The Powers That Beat
Here's the latest snafu in the State of Tennessee: TennCare Changes Benefits Without Notice Effective October 1, 2008.
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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FOR HISTORICAL REFERENCE: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
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Resources
www.familiesusa.org
www.thcc2.org
www.unitedprofessionals.com
