Letter Sent to WTVQ – My Response

Dear Megan,

I am quite disappointed with your recap of Tom Kenny’s story concerning Medicare D prescription drug coverage and my problems with them. While I understand that at 11 pm you only have a short spot to recap the earlier story, I feel the content chosen to recap was misleading, based on the original story and the information I provided Mr. Kenny. It seemed to leave the 11 pm viewer with the impression that Medicare part A & B recipients who had no private insurance carrier prior to January first, (as I am in that category), could still get meds under request the Government has issued to providers.

The fact is there are hundreds of thousands of folk like myself who lost state Medicaid coverage December 31st, or had no coverage at all. The providers working with Part D will offer drugs at the regular out of pocket expenses and co-pays. The thousands of people who are on Social Security disability and who are not eligible for continuing Medicaid coverage; those who qualify for the Low Income Subsidy because they fall in the “gap” cannot afford to pay the co pays and meet the out of pocket when they are on many prescriptions. I am currently on 10 prescriptions for which the co pays total $2220.52. My SSD monthly benefit is $910.00. This is my total income.

The fact that providers are supposed to provide drugs temporarily is not applicable my story. First of all, they will only provide drugs to people who have signed up for a drug plan, or those who had prior private insurance. Secondly, they will only honor this request for Low Income Subsidy eligible people if those people have been given an award letter by Social Security for that extra help. Folks who are eligible for the extension are being told by their pharmacists that they can still get their meds. I was told that I had to pay the full co-pays, which is more than I can afford.

I, and many others do not fit those two categories, and I have been denied the two month extension.

The whole point my story to Mr. Kenny was really about misinformation and the failure of the Government to properly inform patients, Doctors, and Pharmacies, as well as the insurance companies adequately and in a timely manner. The rest of the story was supposed to be about the misinformation I was given on two levels: Prescription Pathways and Medicare, in December. While I do need the Fuzeon before I run out to insure that the Virus does not mutate and leave me without treatment options,

I simply wish you had recapped by saying something about we who are left in the gap of the back log, and the confusion among the Insurance companies who can’t assist us until Social Security and Medicare Get in sync.

I feel as though folks who only watched the 11 PM addition were given the impression that I am an angry alarmist who is disgruntled against our “kinder, gentler, more compassionate” government. I have never said that “Medicare was killing me.” I did say that I am out of treatment options and that I have had great difficulty getting my situation straightened out.

I was quite pleased with the 6 pm presentation. Please consider that not every 11 PM viewer watches at 6 PM. This whole problem IS about miscommunication and the lack of information.

Thanks for your consideration,

Sincerely Yours,

Timothy Spaulding

Press Release to Tom Kenny

Having been on SSD, my coverage for Medications ended with Medicaid December 31 – I had to have Part D by January 1st.
· Received a letter from the state of Kentucky telling me I was eligible for L I S in the fall, but was given no specific instruction on where or how to file.
· I made inquiry on the Internet Medicare Site December 23rd.
· The site was still under construction for the state of Kentucky and did not work. There was also no easily visible info regarding the Low Income Subsidy.
· I called the list of providers and found Prescription Pathways, who covered most of my drugs. When I asked them about the L I S they said that I since I had received a letter from KY, I did not need to do anything else to receive the Subsidy.
· I called medicare to confirm what they had said – Medicare also said that I need not do anything else.
· I signed up for the plan, and immediately called Medicare again to confirm the information Pathways gave me. Medicare also said that I need not do anything else.
· Yet, when I went to fill my prescriptions the 3rd week of January, the Low Income Subsidy was not there. Pathways have refused to work with me until the app for L I S is approved. By law, I am eligible.

This program has failed persons like me, on all levels of Government. Folks at all levels of Government, including the Fayette County Health Department AIDS care unit, were not prepared to inform citizens properly. Their office closed to relocate at the very hour that way needed them.

Medicare was not prepared by December 31.

Prescription Pathways was not fully informed by Medicare on procedures by December 31, at least their phone agents did not have the proper info to give to customers.

It is only thru my persistence and self advocacy that I am able to follow thru on this, however, how many other folks who can’t use the phone, do not have internet access, nor literacy are their who lost coverage Dec 31 and will have serious health consequences because they will miss their meds?

No plan or procedure with in place to help people like me who must stay on their medications, folks who have potentially life threatening conditions; those made worse by lack of treatment.

How many folks are there who cannot find advocacy for whatever reason? The government at large has the same attitude – the attitude of “everybody thinks their situation is more important.” Guess what, if a person could have their health permanently affected, it is most important.

Medicare needs to tell people who are eligible for extra help how to file, specifically. This information should have been distributed to health care professionals, caseworkers, and all agents prior to December 31.

The Idea behind this “new” plan is good, and the offer sounds great, but ideas and good intentions do not keep people like me alive.

In my option, the current outsourcing of medicare and Medicaid prescription coverage has created a bigger bureaucracy by an administration that touts smaller government.

Any third party provider who contracts with Government, either on the local, state, or federal level becomes an extension of that Government and should be held liable for Mis-information they dispense, and should take responsibility for proper communication.

Good Government begins with good communication. This current system is inept when it comes to factual and clear communication; even when a person asks all the right questions.


About Friar Timothy, Franciscan Urban Mission, INC.

Disciple of Jesus Christ with a Progressive Message, Author, Franciscan Friar, Musician, Social Activist, and Urban Missionary View all posts by Friar Timothy, Franciscan Urban Mission, INC.

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