So I have had TennCare as secondary insurance since September 2012. I became entitled to Medicare and basically I get under a certain amount in social security, so I get TennCare, which pays my 100$ monthly medicare premium and basically tells doctors 'We won't pay you, Medicare already paid you more than we would have, but you cannot bill her for that 20% since she has secondary insurance."
Great.
Really, Medicare is an improvement. Seriously.
Anyhoo last Saturday (the 26th of January 2013) I got this beauty. I figured it was some crap telling me about 'changes to TennCare drug coverage program, as administered by SXC Health Solutions', garbage they send me on a regular basis telling me how they don't cover xxx anymore. (I do NOT get prescriptions through TennCare anymore, so I usually disregard these.)
Since it was handwritten, I opened it.
As you can see by the post mark, it was sent out by SXC (TennCare) on January 16, 2013.
(More after the jump)
As you can see on the letter, it is dated August 13, 2012.
Great.. right? Okay, so I was a bit confused until I read the letter.
(Jump with me now!)
Well, I have until September 22, 2012 to appeal my denial on a prescription I asked to be covered. Great, considering you didn't mail it until January 16, 2013.
By the way, I put little arrows for your reading pleasure. I realize its a bit small, but blogger wont let me blow them up anymore :(
Oh.. and the drug I appealed on August 13, 2012? A twin set Epi-Pen.
Epinephrine.. you know for life threatening allergies?
While filing this appeal, I did ask them what drugs they considered to be emergency drugs they would cover.
Epi-Pen is NOT one of them. There are no generics. They wouldn't have covered them anyways since I had reached my limit.
Upon questioning them further (I remember this conversation.. it agitated me) I asked if I had an allergic reaction today, used my Epi Pen (that I didn't have) and had to go to the hospital for treatment, was discharged the next day and needed a new one and had a script from the doctor, would they fill it?
They said if I had reached my 2 brand name limit.. NO!
That's a peach ain't it? Epi-Pen is ONLY for life threatening emergencies. That's what its made for. So how the hell is this not an EMERGENCY DRUG?!
(One more photo after the jump!)
Look.. they repeated themselves!
Well thanks TennCare!
By the way, TennCare is supposed to decide and respond within 90 days of an appeal.. and send this letter out immediately after pharmacy denial.
Look at that, someone broke their own rules! AGAIN.
Can anyone say FAIL?
By the way.. there are about 9 more pages, most in Spanish that I have omitted.
Have a problem like this too? Comment!
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