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The client was placed into LTC facility. The LTS pharmacy was billing SeniorCare and drug cost tripled due to clients large deductible on the SeniorCare program. SeniorCare had lapsed. The drug price went down by two fold. Payee keep calling LTC pharmacy with no outcome. I followed up and asked for all meds to be paid private billing (No SeniorCare). That client saved almost $500.00 dollars. The lesson here is if our client's have a large deducible that they will never meet. They should pay cash/private.
Monetary Impact = $490
1/10/2024
Story #132
Kathy Schultz, EBS of Langlade County, helped a client eliminate her Medicare Part D Late Enrollment Penalty. The client was assessed a Part D LEP because it did not have the information regarding her SeniorCare coverage. The client's friend had tried to help her appeal, but thought the Part D LEP was assessed because she was late on her Part D premium payments (which she was not). After receiving a denial, they came to Kathy, who helped her submit another appeal with the correct proof of SeniorCare coverage dates. C2C Solutions, however, gave this appeal a new number and denied due to it being past the appeal deadline. Kathy worked with her BSSA to draft a good cause late appeal based on the client's diligent work trying to resolve the issue since January. C2C Solutions ultimately agreed, and nine months later her LEP was removed.
Monetary Impact =
9/29/2023
Story #112
Tiffany also assisted a 66-year-old client who was referred in May because she was terminated from her job and was unable to afford the high cost of Trulicity, a new drug her doctor prescribed for her diabetes. The client was enrolled in SeniorCare Level 2B but did not have funds to pay the $850 deductible. Because of her loss of income, Tiffany helped her successfully apply for the Qualified Medicare Beneficiary (QMB) Program in May, and her benefits became effective June 1st. Meanwhile, Tiffany also assisted her with an application for Social Security retirement benefits. Due to this new source of income, her QMB enrollment will only last for one month. However, as a result of having been enrolled in the QMB program, she will have full Extra Help/Low-Income Subsidy (LIS) for the rest of the year. The client was finally able to fill her prescription and she paid the $10.35 co-pay under LIS. Fortunately, she was offered a job which starts next month. The client is very pleased with the assistance she received from Tiffany during a very stressful time in her life.
Monetary Impact = $850
6/1/2023
Story #88
Lindsey Holden, EBS of Portage County, helped a client fix a prescription drug plan issue. The client came to Lindsey after she'd gone to the pharmacy and learned that she'd been disenrolled from her drug plan due to failure to pay premiums. The client had her premiums taken out automatically from her bank account, but when her bank made an update and wanted the client to manage her account with an app, she didn't. The client admitted to receiving so much mail during Open Enrollment that she may have missed messages and thrown something away. Lindsey helped the client call her plan, who explained they would not reinstate her coverage. Before filing a CTM or appealing to her previous plan, Lindsey took the opportunity to run a Planfinder with the client and learned there was a better plan that would save her $500 that year. She helped the client enroll in SeniorCare Level 3 which allowed her to use the SPAP SEP to enroll in this new plan. The client was now better off for the year for visiting with Lindsey.
Monetary Impact = $500
2/28/2023
Story #56
Joanne Welsh, EBS in Richland County, helped a client successfully appeal his Part D late enrollment penalty. The client had been on SeniorCare for a number of years but had not filled out the plan's paperwork correctly to report the creditable drug coverage. Joanne helped the client appeal to C2C Solutions, which found that the client was not required to pay a late enrollment penalty.
2/28/2023
Story #55
Jessica Knippel, EBS in Manitowoc County, helped a couple who each had a late enrollment penalty with their respective Part D plans. The husband and wife, who are 70 and 69 years old respectively, both had SeniorCare for drug coverage for many years. They recently enrolled in Part D plans during open enrollment with two different companies. Neither company accepted SeniorCare as creditable drug coverage and assessed each spouse a late enrollment penalty. Jessica helped both spouses appeal the late enrollment penalties and quickly received favorable results on both.
11/30/2022
Story #45
Jessica Flores, EBS in Door County, recently helped a resident of an assisted living who was referred to her for help with a SeniorCare renewal. During Jessica's visit with her, she showed Jessica a bank statement along with some other papers she needed assistance with. When glancing at her bank info, Jessica noticed she had a really high pharmacy cost. The assisted living facility provided Jessica her current medication list, and from what was on there, the bill from the pharmacy just seemed way too high. Jessica asked the social worker at the ALF if they knew if the pharmacy had all of the correct insurance information on file. The social worker wasn't sure, and the ALF didn't know for sure either, but they assumed it should be. After Jessica came back to the office, she did some research and coordinated some phone calls to the pharmacy. She discovered that somehow, the contracted pharmacy from the assisted living did have the insurance information on file, but they weren't billing correctly. After correcting these mistakes, the client will receive a refund from the pharmacy of around $3,500!
Monetary Impact = $3,500
7/28/2022
Story #20