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Author Topic: The Grey Letter from CMS  (Read 4431 times)

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Offline AndyArrow

  • Member
  • Posts: 1,196
The Grey Letter from CMS
« on: October 08, 2009, 02:03:08 AM »
How quickly things change, just when things seemed to going along relatively smoothly -- excluding the partner just having open heart double bypass surgery leading to an infection that has to be treated with 2x daily trips to for IV antibiotics through a PICC line -- things were going smoothly.  Then I open up my letter from The Centers for Medicare & Medicaid Services and it's a grey letter (the paper they use for this type of letter is grey) telling me beginning Jan 2010 I will no longer qualify for extra help paying for my drugs.  Where exactly I'm supposed to come with an extra 4000 - 5000 to pay for these drugs is anyones guess! 

The next republican I see who tells me they are against healthcare reform better hope they have some damn good insurance because they may not walk again when I'm done with them!  :o

Done with my complaining and back to researching my options come January.

AA
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline rondrond

  • Member
  • Posts: 1,712
Re: The Grey Letter from CMS
« Reply #1 on: October 08, 2009, 04:04:10 AM »
I think it's that time of the year for all good computers to spit out computer generated responses that I now think are just 'busy work' to keep you on your toes.


Good luck with your options. actually I'm hoping it turns out when you contact them about it they will say "oh, just ignore that, it's just a computer generated letter...it doesn't mean anything." o.o


Sorry to hear that your partner has an infection. That has got to be very stressful, and then getting the grey letter: I would have been sorely tempted to just tear it up: but, that wouldn't help anything.

So, he's not admitted, y'all just go in and after he goes through the IV antibiotic bag, you go on your way?  and then return to repeat the treatment?
 
"I may not be exactly where I want to be, but I sure as Hell am not where I was"
Wynnona Judd

Diagnosed/HIV
1993
AZT
Norvir
1994-2001
Crixivan/Epivir/Zerit
No Meds for 7 Years

04jul07/DVT-right leg/Bi Lateral PE's     
16oct08/DVT-left leg
Sept '09  6 blood clots in left arm
Coumadin 5mgs
                                     
Atenolol/50mg/2x
Hydrochlorth 25mg/1x
Gemfibrozil/300mgs/2X
Symbicort
Proventil Inhaler
Potassium
Rhinocort


*APR 08~Viramune/Truvada
March08  CD4 330 23% VL 452.000 
*Jan09 Med change~Epzicom/Viramune

Aug09   CD4 523 23%  VL<48
Diagnosed: COPD
Dec 2013: CD4 645 45% VL 49
Med Change: Viramune/Epivir/Ziagen/Isentress

Offline BT65

  • Global Moderator
  • Member
  • Posts: 9,912
Re: The Grey Letter from CMS
« Reply #2 on: October 08, 2009, 07:43:04 AM »
Andy, that absolutely sucks.  Did they give the reason for this assinine decision?
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline Miss Philicia

  • Member
  • Posts: 24,011
  • celebrity poster, faker & poser
Re: The Grey Letter from CMS
« Reply #3 on: October 08, 2009, 11:08:23 AM »
Ugh Andy, that really majorly sucks.  Try to stay calm while doing the research as I know all to well how stressful this can get oneself.  I guess you are implying that there's not been any major change in your income level so this came really out of the blue?  Hopefully it's an error or something if that is the case.
"Iíve slept with enough men to know that Iím not gay"

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #4 on: October 09, 2009, 02:10:14 AM »
Ron, my partner was admitted for several days but now we just have to show up at 8am & 8pm for the IV infusions.  They take about 30 - 45mins and then we are on our way.

I actually called Medicaid since the letter from CMS lists 4 possible reasons that I won't be getting extra help and the only ones that could possibly affect me were through Medicaid.  So, I called my caseworker ... first the line was busy.  Then I got through and left a voicemail.  She never called back so I called again the next day and got through.  According to her files I should have never qualified for extra-help because I make too much money (a little more than 16,245 which is the cut off). 

At this point I think it's time too move back to the city (Chicago) since Illinois offers RX help to seniors AND disabled (Indiana only seniors) making upto $25,532 (I'd be rich if I made that!).  Oh well ... I liked living in Chicago anyway.
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline BT65

  • Global Moderator
  • Member
  • Posts: 9,912
Re: The Grey Letter from CMS
« Reply #5 on: October 09, 2009, 07:03:15 AM »
Andy, I get extra help with the Medicaid-Medicare thing, but I get way below what you make.  Maybe Chicago would be better.  You're not too far from there anyway, are you?  Would you have to wait until your partner is done with this treatment (probably a stupid question).  I hear the HIV care in Chicago is good also.  I have a friend who lives there, who used to live here, and he loves it. 

I think the whole thing about you not being able to get extra help just plain sucks.  It's like whomever made that law, expects people to pay any little extra they have for meds, which can cost tons for us.  Anyway, good luck.  I'm sorry this has happened. 
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #6 on: October 09, 2009, 05:14:59 PM »
Thanks BT,

The funny thing is I moved here from Chicago 5yrs ago because the cost of living was so much cheaper here.  Go figure!  I'm just across the boarder from Illinois so it's not like I"m moving miles and miles away.  I will need to have everything in place by Jan since that's when the extra help ends.

I'm very lucky that I get what I do from railroad retirement disability but I don't see how they think because I make a little bit over I've got thousands to laying around to pay for meds.  UGH!!!!  Well, this is just one more test being thrown at me ... but us LTS'ers are a resourceful lot.

AA
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline shreveman

  • Member
  • Posts: 27
Re: The Grey Letter from CMS
« Reply #7 on: October 11, 2009, 07:16:13 PM »
Hi Andy:

I'm sorry to hear about your healthcare cut back. I also wanted to say hi as I have not posted in awhile. Maybe there is some resource available through one of those prescription assistance programs. I hope something will work out for you soon. You and your partner take care. Roy

Offline Theyer

  • Member
  • Posts: 2,497
  • Current ambition. Walk the Dog .
Re: The Grey Letter from CMS
« Reply #8 on: October 14, 2009, 01:51:29 PM »
hi Andy,
Sorry to hear your news, its hard to imagine having to deal with such out off the blue financial cruelty.I hope the US gets on with its health reforms,I think you should develop that idea about republicans direct action can be so satisfying.Take care theyer.
"If we can find the money to kill people, we can find the money to help people ."  Tony Benn

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #9 on: October 17, 2009, 01:06:27 AM »
Thanks shreveman & welcome back.

Theyer, the idea of taking that action warms the cockles of my heart (so to speak) but since I don't think I'd do well in prison (and I really wouldn't look good in those orange jumpsuits) I'll just vent here instead.  ;)
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline rondrond

  • Member
  • Posts: 1,712
Re: The Grey Letter from CMS
« Reply #10 on: October 17, 2009, 03:02:02 AM »
I would only want to see you in an orange jumpsuit if you were ringing doorbells and saying "Trick or Treat"

How's your partner doing?



"I may not be exactly where I want to be, but I sure as Hell am not where I was"
Wynnona Judd

Diagnosed/HIV
1993
AZT
Norvir
1994-2001
Crixivan/Epivir/Zerit
No Meds for 7 Years

04jul07/DVT-right leg/Bi Lateral PE's     
16oct08/DVT-left leg
Sept '09  6 blood clots in left arm
Coumadin 5mgs
                                     
Atenolol/50mg/2x
Hydrochlorth 25mg/1x
Gemfibrozil/300mgs/2X
Symbicort
Proventil Inhaler
Potassium
Rhinocort


*APR 08~Viramune/Truvada
March08  CD4 330 23% VL 452.000 
*Jan09 Med change~Epzicom/Viramune

Aug09   CD4 523 23%  VL<48
Diagnosed: COPD
Dec 2013: CD4 645 45% VL 49
Med Change: Viramune/Epivir/Ziagen/Isentress

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #11 on: October 17, 2009, 10:27:50 AM »
I would only want to see you in an orange jumpsuit if you were ringing doorbells and saying "Trick or Treat"

How's your partner doing?





Ding-Dong Avon calling!

He's doing better and if things stay on course he can stop the twice daily IV antibiotics on 1 Nov!!!!  The hole in his chest is still just has long but it's not as wide and isn't nearly as deep.  You can no longer see the bone or part of the wire holding it together so thats a big improvement. 
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline mitch777

  • Member
  • Posts: 3,458
  • wish i were here
Re: The Grey Letter from CMS
« Reply #12 on: October 19, 2009, 07:09:01 PM »
dear andy, the "bleep" replublican "stand" on health care reform is a joke. obviously those of us listening to you think real reform is 30 years over-due!!! UGH! UGH! UGH! my personal situation has not yet hit YOUR crisis mode but i am worried it will hit us all if a more true and meaningfull reform is not enacted now. when i have the energy i have been e-mailing those in power. please keep your spirits up! let's ALL work for REAL help/reform. best to you. mitch
31 years hiv+ (oct. 2013) with a curtsy.

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #13 on: October 20, 2009, 03:24:17 AM »
Thanks mitch -- Currently living in Indiana with one Senator being a Republican (Richard Lugar) and the other being Evan Byah (a conservative Democrat) I have been writing letters doing just that.  I was once told that 1 actually letter means so much more than a phone call or an email so I'll keep the post office busy before crossing the border to IL
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #14 on: November 02, 2009, 11:45:33 PM »
It's official I am an Illinoisan again!

PS -- I think the mustache makes me look older so not sure if it's gonna stay.

[attachment deleted by admin]
« Last Edit: November 02, 2009, 11:47:04 PM by AndyArrow »
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline BT65

  • Global Moderator
  • Member
  • Posts: 9,912
Re: The Grey Letter from CMS
« Reply #15 on: November 03, 2009, 05:42:05 AM »
Wow, you moved already?  I hope things go better for you in Chicago (I'm sure they will).

By the way, that's a very handsome picture.  I didn't realize you are so good looking. ;)
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #16 on: November 05, 2009, 01:55:49 AM »
BT -- you are too kind.  I was at The CORE center in Chicago yesterday and my guide for the day asked me:

"Who do people say you look like?"

I shrugged my shoulders since I don't think I look like anyone.

"I know Jeff Foxworthy."

-- I think the moustache has to go!--  >:(
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline Miss Philicia

  • Member
  • Posts: 24,011
  • celebrity poster, faker & poser
Re: The Grey Letter from CMS
« Reply #17 on: November 17, 2009, 09:10:00 AM »
Somehow I missed this update, Andy.  That indeed was a quick move -- how in the world did you manage to accomplish not just moving but locating the apartment so quickly?  Are you in the city or out in the burbs?
"Iíve slept with enough men to know that Iím not gay"

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: The Grey Letter from CMS
« Reply #18 on: November 18, 2009, 07:45:16 AM »
The thought of losing my meds was a big motivator (athough I've got to apply for the IL program so no guarantees but they were very positive about the outcome and gave me several options if the first one doesn't work).  Also,I have great family & friends to help me out. 

I'm out in the burbs so not really a big change from NW Indiana.
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline denb45

  • Member
  • Posts: 5,051
  • "1987 Classic Old School POZ+"
Re: The Grey Letter from CMS
« Reply #19 on: December 06, 2009, 11:45:30 AM »
The thought of losing my meds was a big motivator (athough I've got to apply for the IL program so no guarantees but they were very positive about the outcome and gave me several options if the first one doesn't work).  Also,I have great family & friends to help me out.  

I'm out in the burbs so not really a big change from NW Indiana.

WOW Andy. I feel your pain as well, I'm like you, I make too much for medicade, and my extra help for part D medicare is now 75%, so that mean, like you I would have ended up paying like 3,000 to 4,000 for my Meds, so, I did some research, and informed my local State ASO office of this problem, the results are somewhat tricky, but, as of 2010, almost all of my med will come form my State...........

 I will be getting and receiving Blue Cross/Blue Shield medicare-carve-out prescription drug coverage as of Jan, 1st 2010......this is paid for by the State of New Mexico NMMIP program, it's called different things in other States, but, medicare-carve-out is what you need, if you cannot afford your part D medicare drug coverage anymore, and you have medicare part's A and B, and you don't qualify for Medicaid any longer, this program meets those needs.

Andy...... you may qualify for THIS:      http://www.chip.state.il.us/elig7.htm
it's called chip in the state you now live in  ;)


......I see that you moved to another State, but, if that helps your situation, I'm happy for you Andy, like you, I'm in that same category when it comes to income, also I hope your partner is doing well, mine is doing well now, and it's been almost 7 yrs. since his Open-heart-quadrupole-bypass back in 2002, as long as he takes his meds, and keeps he diet in check, he may out-live-me  ;D
« Last Edit: December 06, 2009, 12:20:12 PM by denb45 »
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

 


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