There’s an old saying, “the squeaky wheel gets the grease.” Well I became the squeaky wheel regarding the denial of a 30 day temporary prescription fill by AdvantraRx, our Medicare Part D provider.
First, our complaint was filed with Medicare and I cannot stress enough for anyone who has ANY issue with ANY provider of ANY Medicare service – Don’t be afraid to complain, it’s your right! Call Medicare at 1-800-MEDICARE (1-800-633-4227) or the State Health Insurance Assistance Program (SHIP).
It took a lot of “squeaking” to have the issue resolved and we were finally contacted by Coventry Health’s Director of Medicare Appeals and Grievance, someone who could make the decision other than to deny and correct the situation. Understand this was the fourth person I spoke with from this organization. Talk about frustration.
I also contacted a few advocacy groups and special thanks go out to them, although they couldn’t help us personally, they did make available a lot of information and used our situation as an example to Medicare why parts of the law should be changed. The Advocacy Groups that assisted were:
- California Health Advocates – phone: 323-284-5326
- National Senior Citizens Law Center – phone: 510-663-1055
- Centers for Medicare Advocacy – phone: 860-456-7790
If you run into issues that you can’t resolve with Medicare, I suggest you contact anyone of these groups. They were so helpful and again, thank you.
Lessons Learned
When situations like this happen there are always lessons to be learned.
- According to Medicare if you have a prescription drug that is on a restricted list and requires a doctor’s authorization, that authorization is ONLY valid for the current year.
Each and every year you must submit a new authorization from your doctor for the drug if you decide to renew with the plan you are currently enrolled in.
2.If you are switching plans during open enrollment, DON’T rely on the websites but call the plan directly to verify your drugs and find out what, if any, restrictions there might be.
However, what they tell you during open enrollment could change in January of the following year. There are no guarantees the information you receive is accurate.
But, even if you forget to get your authorization for your drug for the New Year or a new restriction has been placed on the drug, the Part D provider should ALLOW for a temporary 30 day fill which will give you time to secure the authorization from your doctor.
I am thankful we could purchase the medication out of our own pocket so my husband’s health would not be jeopardized.
We received a call back from Medicare and they stated that AdvantraRx had made a mistake, but the issue was resolved. They asked if we were satisfied with the outcome, and my response was, reluctantly satisfied.
I am reluctantly satisfied because it took a lot of “squawking” to get our issue taken care of because of a mistake by our Part D provider, and I am sure there are others out there who have had a similar situation and haven’t filed a complaint or are taking a substitute medication.
REMEMBER
It’s your right to file a complaint – “NO” is not always the correct answer!
