of diapers I could buy on my weekly trip to Sam’s Club?

Every time I close the diaper tabs over Elmo’s cute fuzzy little head I wonder.

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