Saturday, January 28, 2006
The real story: disenrollment
Let me tell you about my January. For instance, what about all the time I’ve spent on the telephone trying to get my mother’s prescription drug coverage reinstated by her pension (actually my father’s pension, to which she is a “survivor” beneficiary)? You know, she always got all of her drugs, virtually any famous or infamous drug, for free, that is, for the cost of the $4 postage. Then along comes the stealth Medicare Part D, brought to you by the Republican congress of two (three?) years ago. Obviously, they didn’t dare put Part D into place until after our Preznit got re-elected.
I’ve called the HMO (an insurance company: Secure Horizons/Pacific Care) approximately eight times. Sometimes the calls ended up with me shouting some obscenity at the person on the other end of the line. On my third try today, however, I actually contacted a young woman who was very sincere, pleasant and easy to deal with. Eventually, though, I had to just ask even her for the address to which I would be able to send a formal grievance – as advised by the California Department of Managed Health Care (another phone call I made this morning).
Background: the HMO, where mom has had her Medicare insurance all these many years automatically switched her coverage, as of the first of the year, over into a policy that includes the new Medicare Part D. They said they did this so as not to cause an interruption for mom being able to get her prescriptions. (Reasonable enough, really!) But hey, we didn’t know they were going to do that, didn’t think of it! After all, Medicare had made those prescriptions very inexpensive heretofore, you know, like with just an 8, 10 or 12 dollar copayment. The main point being that until this year, prescriptions were virtually free through Medicare, and now they aren’t. As for my mom, she hardly ever used Medicare for prescriptions because she got her drugs even more free by virtue of one of my father’s pension benefits, "till she dies."
Here’s the rub. The pension plan, pursuant to mom’s having been enrolled in Medicare Part D, cancelled mother’s prescription benefit. Just like that. Like, they were obviously hooked into the Medicare/Social Security database because we certainly didn’t call them and tell them mom was now enrolled in Part D. In fact, we didn’t even know said enrollment was happening, and would not have found out about it at all if mom’s prescriptions (written for one year’s worth of refills) hadn’t had to be renewed by her doctor, as usual, every January. You know, the yearly ritual of sending off her prescriptions to the drug company that contracts with the Pension to supply the prescriptions by mail.
But the actual, proximate reason I found out that mom had been enrolled in Part D is that her HMO sent us a payment booklet, $40 per month, and I had to call them to ask them what this was all about. (Oh, and yes, there's still the copayment, too!)
Remember, (did you see?) the many public service announcements on the television and elsewhere kept advising us all of how “optional” the new Medicare Part D was, and how, in any case, we all had until May 2006 to make up our minds about joining. Now, of course, the US Government agency concerned with this, CMS, is bragging about how “successful" the new program is, and how many millions of (24) seniors have already enrolled. I would wager that at least half of the 4.5 million in the category, Medicare Advantage Plan, are over age 80 and have very little idea, even now a month later, of what has happened to them. Why would they even suspect what their trusted government has done to them, i.e., sold them down the river?
Now, as for how many phone calls I’ve made. As I said above, there were at least 8 to the HMO. When I first started calling, the average time on hold was about 20 minutes . I also phoned the pension plan company (ConAgra Food) four times, and finally heard, or thought I heard them say that it might be possible that mother’s prescription coverage could be reinstated (though an ominous letter that ConAgra had sent out in October warned beneficiaries NOT to join Part D, or they would lose their benefit for good).
I’ve also called Medicare itself 4 or 5 times, most often with long hold times involved. I’ve called a State senator (Republican; I got shut down), and my US Senator, Barbara Boxer (to whom I also faxed a 12 page package of supporting documents). I’ve also called the California State insurance watchdog agency, Garamendi’s office. (No help, they have nothing to do with anything that says Medicare on it. They did give me other agencies’ names, phone numbers, websites, etc. – no use, all obfuscation and passing of the buck.)
Now I have an 85-year-old neighbor, Barbara. She’s the salt-of-the-earth type, always helping everyone, and telling everyone exactly what they want to hear even when she knows it’s the exact opposite of the truth. She happens to have the same HMO that my mother does. Her situation is not the same as my mom’s, but nevertheless, she is at a loss to explain to herself the new payment booklet. Also, and for some reason that I don’t understand either, she is having suddenly to pay large copayments (hundreds of dollars) when she’s gone in for minor (outpatient) surgeries (she always seems to be falling and breaking fingers and such like). So I am going to try to help her get her stuff sorted out, when I finally see my way clear to doing that. Meanwhile, she finally sent in, she said today, her $40 dollars for the month of January.
Now it isn’t just me and my immediate next-door neighbor who are in this kind of fix, do you think? Yet, who has heard of this sort of problem, and obviously, the bewilderment on the part of seniors over the age of say, 80? (Yes, the newspapers have said several times that everybody's confused, but I think it should be on the front page at least every other day, don't you?)
All we’ve heard about are the poorest of the poor, those so-called dual eligibles (Medicare and Medicaid), and other assorted handicapped people, who suddenly found themselves somehow outside the database. Sure this is a big problem, and the various governments have duly stepped in to provide bridge remedies.
The big news? That no one’s heard? My mom and her neighbors, (not all that far out of the official poverty group at the average income for American seniors, approx $15,000 a year) have suddenly had their pockets picked big time. These people are the people that Tom Brokaw called “the Greatest Generation,” or some such blather that made him a lot of money in his own sweet retirement. Well, Tom, I’d like to see you put some of your money where you mouth is, see that these great people are treated with some compassion and respect, instead of being crapped on by the current band of “fiscally responsible” Rethuglicans in Washington.
I’ve almost forgotten. The denouement of my little story here: why do I keep calling all of these people? Well it seems that I could or can get my mother’s pension drug benefit reinstated, as I said above. But, ConAgra’s telephone answerers tell me that I need proof that mother has been “disenrolled” from Medicare Part D. So here’s where the villainy comes in. The HMO refuses, so far, to write a letter, or give me specifics of just when any other official notification of mother’s (now changed) status vis-à-vis Part D will arrive in the mail. That’s all they’ll say is that, for example, her new Medicare Card will arrive in the mail sometime, perhaps 30 days after her change of status becomes official enough to make it into the data base and to trip whatever loop in the program that causes a new card to be sent out. And just who’s responsible for that? Dunno.
In the first place, the HMO was very disingenuous a few months ago, when it sent out the form for choosing a policy (what type of coverage) from among those that were on offer for 2006. On the form they sent, a certain “Medical Only” coverage was not listed as an option. Presumably, one had to telephone them in order to find that such a policy existed. (Yes, I have also scoured the websites!) And, at that, you had to then ask them over the phone the particulars of this coverage. And that would have been about my third call to the HMO. This was all a process that took weeks for me to sort through. A young woman read with me, over the telephone, the different terms of coverage for this policy, “Medical Only,” which it seems is available only in certain counties and certain Zip codes in those counties. Of course, I was blissfully unaware that any changes at all would be needed for this year, as I’ve already explained above.
Now, it’s not a trivial matter, either, that my mom stands to be without drug coverage for the next few months while first, I wait for some sort of proof to arrive from Medicare and/or (?) the HMO, and second, while I send that in and presumably get her pension benefit reinstated with ConAgra Foods. Also then, it will take at least another ten days to resume the prescription fulfillment process. No one seems to care. The HMO has repeatedly and explicitly refused to do anything that might expedite my having some kind of proof in my hands to send to the company providing the pension benefit. It will cost mom 3 to 4 hundred dollars to buy her drugs outright for a period of about 2 months. And (this is a kicker) if my mom’s pension benefit is not to be reinstated, she cannot swich her coverage but once during each enrollment period. Therefore, she couldn’t switch her HMO policy again (to include prescriptions through Medicare) until November.
Fine, my mom will just die, probably while hideous, stupid, useless war in Iraq rages on the television, and her lovely government is busy trying to screw her out of her last dime. Great country! The best in the world! Or could be? ¶ 12:11 AM
I’ve called the HMO (an insurance company: Secure Horizons/Pacific Care) approximately eight times. Sometimes the calls ended up with me shouting some obscenity at the person on the other end of the line. On my third try today, however, I actually contacted a young woman who was very sincere, pleasant and easy to deal with. Eventually, though, I had to just ask even her for the address to which I would be able to send a formal grievance – as advised by the California Department of Managed Health Care (another phone call I made this morning).
Background: the HMO, where mom has had her Medicare insurance all these many years automatically switched her coverage, as of the first of the year, over into a policy that includes the new Medicare Part D. They said they did this so as not to cause an interruption for mom being able to get her prescriptions. (Reasonable enough, really!) But hey, we didn’t know they were going to do that, didn’t think of it! After all, Medicare had made those prescriptions very inexpensive heretofore, you know, like with just an 8, 10 or 12 dollar copayment. The main point being that until this year, prescriptions were virtually free through Medicare, and now they aren’t. As for my mom, she hardly ever used Medicare for prescriptions because she got her drugs even more free by virtue of one of my father’s pension benefits, "till she dies."
Here’s the rub. The pension plan, pursuant to mom’s having been enrolled in Medicare Part D, cancelled mother’s prescription benefit. Just like that. Like, they were obviously hooked into the Medicare/Social Security database because we certainly didn’t call them and tell them mom was now enrolled in Part D. In fact, we didn’t even know said enrollment was happening, and would not have found out about it at all if mom’s prescriptions (written for one year’s worth of refills) hadn’t had to be renewed by her doctor, as usual, every January. You know, the yearly ritual of sending off her prescriptions to the drug company that contracts with the Pension to supply the prescriptions by mail.
But the actual, proximate reason I found out that mom had been enrolled in Part D is that her HMO sent us a payment booklet, $40 per month, and I had to call them to ask them what this was all about. (Oh, and yes, there's still the copayment, too!)
Remember, (did you see?) the many public service announcements on the television and elsewhere kept advising us all of how “optional” the new Medicare Part D was, and how, in any case, we all had until May 2006 to make up our minds about joining. Now, of course, the US Government agency concerned with this, CMS, is bragging about how “successful" the new program is, and how many millions of (24) seniors have already enrolled. I would wager that at least half of the 4.5 million in the category, Medicare Advantage Plan, are over age 80 and have very little idea, even now a month later, of what has happened to them. Why would they even suspect what their trusted government has done to them, i.e., sold them down the river?
The overall enrollment figures as of January 13 are:
-Stand-alone Prescription Drug Plans: about 3.6 million (2.6 million since December 13).
-Medicare/Medicaid: 6.2 million (including 600,000 in Medicare Advantage plans).
-Medicare Advantage: 4.5 million (plus 600,000 Medicare/Medicaid beneficiaries).
-Retiree coverage: About 6.4 million retirees are in employer coverage that is subsidized by the -Medicare retiree drug subsidy. Additionally, about 1 million retirees are in employer coverage that incorporates or supplements Medicare prescription drug coverage. Another estimated 500,000 retirees are continuing in coverage that is as good as Medicare's.
-TRICARE/ FEHB retirees: 3.1 million
Now, as for how many phone calls I’ve made. As I said above, there were at least 8 to the HMO. When I first started calling, the average time on hold was about 20 minutes . I also phoned the pension plan company (ConAgra Food) four times, and finally heard, or thought I heard them say that it might be possible that mother’s prescription coverage could be reinstated (though an ominous letter that ConAgra had sent out in October warned beneficiaries NOT to join Part D, or they would lose their benefit for good).
I’ve also called Medicare itself 4 or 5 times, most often with long hold times involved. I’ve called a State senator (Republican; I got shut down), and my US Senator, Barbara Boxer (to whom I also faxed a 12 page package of supporting documents). I’ve also called the California State insurance watchdog agency, Garamendi’s office. (No help, they have nothing to do with anything that says Medicare on it. They did give me other agencies’ names, phone numbers, websites, etc. – no use, all obfuscation and passing of the buck.)
Now I have an 85-year-old neighbor, Barbara. She’s the salt-of-the-earth type, always helping everyone, and telling everyone exactly what they want to hear even when she knows it’s the exact opposite of the truth. She happens to have the same HMO that my mother does. Her situation is not the same as my mom’s, but nevertheless, she is at a loss to explain to herself the new payment booklet. Also, and for some reason that I don’t understand either, she is having suddenly to pay large copayments (hundreds of dollars) when she’s gone in for minor (outpatient) surgeries (she always seems to be falling and breaking fingers and such like). So I am going to try to help her get her stuff sorted out, when I finally see my way clear to doing that. Meanwhile, she finally sent in, she said today, her $40 dollars for the month of January.
Now it isn’t just me and my immediate next-door neighbor who are in this kind of fix, do you think? Yet, who has heard of this sort of problem, and obviously, the bewilderment on the part of seniors over the age of say, 80? (Yes, the newspapers have said several times that everybody's confused, but I think it should be on the front page at least every other day, don't you?)
All we’ve heard about are the poorest of the poor, those so-called dual eligibles (Medicare and Medicaid), and other assorted handicapped people, who suddenly found themselves somehow outside the database. Sure this is a big problem, and the various governments have duly stepped in to provide bridge remedies.
The big news? That no one’s heard? My mom and her neighbors, (not all that far out of the official poverty group at the average income for American seniors, approx $15,000 a year) have suddenly had their pockets picked big time. These people are the people that Tom Brokaw called “the Greatest Generation,” or some such blather that made him a lot of money in his own sweet retirement. Well, Tom, I’d like to see you put some of your money where you mouth is, see that these great people are treated with some compassion and respect, instead of being crapped on by the current band of “fiscally responsible” Rethuglicans in Washington.
I’ve almost forgotten. The denouement of my little story here: why do I keep calling all of these people? Well it seems that I could or can get my mother’s pension drug benefit reinstated, as I said above. But, ConAgra’s telephone answerers tell me that I need proof that mother has been “disenrolled” from Medicare Part D. So here’s where the villainy comes in. The HMO refuses, so far, to write a letter, or give me specifics of just when any other official notification of mother’s (now changed) status vis-à-vis Part D will arrive in the mail. That’s all they’ll say is that, for example, her new Medicare Card will arrive in the mail sometime, perhaps 30 days after her change of status becomes official enough to make it into the data base and to trip whatever loop in the program that causes a new card to be sent out. And just who’s responsible for that? Dunno.
In the first place, the HMO was very disingenuous a few months ago, when it sent out the form for choosing a policy (what type of coverage) from among those that were on offer for 2006. On the form they sent, a certain “Medical Only” coverage was not listed as an option. Presumably, one had to telephone them in order to find that such a policy existed. (Yes, I have also scoured the websites!) And, at that, you had to then ask them over the phone the particulars of this coverage. And that would have been about my third call to the HMO. This was all a process that took weeks for me to sort through. A young woman read with me, over the telephone, the different terms of coverage for this policy, “Medical Only,” which it seems is available only in certain counties and certain Zip codes in those counties. Of course, I was blissfully unaware that any changes at all would be needed for this year, as I’ve already explained above.
Now, it’s not a trivial matter, either, that my mom stands to be without drug coverage for the next few months while first, I wait for some sort of proof to arrive from Medicare and/or (?) the HMO, and second, while I send that in and presumably get her pension benefit reinstated with ConAgra Foods. Also then, it will take at least another ten days to resume the prescription fulfillment process. No one seems to care. The HMO has repeatedly and explicitly refused to do anything that might expedite my having some kind of proof in my hands to send to the company providing the pension benefit. It will cost mom 3 to 4 hundred dollars to buy her drugs outright for a period of about 2 months. And (this is a kicker) if my mom’s pension benefit is not to be reinstated, she cannot swich her coverage but once during each enrollment period. Therefore, she couldn’t switch her HMO policy again (to include prescriptions through Medicare) until November.
Fine, my mom will just die, probably while hideous, stupid, useless war in Iraq rages on the television, and her lovely government is busy trying to screw her out of her last dime. Great country! The best in the world! Or could be? ¶ 12:11 AM
