"I hear and I forget; I see and I remember; I write and I understand." - Chinese proverb

Tuesday, December 14, 2010


LADY WITH SOUTHERN ACCENT: Good morning, United Health Care, may I help you?
ME:  Yes, I recently received a letter stating that as of January 1st AARP [my Medicare Part D prescription drug company] is not going to cover the brand name of several of my prescriptions. I've tried the generics and they don't do the whole job. I would guess I need to move up a level from the "Basic" to the "Enhanced" plan.  Or switch to a different plan.
LWSA:  Okay, I can help you with that.  [asks for my I.D. number/other boring stuff] Now, our records show that you receive extra help from ConnPace with paying the premium on your current plan, but they wouldn't do so on the Enhanced plan and that premium is $80 [+/-] a month.  As opposed to $30 for the Basic.  Just so you know.
ME:  No, I don't belong to ConnPace.
LWSA:  You do receive extra help paying the premium.
ME:  Yes, from the QMB [Qualified Medicare Beneficiary] program, that's a grant from the State of Connecticut.  Not ConnPace.
LWSA:  Let me check.  Yes, the state's assistance program is ConnPace, that's right.
ME:  Okay.  [maybe they merged or something??]  So what you're saying is I'd be paying the entire premium myself without the extra help.
LWSA:  Yes ma'am.  And did you know you have a $74 balance with us?
ME: Uh...  [several seconds go by]  What?!
LWSA: Yes, we're showing you never paid any premiums for the last calendar year.
ME:  That's correct, because I get the extra help.
LWSA:  Well, you still owe $74, would you like for me to put that on a credit card?
ME:  I never received any bills for this.  I don't get it.  Can you send me a bill and I'll deal with it [toss it in the wastebasket] when I get it?
LWSA:  O-kay.  Now, we don't want to lose you as a customer so I suggest you call ConnPace and talk to them about what might be available for you for assistance, they may know something.  [gives me toll-free number]

BITCHY YOUNG GIRL:  ConnPace, can I help you?
ME:  Yes, my Medicare Part D company referred me to this number to find out about help with premium coverage.
BYG:  Can I have your ConnPace I.D. number?
ME:  I don't know it.  I don't have any I.D. cards from ConnPace.
BYG:  Who did you think you were calling?
ME:  I knew who I was calling, but I'm sorry, I don't have anything from ConnPace.  But I need information on what's available for help with a higher premium, or on what Medicare Part D companies other than AARP would cover my prescriptions in Connecticut.
BYG:  We sent our members a letter back in November with a list of those companies.
ME:  I don't recall any letter from ConnPace.  Can you e-mail me that list?
BYG:  No ma'am I can not.
BYG:  I'm going to suggest you call our Medicare Part D counselor and ask them to recommend some drug companies for you.  Here's the number.

OUTGOING MESSAGE:  Hello, you have reached the voice mail of Jane Smith; my hours are blah, blah, blah.  Please leave your name and number and I will call you back as soon as possible.
ME:  Hi, my name is Laurie Blair and ConnPace gave me your number as someone who can help me go over my prescriptions and find out what Medicare Part D companies in this area would cover them.  Please give me a call at blah, blah, blah.  Thank you.

A half-hour goes by.  Now I'm thinking that if that bitchy girl can't e-mail info to me, I'd better call ConnPace back and have them re-mail it.

MAN ANSWERING PHONE:  ConnPace, may I help you?
ME:  Yes, apparently you mailed out a letter in November that I never got advising which drug plans this area covers.
MAP:  What is your ConnPace I.D. number?
ME:  I don't seem to have one, can you look me up by my Social Security number?
MAP:  What's your number?  [I give him the number.]
MAP:  Ma'am, we only sent that letter to our ConnPace members and we are not showing you as a member of ConnPace.
ME:   Oh, okay.
MAP:  You need to call Medicare and ask them for information.
ME:  Yes.  Sure.  Thank you.
[docile and subdued, or just wiped out is more likely]

On phone to Medicare Part D and it's ringing; call breaks through from Part D Counselor's number, I answer.

ME:  Hello?
COUNSELOR WHO IS ACTUALLY POLITE:  Hi, what can I help you with?
ME:  I need information on what to do with my Medicare Part D coverage since my current company won't pay for brand names starting January 1st.
CWIAP:  Sure.  I can give you that info.
ME:  I could just go up a level but the premium is $80 and they said it wouldn't be eligible for QMB help.
CWIAP:  Wouldn't be eligible for the entire $80, no, but at least $30 would be paid.
ME:  So my premium would be $50?  Not $80?
CWIAP:  That's correct.  There are some companies where QMB pays the whole premium and some companies with higher premiums where they cover part of the premium.  Oh, I can't put my hand on that list.  Let me look for it a minute and I'll call you back.
ME:  Sure.  [she won't]

[five minutes later]
ME:  Hello?
CWIAP:  Okay, here's that list for you, you ready?
[she gives me 8 or 10 companies to write down]
ME:  Okay, so now I just go on the Medicare website and look and see what these companies cover?
CWIAP:  Yes, but to be honest?  AARP actually has one of the best formularies [list of covered drugs] and if they won't pay for it I kind of doubt the other companies will.
ME:  I guess my doctors will have to appeal, then to get the brand names covered.
CWIAP:  Oh, they hate that, it's a real pain, you wanna try to avoid that at all cost.

I look up the companies.  Not even ONE of them had my prescriptions on their list of approved meds.  I call my doctors.  I tell them we have to go generic and then do an appeal -- even $50 a month is more than I can swing right now, not with no raise in disability pay for two years in a row.  (And let us not forget, the first $50 out of every month's pay goes to the vet, who was kind enough to let me run a tab, and the second $50 goes to my dentist, who was also kind enough to let me run a tab.)  And paying out-of-pocket for this stuff is, of course, completely beyond reach.  It's enough to make a person sick.

No comments:

Post a Comment