Boy is somebody going to get sued!!!
Let's give a little background first. I'm on 100% disability and as a
result get a check every month from Social Security. Damn well BETTER after
all those years of paying in, and Uncle Sugar tearing my ass up in taxes
when I was pulling $90K+ a year...
Anyway, I digress. This also means I
automatically qualify for Medicare, and as a trickle down Medicaid for
whatever state I happen to reside in. The coverage state to state varies
obviously but you get the basic picture. Ok, now to throw more of a monkey
wrench into the picture, I also get Medicare Part D (drug coverage). The
drug benefit is not part of the 'Original' Medicare program, which includes
Part A for hospital care Part B for physician, outpatient care and durable
medical equipment. The benefit is administered by private insurance plans
that are reimbursed by the Centers for Medicare and Medicaid Services (CMS).
Everybody sufficiently confused yet?
Ok, at the time I get my Medicare, you have to choose a carrier for your
prescription drug plan. That's cool, can do that. Well just so happens that
Humana has this big booth in Wally World. How convenient I think, and talk
to the rep, and sign up. Guy was totally helpful, and goes out of his way to
get me set up. Even says hey, we'll get you set up for the Humana Gold
Choice Medicare Advantage plan. We'll take care of EVERYTHING. Oh how nice I
think, have enough crap to deal with, and if they can take some of it off of
my hands, outstanding. Now, herein lies the rub. A MAJOR rub. Unbeknownst to
me, because I have Medicaid (TennCare), I am what's termed "Full Dual
Coverage Eligible". What this means IS, in a nutshell I am not supposed to
have ANY out of pocket medical expenses other than co-pay on my medicine.
Which for 2008 is $3.35 for brand name drugs, and $1.15 for generics. No
co-pays at ANY doctor, whether primary or specialist. Nothing for any of my
testing supplies at ALL including strips. Nada.
Now, here is where the suing part comes in. Even though Tennessee never
informed me of this fact, they just roll me over each year, Humana DID have
this information, and chose to mislead me so they could get THEIR little
piece of the pie. The reason I NOW know all of this is because I moved to
Nevada, and get a letter from Humana saying I moved out that plan area, and
have to sign up for a plan here. Ok, I think, that's fair enough, and call
Humana. Well they start giving me some gibberish about pricing tiers,
demographics, and other assorted horseshit. I'm like look, Medicare is
Medicare, and stuff shouldn't change. Eventually I tire of this mess, and
call Medicare because the open enrollment period ends on Dec. 31st. The rep
there says ok, we'll set you up with an identical plan somewhere else.
Herein lies the next rub. It is NOT identical. I did not know this until
today when the rep from the new carrier calls and welcomes me to the
"Sterling Option IV Fee for Service Plan". Um, fee for service? Excuse me,
I'm not supposed to have ANY fees I tell the rep. Luckily she was helpful
enough to un-enroll me, and actually transfers me to Medicare. I talk to a
regular rep at first, and we decide I better talk to one of the plan
specialists. Here I get helped by my new best friend named Mike.
He's like WHY are you on a Medicare Advantage plan in the first place. I'm
like, well the Humana guy said I had to because of the rules governing Part
D. He's like NO, you are Full Dual Coverage Eligible, and TennCare is on
record as being your secondary coverage, and went on to explain to me what I
just explained to you. I had wondered why all those bills had been coming
in. I had attributed it to wrong billing codes and the like. Insurance
carriers are always notoriously slow. It's even hit my credit rating because
the doctors are turning it over to collection agencies. He goes on to inform
me that even though I moved, TennCare still has to pay as they have deemed
me eligible for 2008. This guy was an absolute GODSEND. He set me up for a
new PDP, which automatically kills the other, so they can't get THEIR sticky
little fingers in the pie. This new plan is structured as such, that from
Sept.1 to Jan. 1 of the following year, all of my prescriptions are FREE.
People I tell you, it is SO damn refreshing to find a government worker that
actually cares!
Back to the suing part, and I am DAMN sure going to follow up on this. What
that Humana guy did was fraud. At the very least deceptive business
practices. I have had to pay their premiums out of my disability check every
month when I did not have to, and they KNEW this. They are bound by law to
inform of ALL my choices, which they did NOT do. As of Sept. 1 2005, I
should have had to pay nothing save my prescription co-pay. I am so far past
livid right now it's not even funny. They are going to pay for all those
back bills. They are going to damn sure clear up my credit history as well.
And I am going to seek punitive and compensatory damages as well. And they
will cover any cost incurred from now until Feb. 1, because I am stuck with
that stupid Sterling plan until then.
I apologize to all for being so long winded. However, even though we have
our little disputes, we are still a pretty tight knit group here. If I or
this post can help just one of us from having to go through what I have just
had to, then I believe it is worth it. Folks, PLEASE stay on top of
EVERYTHING. Make sure you know ALL of your options. Don't take ANYTHING for
granted. I am normally fastidious about things like this, and look what
happened to ME. I also apologize for the cursing, but when I get this angry,
I tend to get a bit more verbose than I normally would in polite company.
--
T2 - Oct. '96 -
Lantus, oral meds, diet
http://www.lockergnome.com/darksentinel
Undo the munge to reply by email
Steaming mad right now!! 
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