Seniors and the disabled get their prescription drugs despite problems

When Stephanie Arrigotti calls the insurance provider to inquire about her elderly mother's prescription drug benefit, the phone system hangs up on her.

Sandra Lund was auto enrolled into a prescription drug plan that did not cover any of her mental health drugs.

After long holds on the telephone that went no where, Pauline and George Bauman are starting to get somewhere with his drug plan. It's just in time: He has to fill three prescriptions this week.

Northern Nevadans and millions across the nation are attempting to figure out their new federal prescription drug benefits that went into effect Jan. 1. The surge of end-of-the-year applicants overloaded the system, a Medicare spokesman said, and many participants have not received their plastic identification cards needed to bill the plan provider for their prescription drugs.

Pharmacists complain that they cannot not get the information needed to bill the insurance provider, or even find out whether the patient is enrolled with that plan. Medicare prescription drug coverage, known as Part D, is available to Medicare participants through private insurance plans subsidized by the government, at a federal cost estimated to be $724 billion in the first 10 years.

Sixty-three plans with different premiums and deductibles are offered in Nevada.

"I think we're getting more used to it," said Carson City pharmacist Mike Hautekeet. "We know where to go now. You still have to wait on the phone with the insurance companies for 15 to 20 minutes, but we have to call them less and less because we're getting to know certain plans."

George Bauman, 85, is enrolled with First Health Premier, a private insurer that operates one of the prescription drug plans. He hasn't received his card yet, but the insurance company did send the Baumans his identification number. George is also taking free samples of one of his more expensive pills until the prescription can be filled.

"The pharmacy called a while ago and said they had it all straightened out," Pauline Bauman said.

Lund, 47, who lives in north Reno, is a dual participant in Medicare/Medicaid, so she was assigned to a plan by the government.

"The frustrating part for me was being automatically enrolled into a program by the Medicare/Medicaid people when I had already chosen one that covered my needs," she said. "However I soon found out through my own research the one I chose did not cover any mental health drugs, such as antidepressants. But neither did the one that they chose for me."

After much research she finally found one plan, out of the 18 open to her, that would cover mental health drugs.

Arrigotti of Carson City signed her mother, Mabel Long, up for a prescription drug plan in late November. She has not yet received her card because it was sent to the wrong address. To solve this problem, Arrigotti has had to call the insurance provider. Humana's hotline is overloaded. and has kicked her off every time she's called it.

"I can't imagine how an 81-year-old person would deal with this," Arrigotti said. "If she didn't have me to jump through these hoops, she would have no prescriptions. Or she'd be paying full prices for her prescriptions, as well as having a monthly enrollment fee withdrawn from her Social Security checks."

One million new Humana members are coming on at this time, which has created difficulties, a company spokesman said.

"We are on our way to solving what have been isolated difficulties that are to be expected under the circumstances," said Ross McLerran, Humana media relations manager. "That said, we certainly apologize to any of our new enrollees if they have encountered delays in getting services. We are confident their needs will be met and that the issues cited will be corrected very soon."

Jack Cheevers, Medicare spokesman for the regional office in San Francisco, said Medicare is urging its drug insurance providers to put more people on the phones to handle the increased number of calls. Medicare is also asking the providers to process applications in a few days, rather than the five to seven days it normally takes. It takes three to five weeks for a participant to receive his or her identification card.

"We're urging pharmacists who know of anybody in real trouble, and they are worried about that person's health, to call 1-800-MEDICARE and report that situation," he said. "We'll assign them to one of our case workers in our regional office, to someone who knows how to go into rapid action."

So far, pharmacist Kirk Wentworth has assisted one patient with getting emergency help with prescription drugs. He said the process is getting better, but he never anticipated how difficult it would be.

"We're kind of charged with taking care of the health drug benefits for people who have no family to help them out," he said. "I didn't go to school with that in mind - not in terms of managing people's health insurance. But who else is going to do it if they can't?"

n Contact reporter Becky Bosshart at bbosshart@nevadaappeal.com or 881-1212.