Shoot all the insurance carriers! Steaming mad right now!

Although I tend to shy away from personal stuff since this a tech related blog, this issue needs to be addressed. As I have stated in previous posts I am very active in Internet newsgroups(Usenet), and have been for many years. I am also a Type II diabetic, and have been since being diagnosed in 1996. What follows in a post I made in the alt.support.diabetes newsgroup.

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.

So as everyone can see, you really need to stay on top of things. Especially when you are in a situation like mine.