TennCare and SXC FAIL AGAIN!

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!

Food Stamp Challenge

HERE

I have a problem with this. Its made headlines lately because of New Jersey city Newark's Mayor, Corey Booker.

They are doing it by average recipent amount per state.
So.. what about the 16$ a month minimum benefit that people like me receive?
I no longer receive any benefits, due to a massive error on the great old state of TN's part (ugh) but I'd like to see them all live off .53 cents a day.
Try it.
Its not easy.

I'm participating and I will update with my food choices.
Some notes to remember about me:
I have an adjustable gastric band (Lapband) so I eat LESS in portion sizes than others, but more frequently.
I am coming off a 3 day doctor prescribed liquid diet (that ends at midnight on 12/3 or right about now)

I focus on protein, veg/fruit and THEN carbs if at all.

I do this EVERY month, with or without a 'challenge'.
I regularly skip filling prescribed medicines because I must choose between food, gas (to get to the doctor) and medicine co-pays.

Anyhoo heres an article about Corey Booker and his challenge:

Cory Booker did a little grocery shopping this weekend. A very little.

The Newark Mayor is taking the Food Stamp challenge and will spend one week, beginning Tuesday, eating only what food stamps can provide.

The average monthly food stamp benefit was $133.26 per person in New Jersey in fiscal year 2011, according to the US Department of Agriculture. That's a little over $33 per week, or $4 per day.

No word yet on what Booker bought, but he did tweet that he will be doing without coffee this week.

"I won't be able to afford it," he tweeted.

Adding a little perspective to this is Starbucks' announcement last week that the coffee company is introducing a $7 cup of joe — about two days worth of food for those living on food stamps.

But its not just premium coffee. Milk costs about $3.50, according to the Bureau of Labor Statistics.

The Food Stamp challenge aims to highlight what it is like to live on the Supplemental Nutrition Assistance Program. The challenge is sponsored and promoted by the Food Research and Action Center.

Many people have tweeted Booker in the past week to say they will join him.

Booker has also received several tweets excoriating the idea.

One gentleman named Samuel wrote the mayor, "Food stamps are meant to be supplemental income, not ones ENTIRE income. So this challenge is bunk."

Households must meet an income test to qualify for food stamps. For a household of one, that means net income must not exceed $931 per month.

This all began after a back-and-forth conversation between Booker and a woman who goes by the name TwitWit and uses the handle (at)MWadeNC. They began talking about the idea while discussing the role the government should play in funding school breakfast and lunch programs.

During their Twitter exchange, TwitWit wrote, "nutrition is not the responsibility of the government."

The conversation soon changed to food stamps.

"Why is there a family today that is 'too poor to afford breakfast' "? are they not already receiving food stamps?" TwitWit wrote.

"Let's you and I try to live on food stamps in New Jersey (high cost of living) and feed a family for a week or month. U game?" Booker responded.

In an interview with The Associated Press TwitWit said she is a 39-year-old married mother of two from North Carolina. She spoke to the AP on condition of anonymity because she said she has received threats since her Twitter discussion about food stamps.

She said she is willing to participate in the challenge but wants to know the ground rules before committing. She has not heard from Booker's office and is upset she has not been included in the research process.

"To hear he's planning and setting things up, it makes me feel like I'm a little bit of a prop in the game," she said.

Courtesy of The Star-Ledger

Social Security Doesn't Allow the Disabled to Marry

There are multiple kinds of disability benefits. I'm going to touch on THREE (3) kinds that fall within the 'disability' benefit category.

1. SSDI/DAC 'Adult Disabled Child'
   The SSDI program pays benefits to adults who have a disability that began before they became 22 years old. We consider this SSDI benefit as a “child’s” benefit because it is 

paid on a parent’s Social Security earnings record.
For a disabled adult to become entitled to this “child” benefit, one of his or her parents:

• Must be receiving Social Security retirement or disability benefits; or
• Must have died and have worked long enough under Social Security.

These benefits also are payable to an adult who received dependents benefits on a parent’s Social Security earnings record prior to age 18, if he or she is disabled at age 18. We make the disability decision using the disability rules for adults.

SSDI disabled adult “child” benefits continue as long as the individual remains disabled. Your child does not need to have worked to get these benefits.

      2. Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes):

It is designed to help aged, blind, and disabled people, who have little or no income; and

It provides cash to meet basic needs for food, clothing, and shelter. -- This is referred to as 'the United States biggest Welfare program' by Social Security. 3. SSDI Social Security Disability Insurance, or SSDI, provides benefits to individuals who are disabled or blind. SSDI is funded by employees’ contributions to the Social Security trust fund, or the Federal Insurance Contributions Act (FICA) social security tax paid on yearly earnings. In order to be eligible for SSDI, your loved one must have: Paid some of these taxes in recent years Worked and paid social security taxes long enough to be covered under social security insurance. To sum it up for you SSI is out of general taxes, is for low income people only (with disabilities) and is considered welfare. SSDI is based off taxes you paid into the system while working, and you are only eligible for SSDI disability payments after paying into the system long enough. Your SSDI payment will be based upon what you put into the program via taxes. SSDI/DAC is an SSDI benefit that a disabled child (or adult) may claim, based upon what the parent put into the SSDI program from their earned wages (taxes) Now for the fun stuff. I receive SSDI from my work history AND DAC. Social security works like this: If you get approved for benefits and meet each programs criteria, you must be individually approved for each program. So if you apply to all three and meet the criteria of all three, you will get three approval letters--one from each program. Now you MAY collect multiple checks from a combination of these three sources. BUT, you do not get 'full benefits' from either. For example, you are approved for 400$ a month from SSDI based upon your work history, and also approved for DAC payments based upon your fathers, with a benefit of 900$. You would receive 900$ total from social security, as that is the MAXIMUM you are entitled to. You would receive 400$ from SSDI and the remainder from DAC. You cannot collect more than the highest benefit total you are entitled to. The reason they do this is each pool of money is different. SSI funding is from general taxes, SSDI is based of your work taxes and DAC off your parents work taxes. Anyhoo, I get the DAC and SSDI. (I will explain why I do not get SSI at the end) Both entitle me to MediCARE, and the DAC entitles me to Medicaid as well (as a supplement of sorts) despite the income boost. (if it was just SSDI I would have to qualify with medicaid under the medicaid rules, pregnant under 21, or income guidelines) I was researching about SSDI, DAC and its rules (I have had it since October, I am learning still) and came across a query of 'What happens if I get married on SSDI?'- The answer? Nothing will change. (From social security) So I decided to look, what happens if you get married on SSI? Since SSI is a needs based program they could cut or remove all of your benefits, if your partner made over a certain amount of money each year, kind of like food stamps, since the program is considered welfare. So last but not least I googled the DAC benefit. I was floored. Direct from Social Securitys own website (HERE)  I found this: What happens if the adult child gets married? If he or she receives benefits as an adult disabled since childhood, the benefits generally end if he or she gets married. However, some marriages (for example, to another adult disabled child) are considered protected. Something here is not right. So I did some more digging. Yep, its true. Unless I marry another adult disabled child ACTIVELY RECEIVING THE SAME BENEFIT, I will lose mine! That means no medical, no payment, NOTHING. Upon contacting someone I know who used to work for Disability Determination within SSA, I was told I would lose my SSDI benefit based on my work record too! (I do not know if this is true, I must find a way to link a confirmation or denial of this) I am FLOORED. I cannot, despite days of searching, find a justifiable reason as to why this one category gets singled out. So suddenly I am not disabled because I decided to get married,and instead of rewarding me like the government does with marriage (taxes, health insurance benefits, death benefits, legal rights and so on) I get dropped?! I have some issues with this, which I am sure will raise hell in others eyes. I am sure I will hear you are bitching about free money from the government blah blah blah... save it. Read it all and then complain if you need to. One, I can cohabitate with someone for the rest of my life, even be engaged and cohabitate indefinitely  and keep my benefits but the second I get married out the window that goes? Why does every other category of disability get to marry, without penalty?  Half the reason I am disabled is because I cannot work. I am medically needy and could not find health insurance, even through a spouse most likely, that would accept me with all of my 'pre existing conditions' Even if I did find a company willing to take me, the premiums would be astronomical, in addition to copays, prescription benefits, deductibles and out of pocket reimbursement expenses, that would bankrupt anyone in a matter of weeks. Without this medical care I would die. So my spouse would be forced to take on the financial burden of my inability to contribute to household coffers, astronomical medical costs and the physical responsibility that comes with my medical issues. I wouldn't marry myself with that kind of baggage! So, I would like to ask social security and law makers, why do you stop Disabled Adult Children from getting married and being able to live?

If you are interested in perhaps bringing attention to this click HERE.

How I Got Here

I don't really have a format for this yet, I suppose its more of an insight into the world, my world, of homeless and the struggles and challenges I face on a daily basis.
For anyone who might stumble across this and wonder just how a homeless person is writing a blog on the Internet (shouldn't I have more important priorities.. like selling my stuff to have somewhere to live, perhaps?) well let me tell you.

Homeless is not just living on the streets. It can be living in your car, at a day shelter, a 'working shelter', domestic violence shelter, or just surfing on a friends couch, not knowing if you will be there the next day.


I happen to fall into most of the aforementioned categories,but usually either living in my car, or at a domestic violence shelter.  Currently I'm couch surfing (until tomorrow) at a friends house, who just so happens to have WiFi.


I have a net book that was given to me, which is about 8 years old and so slow it takes me 15 minutes to load Google, but it does its job. Unfortunately its so old and slow I couldn't pay someone to take it and thus, if I can find WiFi, I can write. (Fast food establishments usually leave their WiFi on even after they close at night)


I am lucky, I have  a car. Its old and small (and could use a really good cleaning) and when it dies, well I probably won't be getting another one unless my circumstances change for the better.


I came from the north to take a shot at my luck in the Nashville area and no, not as a musician. Although I have great respect for musicians and artists of all kinds, I certainly do not have the talent or the patience to be one.


I took a leap of faith and trusted family members (perhaps my first mistake) to help pull me out of a very dark time in my life-- recovering after a very serious domestic violence incident.

The domestic violence incident happened to be with an ex relationship of mine, of the serious variety, who nearly killed me, a friend and himself in what I can only assume was in an attempt to try to make a very muddled point. Due to very serious gaps in our laws and even more serious gaps in enforcement of the few good laws we do have (along with a barrel of rotten apple law professionals) I was forced into a domestic violence shelter for my own safety and eventually out of my jobs, continuing education and eventually my state.


I don't want to make myself identifiable just yet so my details are intentionally vague.

My move to the south didn't go so well.  Lets just say, everything went well for about, a month. First problem? I'm fat. Obese, in fact. Not only am I obese, but I have had weight loss surgery (of the reversible kind) which due to my circumstances, has had absolutely no effect. I remain at the weight I was nearly two years ago when I paid for the operation. (I will talk about obesity, poverty and homelessness in another post)


My so called family (DNA donor?) didn't like that. The fact that I can't eat more than a cup of food at a meal was just not right to them. Or that I would rather bypass the fried chicken dinners for say, a salad was just unacceptable. I was constantly critiqued and criticized and eventually had enough.


I also had to deal with major inequality, as a sibling of mine was literally spoiled rotten, while I was literally abused.  I had everything I owned literally stolen from me and was then kicked out on the streets for trying to do something about it. Not only was everything stolen from me, but said crazy ex was given every detail of my life, down to my hair color and my sleeping habits.

What little I had left, I packed into my car along with my dog (a ten pound chi mix) and  checked into yet another domestic violence shelter.  After seven days, I had to leave there due to my schizophrenic roommate, who was clearly unstable (and untreated) and would stand over me in my sleep singing lyrics to death metal songs about, well..death.




..To be continued