OPM: Humana , Inc. Aetna. Medco part d plans under medicare.
The law requires a coordination plan between FEHB and part D medicare. none exists. Insurance companies are selling policies and the beneficiary has no idea what the coverage would be. FEHB is primary for Linda's dependents due to her owcp status. Doyle has ended up paying more in premiums and has less coverage. Our daughter's bills are getting dumped onto medicaid when they should have $0 to cover except premiums. And Linda's bills are all covered under owcp, but ACS has disparately never set up her computer file and any attempt to make give info or make changes has ended up with more files missing. Herresuce inhaler, maxair has to go separately to mail order as the computers at Walmart are so messed up with the govt programs they can't process apart from part d. The formularies themselves discriminate against those with toxic/ respiratory injuries. Linda can't even get a prescribed nebulizer due to the 'death panel' obstruction of care. We are requesting all claims be referred to the proper primary payer for recovery on all of us and a letter of waiver of any overpayment liability due to against equity and good conscience be issued to each of us and our estates as we've tried for years to get compliance with the law. not one part D insurer's sales person has any idea what coverage they are selling. The Dept Appeals board decision of 9/29/2010 M09-1406 upheld his and is the only final one. Requests to OPM go unanswered by their contractor who seems content. Letter to John Berry never answered except for an ombudsman to e-mail me months ago , that: they are looking into it. ( for 6 years?) as FEHB recipients pay for something that doesn't exist. This is a gross violation of civil rights and should violated 50 state ins commissioners laws, too.
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UPDATE; There is now supposedly a coordinaton plan, but detials are really unclear and few seem to know what it is either. Caremark is now the Prescription plan for Fed Blues. But its the same with the other plans I have knowledge of . If one gets special help then there is going to be the smallest of all possible co pays.
I had thought both plans primary and secondary medicare were paying part with very little picked up by the state help. Much of my main meds is now in a compound and that has to be filed for my self after I pay and Medicare does not pay for compunds, but Blues does.
I recently learned nothing has changed and Medicare and the state are paying it all except for the few dollars co pay we pay. So States get burdened even more and no recovery letters are going out to collect the monies back from the primaries.
In my case from Federal workers compensation. WE ARE BEING ROBBED FOLKS because law after law is not carried out and this has been going on a long time before 2009.
i posted an article on Rise Earth of the Elite Running this world.
My news letter is not who is at the top, as we pretty well know who 'they' are.
I am trying to show 'HOW' 'THEY' do it and 'WHO' they hire to carry out the deeds.Its the person(s) we have to deal with like CEO Lynn Blodgett in my case. I pray for him daily as the "gate is narrow" to the " kingdom of Heaven " for those in such a 'squeezed' position with their eternal souls on the line and our 'earthly' lives to often in jeopardy when they 'do as told' as in my case.
Then those we hire in DC And its all those phrases and omissions of oversight in those humongeous bills Congress is not given time to read before passage.
' Who' in Washington DC let the Medicare Prescription Drug plans get passed through Congress in the first place and had no way to recver monies back from the primary payers as does exist under the other parts of Medicare even if not enforced. The liablity insurance industry got a real 'windfall' and still are as no one seems to know anything about rcovery , yet at Medicare Seocndary Recovery govt contractor. Not even the regular kind where one gets an injury,car accident, etc., and later a settlement is made and Medicare can get paid back, BUT NOT FOR MEDICATIONS? Even manyfeederal emplyee fmaiels qualifeid for the apecial help and some never seemed to realize that not ever federal emeployee gets those high pensions 'they' want all others to think we get.
WE GOT LIED TO AGAIN. REALLY NO Coordination PLAN AT ALL IF THE PHARAMCY HAS NO WAY TO BILL CORRECTLY AND NOT EVEN CODE IT FOR RECOVERY.
So 7 years have gone by and how much money is owed bsck to Medicare to never get collected?And that doesn't even take into account that unlike states & VA who negotiated prices with the 56 million who have Medicare and many of them signed up for Part D.
Former Sec of HHS Tommy Tompkins got blamed for it; but personally it was already decided to let more of our money get ripped off as 'they' use our health care dollars as some 'giant slush fund.'
Plus we have tiers of meds: some of which require higher co -pays and for those of us suffering from toxic /chemical injuries for the products 'they ' like to use; often our meds are not on the lists at all and require us to file for special circumstances to cover them, or the ones we need are in the higher co pay already.
I appreciate ha ing the extra help, living on a modest income. Thanks to the tax payers. But you are paying for what is CNA et al's blll and ACS-Xerox is the main documented culprit for obstructing it.
Along with who ever 'stole' four years of my records out of my file several years go before 'they' took control of the program.
Linda Joy Adams 1/5/14
ACS CEO Blodgett still paying without sending part D to recovery as legally required. Today Aetna had no Blues on the common working file they got and has no idea how to make Emblem Health International, formerly Group Health obey the law nor how to make Affiliated Conmputer Services obey the law either as intermediary payer for Part D Medicare. Patients get overpaid due to this illegal dumping on Medicare as SSA still will no proves an SSA 632 as they agreed to do in 2005 and Aetna and all the other insurers are in legal jeopardy, The first penalty assed by HHS OIG under HR 1063 in a similar case as ours was 4 times the amount paid by Medicare. Ours is worse as we have begged for the law t be obeyed and gotten judges' orders etc, Case M09-1406 at Medicare and orders from US Dept of Labor for ACS to post my files from my records and pay, etc. There is a set aside on me and other federal cases and I do not have it and only ACS employees saw the amounts that ACS apparently took and disappeared and we have been left with nothing but a death panel "let her die" order and overpayment liabilities to Medicare. Emblem Health International per ACS illegally deletes every ones primary employer group health plan off the common working file to trick all in to illegal dumping and them now can assign penalties and fines for what they tricked every one into doing. WILL GROUP HEALTH BE THE ONLY HEALTH ISURER LEFT IN THE USA AS THEY CAN NOW PUT ALL THEIR COMPETITORS OUT OF BUSINESS? Since they cannot be internally audited anymore and Congress will not et one penny be spend to shut down the illegal operation, OBEY THE LAW, PLEASE! Aetna kept hanging up on me and PLESE SEND ME A COPY OF THE COMMON WORKING FILE YOU GOT TODAY SHOWING NO FEDERAL BLUES ON IT AS ONE OF THE TWO PRIMARY PAYERS ALONG WITH FEDERAL WORKERS COMP GET THIS TO YOUR ATTYS FOR AETNA TO PRTIECT YOUR COMPANY FROM THIS GOES FOR ALL OUR INSURES. STOP GOING ALONG WITH THIS FRAUD SEND THE PAID COIMS TO RECOVERY AT MEDICARE AND SEND US A COPY SO WE KNOW ITS BEEN DONE, THEN WE ARE ALL OK WITH THE LAW. Linda Joy Adams
We are still sending prescription drugs request for payment of co pays back and forth with Fed Boues and none know how or where to get the co pays for the past paid ones and this is a lot as we have been at this since 1/06 trying to find out and file. pharmacies couldn't split bill with the fed boues deleted off the common working file at the medicare partner as everyone's primary employer group health plan is deleted to permit the illegal dumping onto medicare for those with a primary. Its time for the rights of all of us be obtainable. FEHB policies are a lie as there is no written plan, just that some large pharmacies have been able to do the split billing on their own? making them much more work.
SINCE 3/14, WE NOW KNOW THAT PART D MEDCIARE LAW WAS WRTTEN TO ALLOW MAJOR THEFTS TO OCCUR INSIDE ACS ET AL ETC, AS NOTHING HAS EVER BEEN SENT TO RECOVERY BY THEM WHO PAY THE CLAIMS AS THEIR MANAGERS WERE NEVER TOLD TO DO SO FOR ANY ONE. LINDA JOY ADAMS
UPDATE; We feds still have no written insurance policy that tells us how Part D Medicare works with our Federal Blue Cross Blue shield. On part A and B it's clearly explained in our policy we get each year. Unless we go to a doctor etc that does not accept either insurance , we pay $0 between the two . For the last few years that has been what happens at Walmart, except for the Blues being off the billing system and they have to do a split billing except for a 'narcotic painkiller med as many policies do not cover those. We are supposed to be able to mail in a form and receipt and get the co pays back when it does not get split billed to both at the pharmacy and no one knows where to send them. If certain ones are not in, they can only give us the meds as is on the slip and what is says. And at times we have to remind them to bill the other insurance as the Fed Blues is deleted to do the illegal dump onto Medicare. THE MEDICARE SYSTEM JUST IS NOT TO BE HACKED AS IS HAS FOR YEARS. Prayerfully this has stopped and both will remain the Medicare system and no issues. any more. we have over $1000 we keep trying to send her and there and get money back as a few years ago we had an address and got some back. ILLEGAL HACKING IS NOT TO BE GOING ON AND SINCE THE COUP OF 2002 WE HAVE HAD NO REAL GOVERNMENT TO OFFICIALLY KNOW AND STOP IT. Maybe this is now changing? as its robbing the Medicare trust fund by doing an illegal bail out of our health insurers. All of this should have been known and dealt with before we put the whole nation's health care and lives under the affordable care act based on false data and facts as there is no internal audits allowed to be funded either since the COUP OF 2002 WHEN congress OVERTHREW THE AUTHORITY OF THE REAL GOVERNMENT INTO THE CONTROL OF AN INTERNATIONAL CABAL OF CONTRACTORS. This is one more area, where our elected leaders did not take care of the people's business to make sure those who do the work of government were doing it and doing it legally and constitutionally. Linda Joy Adams 8/19/16
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