The Powers That Beat
Here's the latest snafu in the State of Tennessee: TennCare Changes Benefits Without Notice Effective October 1, 2008.
.
TennCare providers, beneficiaries and advocates are once again unaware of how the new changes will affect their benefits or services concerning changes to the pharmacy plan that were implemented on October 1, 2008. No information about the changes (e.g., formulary changes, benefits coverage, or appeals, grievances or override procedures were given to providers, participants or local sent
TennCare providers, beneficiaries and advocates are once again unaware of the new changes in the pharmacy program that went into effect on October 1, 2008. New procedures were implemented by providers that have obvious HIPPA violations. Federal agencies and advocates should direct consumers to the appropriate federal agencies regarding HIPPA compliance and other possible violations of federal law.
I did find out some additional information, which is this: THERE IS NO INFORMATION!!!
Providers and consumers are unaware of new changes to the Pharmacy program for TennCare beneficiaries.
I have searched the news, the state, and cannot get through to the TennCare hotline... The last I heard, pharmacies began processing scripts late yesterday afternoon, however they are running into significant problems obtaining approval (specifically--overrides) for their TennCare participants.
I gotta tell you that I found some VERY disturbing information that was callously given to each and every TennCare recipient who had prescriptions filled at the pharmacy I went to.
I will tell you that it is a large national chain implemented new procedures for Medicaid recipients covered under the new plan. They claim it was required to obtain reimbursement from the new Rx provider. I necessary to to deal with the new pharmacy program that went into effect Oct 1, 2008..
I will scan that document and upload it to advocates since it is so over the top regarding medical privacy and HIPPA compliance.
I personally refused to sign the document, instead signing "HIPPA" instead of my name. Prescriptions will not be dispensed without the beneficiaries signature on the master list.
Take now for now,
Elyssa Durant
FOR HISTORICAL REFERENCE:
2008: I remember how difficult it was for me to obtain benefits when I first applied several years ago. I am deeply concerned about how the most recent decision to eradicate yet another class of TennCare / Medicaid recipients (the Daniels class that is made up of SSI recipients by way of a pending federal waiver) will affect the poor and disabled residents in Tennessee.
2006: Without my current level of benefits, I simply do not function.
2002: Before my benefits were stabilized, learning to navigate the system consumed every waking moment of my life. I was unable to work or attend school on any substantial level and I am frightened to see at might happen if I were to stray from my established, stabilized, treatment plan. If I lose my benefits, will I still be able to work? To function? To be productive?
2005: The massive number of people being dis-enrolled or limited in their access to medical care and other social services will no doubt create significant anxiety, confusion, and chaos for everyone involved in the social service and health care industries.
2001: I have no other benefits. No Social Security checks to count on; no disability payments to pull together; no Medicare to meet me when the bottom falls out, again. This surely is not the first time my Medicaid has not come through as a reliable source of payment. It is not even the second or third time. It more like the eight or ninth, maybe more often than that. I only recently qualified for Medicaid some eight months ago! Since then, I have already acquired several thousand dollars in unpaid medical expenses that have made their way to collection agencies.
1999: Patient X: Corporate TennCare adjusted the prescription formulary over Memorial Day in 1999 and failed refused to offer a 3-day or 14-Day emergency supply as mandated by Grier.
1996: Throughout the three year process of filing appeal after appeal after appeal, I acquired well over 1/4 million dollars in debt due to uninsured medical expenses and student loans. My life will never be the same. My heart will never be the same.
TODAY: So after all this-- now I face losing my healthcare once again? Where is the safety net? Where is the American Dream that I so diligently chased after for so many years? What was the point spending so much on an education that will never be utilized? I understand the how; I just don't understand why.
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http://unitedprofessionals.org/blog/forum/topic.php?id=105
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Pharmacy Fallout '08: Here We Go Again
Providers and Consumers Are Unaware of New Changes to the Pharmacy Program for TennCare Beneficiaries, Effective October 1, 2008
Here's the latest in the State of Tennessee: TennCare Changes Benefits Without Notice Effective October 1, 2008.
.
TennCare providers, beneficiaries and advocates are once again unaware of how the new changes will affect their benefits or services concerning changes to the pharmacy plan that were implemented on October 1, 2008. No information about the changes (e.g., formulary changes, benefits coverage, or appeals, grievances or override procedures were given to providers, participants or local sent
TennCare providers, beneficiaries and advocates are once again unaware of the new changes in the pharmacy program that went into effect on October 1, 2008. New procedures were implemented by providers that have obvious HIPPA violations. Federal agencies and advocates should direct consumers to the appropriate federal agencies regarding HIPPA compliance and other possible violations of federal law.
I did find out some additional information, which is this:
THERE IS NO INFORMATION!!!
Providers and consumers are unaware of new changes to the Pharmacy program for TennCare beneficiaries.
I have searched the news, the state, and cannot get through to the TennCare hotline... The last I heard, pharmacies began processing scripts late yesterday afternoon, however they are running into significant problems obtaining approval (specifically--overrides) for their TennCare participants.
I gotta tell you that I found some VERY disturbing information that was callously given to each and every TennCare recipient who had prescriptions filled at the pharmacy I went to.
One large national drug store chain implemented new procedures for specific to Medicaid recipients covered under the new plan. The pharmacy manager claims this was required by the underwriters in order to obtain reimbursement for covered medications and/or pharmacy services. These changes went into effect the day before the new plan was set to launch.
I will scan that document and upload it to advocates since it is so over the top regarding medical privacy and HIPPA compliance.
I personally refused to sign the document, instead signing "HIPPA" instead of my name. Prescriptions will not be dispensed without the beneficiaries signature on the master list.
Elyssa Durant
TennCare Beneficiary
--------------------------------------------------------------------------------
Resources
www.familiesusa.org
www.thcc2.org
www.unitedprofessionals.com
Wednesday, August 13, 2008
Sorry Works!
We live in a society where no one accepts responsibility for their mistakes, no one is held accountable for their actions, and no one, EVER says they are sorry.
Let me you a small glimpse inside the day in the of un/underemployed where I spend day after day after may doing the same thing without any result: I can only offer you a glimpse into day in the life because there is no room left sit in my car, and I believe my apartment may actually be a fire hazard... This was my daily update posted at 7:30am:
I have done everything humanly possible to clean up the slack; however, I feel I have no other choice than to file a formal complaint so that my entire case is reviewed. The number of mistakes is so overwhelming that I simply don't have enough time to documents each and every one within their respective agencies.
I will try to be more specific later without going into too much detail, but unfortunately, that level of detail is required to file the necessary appeals. Ironic huh? This apartment is like my own little cage, and I am just pathetic enough to run around in circles, hoping to find the much like a hamster wheel, rodent chasing in circles hoping to found my way out my way out before I run out air. If only I had finished my damn PhD, I would do my own case study or reality show on how far we'll go to have nothing at all...
I have taken care of the subrogation claim, however, that does not minimize my level of frustration because I am DROWNING in paperwork. I have contacted several agencies for assistance such as the Disability Law and Advocacy Center; however, I do not have the resources necessary to provide them with a timely response and additional documentation they would lead to do a thorough investigation. There is a very small window of time permitted to file a Request Reconsideration, or file administrative appeal.
This is not new information to anyone who has been reading this message-- and if it is, then the agency involved is in much worse shape than I believed. I WANT A RESPONSE~ I WANT AN EXPLANATION- and oddly enough, I WANT AN APOLOGY!
The simple fact that the only time I received a response from MH was when the "fraud" was entered into the conversation. Yet I was not the one who introduced it into the dialogue. It is very unfortunate that my advocate from the DLAC retired just days before we were scheduled to review my case. That was three years ago, and not a single person who sat in on that meeting has acknowledged that it even took place. So here we are, three years later, and I am asking for the exact same things: assistance filing a social security appeal, vocational rehabilitation, and to be treated with a shred of common courtesy. I cannot believe I have to spell that out for you. For anyone. Professional or otherwise. Has no one read my file? Because anyone who has would understand why I find it to be beyond comprehension that trained mental health professionals would do this to any human being, obsessive compulsive or not. Since I first moved to Nashville, I worked very hard to improve community services and de-stigmatize mental illness, yet here I am having to say this AGAIN, OUTLOUD.
I guess none of remember that I same almost the same person I was when I first moved down here. Actually, that not true. I am FAR WORSE, and feel as though I have been stripped of my dignity, professionalism, and any hope I once had to go back to work and be integrated into the world of the living.
I do not even feel comfortable in attending the very came community activities that I used to helps plan. I am so completely baffled and just plain horrified that I actually have to say these things outloud.
There is local attorney I have known or many years. He recently made some very serious, very public and very embarrassing mistakes. Prior to that event, he worked on legislation capping damages in medical malpractice claims. He had an expression that he would use quite often and that was, "Sorry Works!" He was right. "Sorry" does work, yet still haven't heard it being said. Ultimately, those two little words became the driving force behind his political legacy and the force at the core of his being when he went in to recovery. The last interview he did on TV, he told the reporter that he does not wish to be remembered for the mistakes, but how went about correcting them. People, listen up, "SORRY WORKS!"
I also want to be clear that every time I have to call Social Security or DHS, it only compounds my cost of living expenses (40 cents per minute on the telephone -- a bill which is not even considered to be a justifiable expense) Most agencies do not include self-addressed stamped envelopes, and I cannot afford the postage required to mail out all of the requested documentation (e.g., utility bills, medical bills, pay stubs, etc.) So when one your employees tells me that he has removed himself from my case, I should not have to spend 29 minutes on old with the Social Security Administration just to learn that he was trying to intimidate me by threatening to have my funds frozen immediately. I think I should be reimbursed for that phone call. I think he should have to pay out out of his own pocket.
That statement was made not only to me, but also in front if other employees at your agency. It is not only irresponsible and unprofessional, but it also probably illegal, and justifies the complaint I will be filing against him in order to re-cap dome the damages. It is called breach of fiduciary duty, although I expect you probably already know that, but if you don't, you should look it up along with subrogation, since I'm pretty sure that one falls should the scope of services you were contracted to provide for at that time.
Fortunately, a number of agencies will take online complaints. Unfortunately, my internet was interrupted for non-payment for several weeks and there is no funding resource or community agency that provides subsidized Internet access or free printer ink. Transportation costs are ridiculous so going to the library is not an option. Neither is returning to work right now, since it would cost too much to get to the interview or provide official (expensive) copies of my graduate school transcripts necessary to update my teaching credentials, were oh, such a good investment!
Set aside, I am not the most user friendly person right about now, so I have found it difficult to put on a happy face so I can work at McDonald's which pays more than Metro anyway.
The subrogation claim has been resolved but I just learned that my breast biopsy was not pre-authorized and I was told by my INSURANCE CSR (the person who answers the phone!) that I should not have the surgery that has already been scheduled at the Women's Hospital for 8/21/2008. AmeriChoice (United HealthCare) did they did not authorize the biopsy last month, and have not, as of yet, received a request prior authorization for the surgery next week...
This was a lovely 54 minute conversation because he would not mail me copies of my EOBs or confirm that what, if any, requests have been submitted for payment since my last inquiry and change of address. He finally told me to call the state (Tennessee) which I have already done several times, and they told me to call Social Security but it was already past business hours and I am not authorized to make changes to my file anyway.
I'll be in touch when I can. Unfortunately, each agency has different deadlines, and it takes a lot of energy and time to scan in, copy, or respond to each inquiry in writing, so I find myself running out of time since I can't seem to get anything done unless I just do nothing at all.
And even though my life is a living hell, I have almost learned how to enjoy the sheer irony of it all... for someone with OCD and posttraumatic stress, this is truly a ridiculous little experiment.
I am becoming increasingly inspired to just burn every last document I own, throw away my keys and my cell phone and take Spotty some place where we can live off the land and ignore the fact that society has me chained to a computer screen that screen that does provide the basic necessities I need to live in this .
I have come this far, and I am becoming rather skilled and at expressing myself without needing an audience or the obsessive need to check every fact, throw, and typo for capitalization and perfection.
So for now... I write.
Maybe later, I'll read, but if there is any justice left in this world, someday, I'll actually live.
Good-bye for now. I need a break.
With love,
Let me you a small glimpse inside the day in the of un/underemployed where I spend day after day after may doing the same thing without any result: I can only offer you a glimpse into day in the life because there is no room left sit in my car, and I believe my apartment may actually be a fire hazard... This was my daily update posted at 7:30am:
I have done everything humanly possible to clean up the slack; however, I feel I have no other choice than to file a formal complaint so that my entire case is reviewed. The number of mistakes is so overwhelming that I simply don't have enough time to documents each and every one within their respective agencies.
I will try to be more specific later without going into too much detail, but unfortunately, that level of detail is required to file the necessary appeals. Ironic huh? This apartment is like my own little cage, and I am just pathetic enough to run around in circles, hoping to find the much like a hamster wheel, rodent chasing in circles hoping to found my way out my way out before I run out air. If only I had finished my damn PhD, I would do my own case study or reality show on how far we'll go to have nothing at all...
I have taken care of the subrogation claim, however, that does not minimize my level of frustration because I am DROWNING in paperwork. I have contacted several agencies for assistance such as the Disability Law and Advocacy Center; however, I do not have the resources necessary to provide them with a timely response and additional documentation they would lead to do a thorough investigation. There is a very small window of time permitted to file a Request Reconsideration, or file administrative appeal.
This is not new information to anyone who has been reading this message-- and if it is, then the agency involved is in much worse shape than I believed. I WANT A RESPONSE~ I WANT AN EXPLANATION- and oddly enough, I WANT AN APOLOGY!
The simple fact that the only time I received a response from MH was when the "fraud" was entered into the conversation. Yet I was not the one who introduced it into the dialogue. It is very unfortunate that my advocate from the DLAC retired just days before we were scheduled to review my case. That was three years ago, and not a single person who sat in on that meeting has acknowledged that it even took place. So here we are, three years later, and I am asking for the exact same things: assistance filing a social security appeal, vocational rehabilitation, and to be treated with a shred of common courtesy. I cannot believe I have to spell that out for you. For anyone. Professional or otherwise. Has no one read my file? Because anyone who has would understand why I find it to be beyond comprehension that trained mental health professionals would do this to any human being, obsessive compulsive or not. Since I first moved to Nashville, I worked very hard to improve community services and de-stigmatize mental illness, yet here I am having to say this AGAIN, OUTLOUD.
I guess none of remember that I same almost the same person I was when I first moved down here. Actually, that not true. I am FAR WORSE, and feel as though I have been stripped of my dignity, professionalism, and any hope I once had to go back to work and be integrated into the world of the living.
I do not even feel comfortable in attending the very came community activities that I used to helps plan. I am so completely baffled and just plain horrified that I actually have to say these things outloud.
There is local attorney I have known or many years. He recently made some very serious, very public and very embarrassing mistakes. Prior to that event, he worked on legislation capping damages in medical malpractice claims. He had an expression that he would use quite often and that was, "Sorry Works!" He was right. "Sorry" does work, yet still haven't heard it being said. Ultimately, those two little words became the driving force behind his political legacy and the force at the core of his being when he went in to recovery. The last interview he did on TV, he told the reporter that he does not wish to be remembered for the mistakes, but how went about correcting them. People, listen up, "SORRY WORKS!"
I also want to be clear that every time I have to call Social Security or DHS, it only compounds my cost of living expenses (40 cents per minute on the telephone -- a bill which is not even considered to be a justifiable expense) Most agencies do not include self-addressed stamped envelopes, and I cannot afford the postage required to mail out all of the requested documentation (e.g., utility bills, medical bills, pay stubs, etc.) So when one your employees tells me that he has removed himself from my case, I should not have to spend 29 minutes on old with the Social Security Administration just to learn that he was trying to intimidate me by threatening to have my funds frozen immediately. I think I should be reimbursed for that phone call. I think he should have to pay out out of his own pocket.
That statement was made not only to me, but also in front if other employees at your agency. It is not only irresponsible and unprofessional, but it also probably illegal, and justifies the complaint I will be filing against him in order to re-cap dome the damages. It is called breach of fiduciary duty, although I expect you probably already know that, but if you don't, you should look it up along with subrogation, since I'm pretty sure that one falls should the scope of services you were contracted to provide for at that time.
Fortunately, a number of agencies will take online complaints. Unfortunately, my internet was interrupted for non-payment for several weeks and there is no funding resource or community agency that provides subsidized Internet access or free printer ink. Transportation costs are ridiculous so going to the library is not an option. Neither is returning to work right now, since it would cost too much to get to the interview or provide official (expensive) copies of my graduate school transcripts necessary to update my teaching credentials, were oh, such a good investment!
Set aside, I am not the most user friendly person right about now, so I have found it difficult to put on a happy face so I can work at McDonald's which pays more than Metro anyway.
The subrogation claim has been resolved but I just learned that my breast biopsy was not pre-authorized and I was told by my INSURANCE CSR (the person who answers the phone!) that I should not have the surgery that has already been scheduled at the Women's Hospital for 8/21/2008. AmeriChoice (United HealthCare) did they did not authorize the biopsy last month, and have not, as of yet, received a request prior authorization for the surgery next week...
This was a lovely 54 minute conversation because he would not mail me copies of my EOBs or confirm that what, if any, requests have been submitted for payment since my last inquiry and change of address. He finally told me to call the state (Tennessee) which I have already done several times, and they told me to call Social Security but it was already past business hours and I am not authorized to make changes to my file anyway.
I'll be in touch when I can. Unfortunately, each agency has different deadlines, and it takes a lot of energy and time to scan in, copy, or respond to each inquiry in writing, so I find myself running out of time since I can't seem to get anything done unless I just do nothing at all.
And even though my life is a living hell, I have almost learned how to enjoy the sheer irony of it all... for someone with OCD and posttraumatic stress, this is truly a ridiculous little experiment.
I am becoming increasingly inspired to just burn every last document I own, throw away my keys and my cell phone and take Spotty some place where we can live off the land and ignore the fact that society has me chained to a computer screen that screen that does provide the basic necessities I need to live in this .
I have come this far, and I am becoming rather skilled and at expressing myself without needing an audience or the obsessive need to check every fact, throw, and typo for capitalization and perfection.
So for now... I write.
Maybe later, I'll read, but if there is any justice left in this world, someday, I'll actually live.
Good-bye for now. I need a break.
With love,
Saturday, August 9, 2008
Media Manipulation: Metro Nashville Public Schools
Educated Decision or Media Manipulation? (The Nashville City Paper, July 17, 2008)
If I didn't know better, I would think that the local media is supporting the ridiculous decision to transfer MNPS principals from one failing metro school to the next after reading "State reorganization moves on to school principal assignments," July 9, 2008.
I find it deeply disturbing that the media (and the community) have failed to recognize this for what it is: a desperate attempt to convince the community that we are actively working to improve the quality of education in our public schools.
This last minute attempt to restructure neighborhood schools will most likely do more harm than good to the community at large. The high rate of student mobility in Metro (approximately 40% per year) is compounded by the constant shifting of district-wide changes to school personnel by transferring teachers, administrators, and support staff on a regular basis.
Everything we know about the sociology of education in urban schools shows us that there is a strong correlation between parental involvement and student performance.
One thing that makes magnet, lottery, charter, parochial, and private schools so good is the fact that parents, teachers, students and administrators fight to get in, and fight to stay there.
Successful schools are an extension of the community at large, where everyone works together to create a common set of experiences; creating an environment that encourages parental involvement and community participation.
If Metro continues to alienate educators by disemboweling the organizational structure within public schools, we may just lose the few experienced and dedicated teachers we still have left to surrounding districts, cities, and states.
By failing to examine the issue in further detail, the press and our community leaders are failing in their mission to provide the community with the information they need to participate in the political process that is MNPS. The media have a responsibility to examine and provide the community with the information they need to make informed policy decisions.
Elyssa Durant, Ed.M.
Nashville, Tennessee
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Posted: Thursday, July 17, 2008 1:47 am
If I didn't know better, I would think that the local media is supporting the ridiculous decision to transfer MNPS principals from one failing metro school to the next after reading "State reorganization moves on to school principal assignments," July 9, 2008.
I find it deeply disturbing that the media (and the community) have failed to recognize this for what it is: a desperate attempt to convince the community that we are actively working to improve the quality of education in our public schools.
This last minute attempt to restructure neighborhood schools will most likely do more harm than good to the community at large. The high rate of student mobility in Metro (approximately 40% per year) is compounded by the constant shifting of district-wide changes to school personnel by transferring teachers, administrators, and support staff on a regular basis.
Everything we know about the sociology of education in urban schools shows us that there is a strong correlation between parental involvement and student performance.
One thing that makes magnet, lottery, charter, parochial, and private schools so good is the fact that parents, teachers, students and administrators fight to get in, and fight to stay there.
Successful schools are an extension of the community at large, where everyone works together to create a common set of experiences; creating an environment that encourages parental involvement and community participation.
If Metro continues to alienate educators by disemboweling the organizational structure within public schools, we may just lose the few experienced and dedicated teachers we still have left to surrounding districts, cities, and states.
By failing to examine the issue in further detail, the press and our community leaders are failing in their mission to provide the community with the information they need to participate in the political process that is MNPS. The media have a responsibility to examine and provide the community with the information they need to make informed policy decisions.
Elyssa Durant, Ed.M.
Nashville, Tennessee
Share: Digg Del.icio.us Technorati Newsvine StumbleUpon Google
Posted: Thursday, July 17, 2008 1:47 am
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