For Professionals: Advocacy & Policy
Joint Informational Hearing: Medicare Prescription Drug Coverage: Challenges of Implementation and Status of State Assistance Efforts
February 1, 2006
Testimony of Marta Erismann, California Health Advocates
Good afternoon committee members, thank you for the opportunity to provide information this afternoon. I am the community outreach coordinator for California Health Advocates and a HICAP volunteer counselor. California Health Advocates is non-profit organization dedicated to Medicare beneficiary advocacy. As part of our work in support of the Local HICAP’s we handle calls into the 1-800 phone line that have been incorrectly routed. With limited resources, California Health Advocates has responded to more than 1600 phone calls from Medicare recipients and dually eligible, seeking assistance with the Part D Program from October 1, 2005 to January 26, 2006.
I personally assisted over three hundred Spanish-speaking callers, during the same period, that had been referred by Social Security to California Health Advocates for assistance. My testimony is based on my conversations with these callers.
First some general comments and I will end my testimony with anecdotal references and quotes from many of the callers.
Many Hispanics do not have land-based telephones. They use prepaid minutes for their cell phones. Many saw their minutes drained as they waited “on hold” for hours for a Medicare Representative or a Health Plan Representative. Some had to borrow funds to obtain additional minutes to continue their efforts to contact Medicare or seek information from their plans.
Many Spanish-speaking reported that the plans did not have bilingual representatives, or if they did the number of bilingual staff was limited and unable to respond to the demand. Many told me that they were put in hold for many hours waiting for the Spanish-speaking counselor, only to be disconnected after waiting for an hour or more. Many were told numerous times to call back in one hour on several continuous days. By the time these callers reached California Health Advocates they had not been successful in communicating with “their” Plan despite continuous efforts for several days.
Many callers were frustrated by the non-responsiveness of the plans, once they were able to leave a message on their recording; some had waited two weeks or more to receive a call back from their plan. And when they were able to talk to Plan staff, the staff was not knowledgeable about Part D and unable to respond to their questions
Many pharmacists, due to lack of bilingual staff, were not able to communicate to the dually eligible the reason why they were being denied medications. Many of these dual-eligible left the pharmacy in tears, not understanding why they had been denied their medications
Another dually eligible believed that “if Medical inscribed us in a program” it must be the best for us. Only to discovered when they went to refill their prescriptions that their plan did not cover their medications, or that they needed a card to obtain their meds, or that they were not enrolled in any program.
Yet others, that had contacted Medicare with the help of family members who spoke English to check if their Meds were covered, they discovered that their meds were not covered in the tier they were enrolled, and were not told that they would have to pay “extra” to move up to the tier that included their medications.
Medicare Part D’s information is mostly web based. Yet the beneficiaries of the program are the least computer savvy of the population. When it comes to the dually eligible, not only age and disability is a barrier, but also financial barriers to own a computer and connect it to the internet. For non-English speaking these barriers are ten times more difficult to overcome.
Many dually eligible take multiple medications, while a co-payment of $1 to $3.00 is not a burden to many of us. It is a burden to those that are at or below the income levels of poverty. For someone at poverty level, taking 15 medications with $3.00 monthly co-payment each, is an undue burden on their financial situation
Some of my callers had hearing difficulties, which made it difficult to navigate Medicare and the Plans phone trees. These Medicare recipients are hard of hearing and could not understand or make sense of the instructions in the recorded messages.
For me the month of January has been especially emotionally taxing due to the intensity of negative emotions shared by some of the callers and my feelings of helplessness to alleviate their circumstances.
Mr. Rivera, from Bell Gardens, Los Angeles County called on January 12th. Mr. Rivera is a diabetic and legally blind He had been without his insulin for three days. Mr. Rivera’s glucose reading was above 500. His local pharmacy refused to refill his prescription and told him that it would be three or four days to resolve the computer glitch. Mr. Rivera was very fearful and was feeling without energy and dizzy. I knew that Mr. Rivera would be in great danger if he waited 3-4 days for the computer glitch to be solved. I told him that if I was not able to help him in the next 2 hours that he needed to go to the emergency room of the nearest hospital to receive the insulin he needed to get his life out of jeopardy.
Fortunately, I contacted Mike Negrete’s office at Premier Pharmacists Network and requested their assistance with Mr. Rivera’s pharmacy. I do not know what Mike’ Negrete’s office said , but 30 minutes later when I contacted the pharmacy, they told me that Mr. Rivera could come and pick up an emergency supply until the computer glitch was fixed.
Tragedy was averted! But how many Medicare recipients have Mike Negrete’s phone number at their fingertips to get the help they need…. Mr. Rivera was very fortunate indeed.
Mrs. Delaney, from Fortuna, Humboldt County. Mrs. Delancey, a disabled diabetic was enrolled in a Medicare RX program but on January 2nd, her pharmacy would not refill her medications, despite her being enrolled in a plan. Mrs. Delancey initiated contact with her plan on January 4th. Mrs. Delancey did not receive a call back until January 12th. The customer service representative told her that they did not have any information about her, promised to hand Mrs. Delancey’s phone number to her supervisor, who would call her. On January 13th, still no call from the plan. Mrs. Delancey contacted California Health Advocates. I contacted Medicare, who confirmed that Mrs. Delancey was enrolled in the plan and I also requested the phone number at CMS to lodge complaints about Plans responsiveness. I Spoke with Mr. Max Wong who promised to contact the plan. Within two hours I had received calls from two supervisors and the problem was resolved with Mrs. Delancey being able to receive her medications on that day. I spent about 6 hours in helping Mrs. Delancey.
How many more Medicare recipients are out there that need this type of individualized assistance and don’t know who to contact?
Mrs. Maduro’son, from Hollister, San Benito County called on January 13th. His mother, a diabetic had not been able to fill her prescription for an antibiotic to treat an infected toe. The call came at 4:30 in the afternoon of Friday. I knew that I would not be able to help Mrs. Maduro that day. Mrs. Maduro is a very low income person; neither she nor her son had the means to pay for the medication. I asked the pharmacist to give her antibiotics until Tuesday, (Monday was Martin Luther King Holiday); due to the holidays it would difficult to solve the situation until then. When the pharmacist was unable to give her an emergency supply, I knew that a diabetic with an infected toe and no antibiotics for three days could result in an amputated foot. For that reason, I had the pharmacy charge the five day supply to my personal credit card. On Tuesday, January 17th, I was able to assist Mrs. Maduro’ son in enrolling his mother in a plan, and again Mike Negrete’s office was able to intercede with the pharmacy to give Mrs. Maduro a five day supply of the antibiotic until Mrs. Maduro’s information made it to the computer
In closing I would like to quote from many of the callers I have spoken with during the past month:
- “I may just lie down and die”
- “They don’t want to pay for us old people, so they are just going to kill us”
- “Now I have to choose between dying of sickness and dying of hunger”
- “I worked all my life, what have I done to deserve this?’
- “I only get $760 month, my rent is $500 and now I have to pay $45 for my Medicines, where am I going to get the money?
These are terrible situations, they should not be happening in the United States. Why are we putting our most vulnerable citizens in these dire circumstances?
Thank you for your time and consideration.
Marta Erismann
California Health Advocates
