February 6, 2006This is my 93-year-old "Mam-ma," who is on Medicare and Medicaid. Remarkably, and with the help of home health aides/nurses and family/friends, she still lives alone. Last fall, as soon as was permitted, I spent hours researching the various prescription drug plans, and I selected CignatureRx for her, as it paid for all but one of her six prescriptions, with a $1-$3 co-pay per prescription, and no premiums or deductibles, since she is a Medicaid recipient.
My grandmother draws less than $700/month Social Security. From this she pays for all of her utilities, food, household necessities, and first and foremost, 10% to her church! She receives $10 per month in food stamps. It’s very tight, but she does manage. While she does quite well on her own, I have Durable Power of Attorney and am her primary caregiver, and I manage her checkbook and pay her bills, etc. I made sure I chose the best possible coverage for her with regard to the new Medicare Prescription Drug plan (or so I thought!), and CignatureRx was the choice.
In late December, I received 2 separate letters from CignatureRx, explaining that $33.80 would be deducted monthly from her Social Security check as a monthly premium. I telephoned the 800# for support and was told to toss the letters – that I had received them in error. I kept them. On January 6, my grandmother had her most expensive prescription filled at her local pharmacist, and the bill was $150. The pharmacist suggested I charge this amount, as he was having difficulty with many companies getting things squared away, but he felt eventually he would be able to file this charge and get paid. He asked for my grandmother’s card, and I told him we had never received one. I did, however, have these letters with all of her account numbers. I telephoned the pharmacy later with these numbers, and he filed the charge for the prescription.
A couple of weeks later, subsequent prescriptions needed to be filled, and the co-pay applied, $1 - $3 per prescription. I asked about the initial prescription for $150, and the pharmacist said, “Something still isn’t right… it now says she owes $130.” He gave me a name and number to call, and about 5 persons (and 4 phone calls) later, I had found this person, who assured me she would give my grandmother’s CignatureRx information to someone in Ft. Worth, and get it fixed.
On January 31, I received a call from someone with Pacificare Prescription Services, wanting to know about my questions regarding my grandmother’s coverage. I was finally able to determine that she was NOT enrolled in CignatureRx as her primary coverage… Medicare had arbitrarily enrolled her in Pacifica, and that Pacificare does NOT cover her $150 prescription. The rep at Pacificare recommended I contact Medicare. I did call Medicare, and after several attempts to use their voice activation system and giving my grandmother’s Medicare number at LEAST 5 times, the auto-attendant reports that my request can’t be understood, so I’m being transferred to a customer service rep. Hallelujah!
By this time, I am wondering how in the world any senior citizen could possibly be expected to have the patience to continue this process. My Medicare CS reps shuffle me around. Someone hears my story and tells me they can cancel Pacificare and re-enroll her in CignatureRx, but I will have to talk to Pacificare about the $150 charge! I nearly blew a gasket, and this person connected me with a supervisor named Dontavius, who assured me that he had determined that, indeed, Medicare did overwrite my application to CignatureRx and enroll my grandmother in Pacificare. He cancels Pacificare, re-enrolls her in Cignature, and tells me to call Cignature on February 1 and get new numbers for my grandmother. He also advises me to have my pharmacist re-file the $150 prescription on CignatureRx after February 1.
February 1, I called CignatureRx and got new numbers… am told that all is well by someone named “Susan” and that I can have the $150 prescription charge re-filed… that my grandmother has a “value plan” with no premium and no deductible, and $1-$3 co-pays on her 5 prescriptions CignatureRx covers.
February 6, my grandmother received a letter in the mail telling her that $33.80 will be deducted monthly from her Social Security check as a premium. I told her not to worry - that wasn’t right. However, I phoned CignatureRx and was told that yes, she did have a premium. I insisted she did not, retelling my tale of the recent activities, and I was shuffled through several representatives to someone whom I believe was named Natania. She informed me that I would need to provide a letter from Medicaid proving my grandmother was a Medicaid recipient. I got irritated at this point and asked her how much longer all of this was going to take… my grandmother now needs the $150 prescription refilled again, and the first scrip hasn’t even been paid for. She put me on hold, and when she returned, she said she was “working it out.”
When she returned again, the connection was so garbled it was like a bad cell phone connection - times ten. I repeated back to her what I THOUGHT I was hearing her say, and she would say “that is correct.” According to what I heard, her supervisor agreed to temporarily accept that my grandmother is on Medicaid, and they will request proof from Medicare of this, and the deductible and premiums are waived, and she will be on the $1-$3 co-pay, so I can have her prescriptions filled this month on that plan.
Now… here’s the thing. This has cost me hours and hours of time and frustration. Thankfully, I have been able to keep this worry from my grandmother. But my question to the people at Medicare is… how in the world is the average senior citizen supposed to cope with all of this? I firmly believe that 90% of the time, they will give up, and either accept the charges or just refuse the expensive medications and suffer the consequences. I can’t imagine many of them would endure the endless reconnections and voice activated phone systems and being put on hold over and over. Furthermore, had the co-pay been somewhat in the ballpark on my grandmother’s prescription, I might never have caught that she was not on the plan in which I enrolled her last November. And if this system (and the online enrollment) are so darn wonderful, then why did it not work?
I feel like I am quite internet savvy, and I felt confident that I had successfully enrolled my grandmother in CignatureRx. However, at the time of enrollment, I voiced concern to many at the complex nature of the enrollment process and how I didn’t feel the average senior would ever be able to make his/her way through it. Now I can see that the average, internet-savvy magazine publisher cannot, either!
I am disgusted with how we treat our seniors. I see the way they are treated at the DHS office when I visit to file papers for my grandmother (and there were a TON of them in January). If a professional with a Master’s Degree in Education (me!) cannot figure out how to fill out all of these papers and handle this successfully, what makes us believe that a senior citizen, particularly one who is 93, can do this? My mother-in-law attended an in-service on applying for the prescription drug program last October, and the first thing they told the attendees was to look some information up on the internet. She is 79 and doesn’t even own a computer! How was that logical to recommend the internet to this group?
Frankly, if this is best that we can offer our seniors with regard to prescription drug coverage, we better get busy rethinking things. If we haven’t had illness or death result from this fiasco yet, we will. I can assure you that my grandmother would forego a $150/month prescription before she would spend that kind of money, if she had the choice. Thankfully, she has someone to advocate for her. I shudder to think about the countless Americans who have no one to assist them, and may not even realize that they NEED assistance. Incidentally, the reason I did not let Medicaid choose a drug plan (or so I thought) was that the plan I was told would be most likely selected did not cover ANY of the 6 drugs she takes. Now how is this supposed to be better for our seniors?
I have seen Senator Lincoln’s commercials where she assures seniors this will be BETTER. From my vantage point, there is NOTHING better about it, so far. I am told by 2 pharmacies in Heber Springs that many Medicaid recipients were switched to the plan of Medicaid’s choosing without their knowledge, as my grandmother was. Why did we do all of this if it didn’t matter? My grandmother’s ability to live at home depends on me having time to see to her needs. If I squander that time on this drug plan’s ineptness, she will suffer needlessly in the end… but nothing compared to that of countless others in this country who have no advocate.
February 7
Here's TODAY's portion of my saga to get my grandmother enrolled in a prescription drug plan. My grandmother had a medication refilled - the bill was $150. CignaRx co-pay was denied. After talking to her pharmacist, we tried EVERY number we've been given by CignaRx so far, and low and behold, the original ID number was accepted, and the co-pay was applied... my grandmother's cost is now $3.
I asked the pharmacist what he suggested I do about January's prescription bill for $150 for this same drug, and he recommended I call CignaRx and talk to someone who might be able to override and co-pay for last month. I did so, and a somewhat curt rep named Max informed me that I needed to provide CignatureRx with a "letter from Medicaid" stating that my grandmother is a Medicaid recipient... that she has temporarily been approved for CignaRx until February 15, pending receipt of this letter. Now, yesterday, the rep I spoke with at CignaRx said THEY would obtain this letter from Medicare. Today, Max at CignaRx says that I have to contact Social Security and get the letter faxed to me, and fax it to CignaRx before February 15. (He also informed me that I was going to HAVE to let him talk! He did NOT want to hear my story!)
I phoned Social Security... waited on hold for over NINE minutes for someone to assist me, and finally told my tale of woe to a very nice person named Jan. She informed me that the letter is a "letter of extra help" and that she might be able to connect me with someone who could assist me... that I should have received this letter last December telling me that Medicare would choose a plan, or we could choose our own. I very well may have gotten such a letter, but since I had chosen a plan for my grandmother, if I got it, I tossed it. Jan put me on hold, and I was subsequently disconnected.
I phoned again, and this time I waited on hold over TEN minutes for someone whom I believe was named Jackie. She was not interested in hearing my story, and she asked to speak to my grandmother. I told her my grandmother lives alone, and not with me, and she refused to give me ANY information without her verbal consent. I told her I have durable power of attorney and she told me that didn't matter, and if I wasn't the payee or the authorized rep, I couldn't discuss this with her. She asked for my grandmother's Social Security number and when I gave it, she told me she didn't know WHY Jan had spoken with me, but she could not talk to me about this. I asked her just what she suggested I do, and she said, "You need to call Social Services." She offered me an 800#, but I asked if that was the same as our local DHS, and she said, "If you want to go that route." I thanked her and hung up.
Thankfully, I have a lifelong friend who works at the DHS in Little Rock, so I called her in desperation, and she explained that Social Services has nothing to do with this... it is indeed Social Security, and that my best bet is to put my grandmother in the car and drive to Searcy (30 miles) and meet with the Social Security manager there and get this "letter of extra help". She said I should also get it down in her Social Security file that I am the authorized rep... something nobody has ever told me before in the many years I've been her primary caregiver.
So... Wednesday morning, I tried to contact Social Security in Searcy for an appointment. Meanwhile, I found a letter from 2005 that was sent to my grandmother explaining her new Medicaid drug coverage. I called CignatureRx to see if THAT letter would suffice... it wouldn't... need something current. I told him I had to put Mam-ma in the car and drive 30 miles to get that letter, and he said, "No, you don't. Call the Social Security office and have them fax it to us." He gave me a fax number. He also said that $150 charge from January can be refiled and co-paid, once this is all resolved.
Now, Tuesday night, in frustration, I had e-mailed this tale of woe to my congressmen, my senators, the governor's office, and even Hillary Clinton! Wednesday morning, someone from the governor's office e-mailed me and said she thought she could help. Subsequently, so did someone from Congressman Marion Berry's office. This woman in the Pharmacy Unit at the governor's office has been my angel. Seems she's been down this road with her parents, and she is more than willing to help me. She has contacted the Medicare office in Dallas, and we should hear something today (February 9). I am hoping this will all be completed by the end of today or tomorrow at the latest. If not, all of these fine elected officials will be hearing from me again! How sad that you have to practically kick and scream to get results. And again, who does this for all of those who have no advocate? Stay tuned... this saga continues!
