A friend called the IBM Service Center about the enrollment requirements to gain access to the HRA. The first representative got it wrong and said retirees had to buy all their insurance policies through Extend Health. She wisely called back and the second representative told her that was wrong. I suggest the "call 3 times" process when you are asking an important question. If you get the same answer from 3 different agents there is a good chance it is correct.
It's easy to understand why the Service Center staff would give wrong answers. There have been rule changes upon rule changes. In addition, none of the changes have been officially communicated so it is no wonder no one knows anymore what the requirements are for HRA subsidy access.
The more people write emails to Dr. Rhee and/or Extend Health to complain about this whole process the less Dr. Rhee will be able to claim the program is a success. It won't stop the transistion but it might rattle some cages.
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Posting here because it's a recent thread, hoping someone will see & can suggest help. I am on IBM long-term disability, and ever since I became ill in 2002, I have been grateful to IBM & to MetLife pretty much every day, because I would not be alive without the generous help they have provided. A key part of that has been the HMO plan they've offered to supplement Medicare through Employee Services, which has covered most of my Part B excess, prescription coverage and most other costs. Now, that is gone, suddenly, along with dental coverage I desperately need because extreme tooth damage is a built-in part of my condition. Coverage through Extend Health will increase my costs beyond imagining - not only will premiums roughly quintuple, I will also be in donut on Rx by mid-Jan with Rx costs of $1900 in Feb. Essential PT/OT services will be sharply curtailed, I'm told, though considered a necessary standard of care for my disease, and my only hope of keeping my limited mobility & holding the line on increases in joint & spine damage & "chronic acute pain." Ditto sharply reduced coverage for injections that I quickly become incontinent without (as well as unable to stand due to intractable neuropathy for which all other treatments have failed). I see well over a dozen specialists; even Extend Health rules out Medicare Advantage for me due to costs.
ReplyDeleteMeanwhile, contact with Extend Health has been terrifying. My first call with them connected me to a very sympathetic man. Plan options weren't even available yet, but after just hearing a list of my MDs and a partial list of my appx 30 prescriptions, he said, "Don't worry, dear, we'll think of something - we won't let you die." I laughed - if properly cared for, I still face progression of my conditions, but WITH CARE can hope to avoid life-threatening complications for some time. Even when bedfast, I find joy in life! I found, though, that he wasn't kidding.
Other reps have been much scarier, from the one who told me, when I asked what "attained age rated" meant, that it meant ppl of a certain age liked it, just as community-rated meant ppl in the community liked it. (!!!?! Wow.) Another replaced the Rx listing for my topical steroid cream with an injectible anti-psychotic that must be administered by an MD in a hospital setting (with my many problems, that's *not* one), skewing my costs by $23,000+. Several others told me my time was up on the call, despite the promise of unlimited counseling. There's more, but complaints are just offered as illustrations. More important is that their counselors, and a private case manager my current plan is providing, all agree I am in a pickle, and that affordable options for me don't appear to exist, even with the IBM HRA.
Continued - part 2
DeleteI've had 3 appts with EH and am still not enrolled, because I don't have answers to essential questions - can I move home to family in a year or two if needed without being subject to all the underwriting concerns? (I'm being told by docs I need caregivers, etc.) Can I keep my docs/med group of 25 years - do they work w supplement? I'm being told I need to call drug companies to get financial assistance, seek dental plans on my own, and more. Also being told I have until Dec 31st to register. At least two more calls planned. Now I see action is required on HRA. These tasks are almost insurmountable - if I could manage all this, oh, how I would rather be working!! As it is, I struggle to perform basic self-care & can do very limited tasks of any kind. If you're healthy, you'll be surprised, but I've overdone it just typing this, about 1 letter/second, and am crying tears of pain from hand use and of tears of sheer frustration with this horrible process. Finding out in September was virtually planning for me to fail, to quote the old saw.
My docs have always applauded my optimism - while I'm unlikely ever to improve substantially, I've always held out hope of someday being well - or better enough - and working again. Now, for the first time, I am truly afraid, on every level - afraid I will decline, perhaps beyond help, and that if I do manage to pay for meds & docs, that I will swiftly be without necessities like a roof & food & heat - and hope. Disgusted with myself to sound so pitiful, but apparently, I am. I'm alone out here, can't even read more sites, really ... Can't sit or click or any of it any longer now. I just pray someone will see this and know what's to be done - and that I can do it. Thanks for listening.
You need experts to help you. I urge you to do two things. First, you can try to call Robert Wilson who is a specialist at Extend Health - he is at 1-801-415-1735 and is a trouble shooter for EH but there is only a small chance he might help you. Extend Health is nothing more than an insurance agent so they are not great experts for complex situations and advising you on what to do so do not rely on their answers. Even Mr. Wilson sometimes gets it wrong. EH knows the Medicare insurance products they sell and some Medicare law. In your case, you need to really understand that what IBM is doing is setting you loose into the world of Medicare and Medicare is complicated. You need to talk to expert people who understand Medicare law and low income subsidy rules. Because you are spending so much money on health related issues you might be eligible for low income programs. There are also different rules in different states so you need local expertise to help you. Start by calling the Medicare Rights Center at 1-800-333-4114. I volunteer ther. It is a national non-profit that has a lot of Medicare expertise and sometimes takes on special cases (for free). They will start to help you find the right solutions for your situation. The second resourse to use is an organization in your state called the State Health Insurance Assistance Program. To find the phone number for your state go to www.shiptalk.org. The agency is typically run out of dept of the aging in the states. That agency will tell you what resources are available in the state including special prescription drug assistance programs and dental clinics. There is a lot of help available - losing IBM as an advocate is a pity but don't lose heart. There are a lot of smart and kind people in the non-profit world who will help you figure this out.
DeleteCorrection on Mr. Wilson's phone number ... it is 1-801-415-1732. Sorry for the error.
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