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Author Topic: 1st EOB Statement, Part D  (Read 1735 times)

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Offline AlanBama

  • Member
  • Posts: 3,670
  • Alabama: the 'other' 3rd World Country!
1st EOB Statement, Part D
« on: March 10, 2007, 09:08:08 PM »
I received my first Explanation of Benefits Statement today from my Medicare Part D Provider, Sierra Rx.

It states that my total drug cost for January was $1,269.62; my share of that cost was $160.00.   What it conveniently does NOT list are the meds that were considered to be "non-covered'.  When I add up all those, my total out of pocket costs for January were $257.07.

My significant other was 'dis-enrolled' by Sierra this week; we received the same threatening letter, however I was not dis-enrolled and he was.  Go figure....
The same agency (AL MEDCAP) pays our premiums, and in fact, they were most likely paid by the same check.  It has really been a nerve-wracking week for us, trying to figure out how he is going to get his meds.   He told me "for the first time in 20 years, I am actually afraid I am not going to have access to my medications."  Scary times......

Ah, life on Medicare -- definitely not something to strive for!   Forgive me for whining, just needed to vent a little bit this evening.   On a side note, you know how some of us old guys slip up now and again and miss a dose of our meds?  While sitting at dinner tonight, I thought "wow, I have felt really good today; had a lot of diarrhea, but mostly felt good, and got a lot accomplished."   Then it dawned on me, that I had completely missed my morning and noontime meds.

I'm getting goofier as I get older......

"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

Offline Blixer

  • Member
  • Posts: 712
Re: 1st EOB Statement, Part D
« Reply #1 on: March 10, 2007, 09:14:10 PM »
Sorry to hear about the problems Alan.  And just the type of things that you mention is what scares me.  You would think that in a nation such as ours there should be universal access and no one should ever have to worry about not having needed medications.
Diagnosed 1/9/06
8/27/2007 CD4 598, 29%, VL 58 (72 wks)
11/19/2007 CD4 609, 30%, VL < 50 (84 wks)
2/11/2008 CD4 439, 27%, VL <50 (96 wks)
5/5/2008 CD4 535, 28%, VL <50 (108 wks)
10/20/2008 CD4 680, 28%, VL <50 (132 wks)
Changed to Atripla in 2012
1/14/2013 CD4 855, 35%, VL <40

Offline Jody

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  • Posts: 1,935
Re: 1st EOB Statement, Part D
« Reply #2 on: March 10, 2007, 09:16:29 PM »
Dear Alan...I am so sorry that you and your partner are going through this awful trauma of very high out of pocket payments and not knowing whether he will continue to have access to his meds...Do you both have case workers and professionals to get answers for you?  I will be thinking of you.

"Wake up to find out that you are the eyes of the world".
 "Try to discover that you are the song that the morning brings."

Grateful Dead

Offline AlanBama

  • Member
  • Posts: 3,670
  • Alabama: the 'other' 3rd World Country!
Re: 1st EOB Statement, Part D
« Reply #3 on: March 10, 2007, 09:20:51 PM »
We have the same caseworkers, Jody.  Very nice people, but so far, have not been a whole lot of help.   He is WAY more vocal than me, and has worn the dial out on his phone this week calling everyone he can think of.   He's not going to take it lying down.

I, always trying to find SOME good in everything, said "look at it this way; at least we are both fairly healthy right now.   Suppose we were really ill, too ill to fight?"   It sure does scare you though.

"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

Offline Andy Velez

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  • Member
  • Posts: 31,889
Re: 1st EOB Statement, Part D
« Reply #4 on: March 10, 2007, 11:46:13 PM »
Hi Alan,

It's awful to hear what you guys are going through. You're hip to all of this stuff so I assume you've contacted any appropriate AIDS service organization for help with the bureaucratic crap.

Would it be worthwhile for instance to contact your local congressperson? The Mayor? I mean as in pull out all the stops. Or even a local newspaper if there's a health reporter. Of course as you've noted, you need strength to do that kind of stuff. I'm just sitting here wondering about what/who might help.

Cheers buddy,
Andy Velez


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