Red tape is the worst bandage

There’s a wryness to John Kerr that flatters him. Good thing, because life has not been particularly generous in recent years, dealing him a package of illnesses with long names and ugly intentions. In such moments, wry works well.

“I’m metal all over,” he says, referring to various titanium inserts for bones that are dying, including a total shoulder replacement.

But even that isn’t what he means when he refers to “my catastrophe.” That is the description he reserves for the duel he fought by phone and letter with his HMO over prescription drug reimbursement.

In a sense, his tale is of a type we’re all familiar with -- trying to crack through a bureaucracy or a company to get something done. But haggling over a credit card bill is one thing; dealing with a healthcare agency while you’re physically sapped and hurting for money is much more draining.

To make his case, Kerr, 54, and permanently disabled since 2001, gives me a stack of papers that, more or less, lays out the chronology. Included:

* The letter dated Nov. 7, 2006, from the Social Security Administration telling him he’s “eligible for extra help with Medicare prescription drug plan costs.” It later was determined that Kerr, as of last October, would get a significant discount on his complement of nine drugs he was taking for osteonecrosis and ankylosis spondylitis. However, Kerr continued paying the full amount through the end of 2006 as the paperwork for reimbursement meandered through the system;

* The letter from April 13 of this year from Prescription Solutions, the company that reimburses members from the HMO, which in Kerr’s case was SecureHorizons. In that letter, Prescription Solutions told Kerr it was denying his claim for reimbursement on the drugs;

* The letter from SecureHorizons dated May 17 that said it was overturning the denial and approving his claim.

That makes it sound as if it were a simple three-step process, or as though those were the only agencies with which he dealt.

If only, Kerr says.

Instead, his effort to be reimbursed for the October-through-December period involved innumerable phone calls with uncounted on-hold delays, conflicting information from various agencies, time-consuming exchanges of mailed correspondences, broken promises of return phone calls and, in the end, a sense of utter frustration and anger.

Along the way, Kerr says, the delay in payment -- which he believed was going to be several hundred dollars -- cost him a place to live and contributed to depression that led him to a suicide attempt in a storage garage in January.

What exasperated him, he says, was the sense of powerlessness at a time when his diligence and will were being stretched to the breaking point. His psychological collapse in January, he says now, was a product of “a lack of control over things and that there was nothing I can do no matter how often I called, who I talked to. So, I reached a point of hopelessness that I couldn’t go on.”

A spokesman for UnitedHealth Group, the parent company of SecureHorizons, responded with a prepared statement to my request of several days ago to discuss Kerr’s situation.

“SecureHorizons is committed to providing high-quality service to each and every one of our members,” the statement read. “Unfortunately, issues with the transmission of information regarding Mr. Kerr’s membership status set into motion a series of events that resulted in the delays he has experienced. We have offered Mr. Kerr our sincere apology for the inconvenience this has caused and taken action to resolve the situation. This was an isolated situation and does not reflect the high level of service that our members have come to expect from SecureHorizons.”

What most sobered me in talking to Kerr, who lives in Costa Mesa, is that he’s no babe in the woods. During his professional life, he worked for a number of social service agencies, most notably a 10-year stint with the American Red Cross in Los Angeles.

In other words, he knows how bureaucracies work and, presumably, how to navigate the system. I try to imagine an elderly person, perhaps in worse physical shape than Kerr and without his level of knowledge in such things, having the same persistence. It’s hard to do. Much easier to picture is that person just dropping the whole thing.

Precisely, Kerr says. “I’m not unique here. They wear you down, and you give up, or you give up hope, and then if you hang in there long enough, they send you a check for an amount you know is wrong, but you’re so grateful to get anything that you let it go. You don’t even bother to fight it, because the idea of going back and saying ‘This is wrong’ is so overwhelming.”

That is a harsh indictment, and one I can’t possibly verify. To the contrary, I’m content to stipulate that HMOs handle their business in a professional way and do right by many of their members.

But I refuse to believe that Kerr’s case is an aberration. It isn’t lost on me that had he died or given up at any point during the months-long process, the HMO would have pocketed the money.

I don’t pretend to be an expert on the prescription drug business. But if millions of people are going through what Kerr went through, somebody needs to fix it.

Kerr’s quest appeared to end Aug. 8, when he got a reimbursement check for $304 to cover the October-December period. A Prescription Solutions official, he says, has told him the check was dated June 1. Kerr suspects it was backdated so it would conform to a requirement that it be sent out within 30 days of his appeal being granted.

Given what he’s been through, I can forgive his conspiracy theory inclination.

As Kerr walked me through his ordeal, there were moments when the absurdity of it all made him chuckle.

Such as, he says, when the HMO told him he had to file an official appeal of the denial on his claim even though it had, on its own, realized the denial was the wrong decision. Or when one agency said a check would be coming in four weeks and another said it always takes eight weeks. Or when, out of nowhere, he received a check for $36 for a pharmacy purchase last December.

Now, for the epilogue.

Not even Kerr’s happy ending was completely happy. When Kerr told me he finally got the reimbursement check last month, I congratulated him. Not so fast, he says. Based on his records, he says, the amount should have been about $900.

The HMO told him he could appeal.

Surely, I say, you’re not considering that.

“I’m absolutely going to,” Kerr says. “If I don’t, it’s a total victory for them. It confirms that what they’re doing works for them.”

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Dana Parsons’ column appears Tuesdays, Thursdays and Saturdays. He can be reached at (714) 966-7821 or at dana.parsons@latimes.com. An archive of his recent columns is at www.latimes.com/parsons.