VIOLATIONS OF CIVIL RIGHTS PAGE 46: TO CAREMARK-FED BLUES PRESCRIPTION PLAN.

Linda Joy Adams: VIOLATIONS OF CIVIL RIGHTS PAGE 45: RESPONSE TO HUMANA PART D MEDICARE This is a link to  a posting  ad filing with Humana which is Doyle's Part D Medicare plan

All of us have had similar problems with our various plans as explained in that filing where  until this year, we have not received pay for our co pays. We were misinformed that there was none and to this year, our federal Blue Cross Blue Shield booklet ( contract) does not tell us what the coordination plan is between FEHB plans and Part D Medicare.. We are now paying $0 at Walmart.

Linda  just spoke to some nice people at the mail order service for Blues and they still can not do split billing and have no idea what the coordination plan is either

When Doyle turned 65 a few years ago he contacted several part D plans and not one salesperson could explain what the coverage would be. All he was told is sign up and see what happens. he initially signed up with Aetna and went to fill a prescription and Nothing was paid not even the Blues part.

So he cancelled the plan and waited a year.  Now we know he could have had full coverage all that time;

 In 2011,walmart, made a deal with Humana that they would offer the $4 for any generic under their Part D plan and Doyle signed up. But he does not get special help so he has had to pay  the premiums and Linda doesn't as she was grandfathered in she was told under the provisions that cost of living raises does not cancel one from the special assistance. Doyle has had a hearing pending on that issue for several years .

The dependent on the Blues was converted from Medicaid to Medco and now they have an Express Script plan and all of us have had to pay what we were repeatedly told the lower of the two co pays of the plans which would be the Medicare co pay.

NOW WE KNOW THAT IS NOT TRUE AND NO ONE HAS EVER GIVEN US ANY WRITTEN PLAN ALTHOUGH WE HAVE CIVIL RIGHTS COMPLAINTS PENDING ON THIS AND APPEALS AND WRITTEN REQUESTS THAT HAVE NEVER BEEN ANSWERED PLUS NUMEROUS PHONE CALLS.

Linda had Silver script   in 2006 and then  AARP before  the special assistance programs said she had to switch and did to Aetna. None of them could ever answer and give the policy in writing and all never had Blues pay anything. Now we find out. Even AARP could not get an answer?,.

And when Medicare pays and Medicare is not primary the patient or their estate  is over paid and ACS-_Xerox has never sent any of the paid claims to recovery unit to get the money back.  That action would relive both the patient and the pharmacy of any liability.

     Our Forms SSA 632 for a waiver of liability have never ben answered by Social Security which agreed to process these in 2005 for CMS. These are where  we give no personal financial info as its "against equity and good conscience' for this to be occurring and we have done everything legally possible to stop this but the govt itself can't either?

HOW CAN ONES INSURANCE COVERAGE BE 'SECRET' EVEN FROM THE PHARMACY?

It can under the current coup of govt contractors in charge where there are no internal audits so no govt official has any idea what is going on as its all up to these unaccountable entities and NGS ( Northrup Grumman? we are led to believe and they under Affiliated Computer Services -Xerox and CEO Lynn Blodgett are the final authority and not the Medicare judges, nor Congress nor the President at all. THAT IS A REAL COUP AND DEATH PANEL OF THE US CONSTITUTIONAL RIGHTS OF EVERY ONE WHO HAS MEDICARE AND ONE OF THE FEDERAL HEALTH BENEFIT PLANS WHETHER ITS PRIMARY OR SECONDARY TO MEDICARE.

                                              ATTACHED ARE FORMS ASKING FOR ALL THE CO PAYS BE PAID BACK TO 1/1/06 ON Linda, AND BACK TO THE ENTITLEMENT DATE FOR Medicare FOR Doyle AND FOR _____________.

We understand we are in a process to obtain these. But there is a documented history of attempts still pending that far back  to find out and filings on this back to 2005, when Linda had to make a choice of signing up or not for a Part D plan which it seems the press was to discourage the feds from doing so and in light of what the coordination plan is and was as the Blues booklet has never said there was any change since 2006, just never said what the plan was. , Many would have signed up and been greatly helped on fixed incomes as most feds do not get those higher Pensions that are so spewed out about in the media. Those are gotten by the upper echelon not the rank and file worker.

   Linda doesn't even know what a permanent retirement pension might be as the leave buy back is not done until she retires by US Dep,t of Labor coordinating with her employing agency.  We can't even get a coordination plan given for Medicare and FEHB plans . But part A and B of Medicare does and means $0 has to be paid, except for a few items not covered under one or the other,.

        The 2014 Blues  Booklet , pages  attached, shows that Medicare makes the decision as to who pays first. The official posting on us comes from the US Dept of Labor on Linda and even the Medicare appellate judge has ruled it is accurate showing Linda as active duty and Medicare is secondary to federal Blues and for Linda  Fed Blues and Fed worker comp.'s are her primaries.

So why is their any more discussion and the deletion of the Blues form the commons working file to make it come out otherwise by tricking all to bill Medicare and not the primaries?

      Since CEO Blodgett has total  info control of all  the plans and his company ACS-Xerox even  pays the Part D Medicare claims for all; he disagrees with the Judges rulings and has ordered all the plans to defy the law, the Judges and even all of their govt contract terms.

Our Blue Cross/ Blue Shield is only on the common working file a few hours every other Tues AM and then deleted on his orders to Blues through NGS and our reports and letters  received from parties says he has personally given the false info they are bound to follow against the law, and the US Constitution and judges rulings even though the Blues policy says the judges orders are the ones to follow as  that is the ultimate authority at Medicare of interpretation of  the whole not the govt contractor..  No one is allowed to alter the official posting and its accurate according  to the real records at OPM  their general counsel  accessed  a few years ago  on Linda and also by  Linda's personnel file that has gone missing into the hands of ACS? and CEO Blodgett misinformed the Commissioner of SSA that Linda had gotten a settlement and retired and she was deleted from SSA rolls without any paper work and AFGE union got her dropped form the list they get, too..

 NONE  get any bi- weekly notice of this deletion of our coverage and no appeal rights either for them to do this. One gets deleted and is not notified?  No Fourth amendment rights of due process? Keep hard copies of your employment records as  one may need them.

                                   PERSONAL PLEA

Please do respond to this from what you are to legally do and if need to ask your legal dept for assistance as they can access the case number of the appellate ruling M09-1406 and no change in status has occurred since as CEO Blodgett still refuses to comply with US Dept. of Labor appellate  Judges who ordered him to post Linda;s Federal worker;s comp  file using her records and process and pay  and ASK ILNDA FOR THE FACTS OF THE CASE, etc. Included in that is her pending request for permanent disability and schedule award which has to be done before she can legally retire.



 Linda's repeated contacts and certified letters are ignored to set up a systematic working through of the back log of items to process that have never been done,  and Linda has suggested start with 1989 and finished up the few items left from there and work the way through the years chronologically as discoveries and conditions, etc. were known from  the original 1/10/89 injury of Toxic fumes inhalation with bronchial spasms and the resultant occupational asthma disease and chemically induced pneumonitis that has already been established  as of 1/10/89, too. on her permanent medical benefits due to workers comp outing her on  home liquid oxygen  for life almost 20 years ago and the supplier in the area needs to be paid and permitted to service and come and send in the claims. which they have been denied this since ACS took over.. her current medical needs need to be paid for and addressed.

There are a few items pending as far back  as 1989; as well as the current benefits that need to be paid.

There has been a 25 year pattern of file disappearances and rifling that caused over  and over such  interruption in claims being paid as Linda had to appeal and always was reinstated and items processed. as judges and hearing officers were obeyed. But this time the govt contractor defies the judges as they are not subject to their orders? Her claims examiner Ms. Carter  says she is unable to do anything to get access to her file which was shredded according to an employee of ACS.

Shredding a file does not end appeals, judges orders nor the permanent medical benefits she already has for them and they should be paying for her prescriptions and Blues should be sending them a request for repayment..

Linda files and they respond  referring to a missing million per head of suspected embezzlement ring according to OPM's OIG and they have never been allowed to investigate as Linda is not the only one ACS Employees say  it shows on their screen back when they took over. That  million is somewhere for  each of us? Initially  ACS was saying to medical providers and even Lincare her oxygen supplier back in 1/06, that she had the million. and didn't get such and started to try and find out...leading her to OIG at OPM. It would be nice for  every one not to deal with filing claims and begging for medical care to stay alive, but no one has ever heard of such a law...for federal employees. We do know that the parties directly involved  were involved with the Jack Abramoff bribery scandal and from all we know the money for our medical care for injured workers was used to pay bribes in all of the agencies other than Indian Affairs as allegations have been made re at SSA, HHS, US Dept. of Labor and ? Those investigations were never fully completed as far as any one knows are any allowed to say, No one has ever said they are done with at all.             

   We are not in a position to be privy to any on going criminal investigations other than we have been told they can do none against a govt contractor or employees of them until Congress allows money to be spent for that purpose is the message given to us by even Mr Gould in the US Justice Dept. assigned a few years ago and said they couldn't until Congress allows, it. on any of the crimes we have discovered in trying to get medical care and get out form under the over payment liability.

Tine to elect a Congress that will see it is done as lives  and livelihoods as well as the taxpayers money is in jeopardy and already many have been lost of all.

                                       NEW COMPOUND CLAIMS

Also included are the claims for the compound which Part D Medicare does not pay for nor does Part B. and for many like Linda there are no safe inhalers anymore.

Just as Medicare does not pay for oxygen if there is no supplier, all of these issues have hearings pending at Medicare but our files have disappeared into the hands of CEO Blodgett and ACS and that is part of the mountain of paper work to be followed up on. And its difficult for old, and disabled persons to do this all, but when ones very life depends on it, etc. we try our best.

        Thanks for your consideration in this and hope to receive full reimbursement for all the co pays back to 1/1/06, also.

We have attached the print outs from  Walmart and others should be on file with you where we used the Mail order. We beg that you not make us put all these on the separate claims forms but can just run the systems records for reimbursement. We understand at this point, you are having to pay second to Medicare as that is your orders and we have asked the Part D plans to send all their paid claims to recovery to recover back the portion you should have also paid as primary,

Its unconstitutional and a violations of our civil rights that no one involved with these plans have ever been allowed to have a written coordination plan and to this day none has been made available. We just know, that with no new changes this year, all of a sudden, we get the total paid for.

                                               



Linda Joy Adams, Doyle E Adams, and ________________ 7/15/14