Medicare Customer Service Issues

I have a personal care aide who helps me six days a week, but unfortunately, the company she works for does not offer transportation services. Since the beginning of this month, I have been part of the Humana Coordinated Care program and have faced challenges in attending my appointments due to the lack of transportation. Previously, with straight Medicare and Medicaid, I never missed appointments as transportation companies provided reliable services. However, since switching to Humana and being dual enrolled, I have been unable to secure transportation services despite numerous attempts to resolve the issue over the phone. It seems that the addition of the Humana program has caused a disconnect, as my information does not appear in their system under the new enrollment. Interestingly, both my Humana and Medicaid numbers are the same, further complicating the situation.

After my mom's recent hospitalization, the doctors advised she needs constant care. We've arranged for certified CNA's to be with her for 10 hours daily as we don't reside in her area. They assist her with daily activities due to her health conditions including congestive heart failure and COPD. Because she struggles with breathing, walking is limited. She is now enrolled in a hospice program through Palmetto Health Richland with a nurse visiting twice a week. I'm wondering if Medicare covers the costs for caregivers in this situation. Her name is June Suttles Davis, born 11/9/29, and her Neucare ID is: [redacted]-42-[redacted]-A.

I enrolled in SCAN HMO coverage in February [redacted], which started on March 1st, [redacted]. However, I regret my decision as I can no longer see my longtime doctors who are not on SCAN's approved list. I am 73 1/2 years old and don't want to start over with new doctors. Therefore, I disenrolled from SCAN on April 30th, [redacted], and returned to Original Medicare on May 1st, [redacted]. Unfortunately, I lost my Medicare Part D prescription drug coverage in this process. I am concerned and wondering if there is a way to reinstate my Part D coverage before the enrollment period in October. I was informed that even then, it would not be effective until [redacted]. Although my AIDS medications are covered by the ADAP in California, I need assistance with my non-AIDS related medications. Can I do anything before [redacted] to get my Part D coverage back?

My mother had a stroke on 4/27/18 and was taken to Erlanger Hospital in Chattanooga, TN. She was transferred to Lifecare Cleveland on 5/1/18 and was showing progress. However, on 5/18/18, she was taken to Tennova Hospital due to passing fresh blood, which was attributed to excess heparin at Lifecare. After being in the ICU until 5/24/18, she returned to Lifecare on 5/25/18. She developed a heel sore while in bed at Lifecare and received ultrasound treatment. Despite receiving less physical therapy and not eating much, the facility plans to transition her off skilled therapy, which would result in loss of Medicare and TriCare coverage. As her Power of Attorney, I am concerned about the "[redacted] day rule" and the possibility of her needing to pay privately at $[redacted]+ a day. I am seeking guidance on how to challenge this decision and ensure she receives proper care without financial worries. Any clarification and assistance on navigating Medicare rules and regulations would be greatly appreciated. Thank you. - Cassandra L B. Email: [redacted] Phone: [redacted] Address: [redacted] Ramsey St NE, Cleveland, TN [redacted]

I wish to speak directly with a Medicare agent. I have been diagnosed with COPD and Hypoxia, requiring continuous supplemental oxygen via 2L nasal cannula. The oxygen tanks I currently use do not hold enough oxygen to complete simple tasks like grocery shopping due to waiting in line at checkout. Allow me to explain my experience with Hypoxia. When walking at a slow pace for 10 seconds (more commonly 5 seconds), my oxygen saturation level on oxygen is 95. Without oxygen, it drops to between 87-90. Any movement causes a significant drop, with my lowest saturation level reaching 76. This leads to muscle fatigue and weakness due to inadequate oxygenated blood flow throughout my body, exacerbated by the heavy oxygen tanks I currently rely on. I have reached out to multiple oxygen companies for a portable oxygen concentrator that can provide more oxygen, but they all mentioned that Medicare will not cover it, deeming it a luxury item. Breathing and maintaining an open airway are basic human needs, not luxuries. As a nurse with over 40 years of experience, I find it absurd that a portable oxygen concentrator is considered a luxury item by Medicare. I am willing to take legal action against this decision-maker. My name is A. Turner. I will provide my contact information when Medicare directly emails me.

I recently learned from my doctor at UVA spine clinic that Medicare no longer covers Vertebraplasty and Balloon Kyphoplasty procedures for compression fractures. This change has impacted my treatment options for a compression fracture at L5, resulting in significant pain. I'm seeking clarification on why Medicare has ceased coverage for these procedures. I would appreciate any insights on the reasons behind this policy shift.

In January or February of this year, I visited my doctor who advised me to get a recast infusion for my bones, as it had been two years since my last one. The requests were supposed to be sent to infectious disease in Tampa, Florida. After not hearing back, I returned to my doctor, and they assured me the requests had been sent. As it had been over three months, I needed a new blood test. The main doctor at the office promised to secure me an appointment immediately. I eventually visited infectious disease but only had a consultation, not the infusion. Despite my previous efforts, they mentioned ordering the medication and promised to call me. This was on June 28th. Despite my numerous follow-up calls, there has been no progress, with one call mentioning checking with Medicare. I feel frustrated by the lack of progress and confusion surrounding my treatment.

I recently discovered an increase in my share of cost from $[redacted] to $[redacted] due to a slight income rise putting me over the limit. This is a significant portion of my income, and I am struggling to manage it. I have been dealing with health issues and treatments, making it challenging to address this matter promptly. I received a letter in late July, stating the new share of cost starting August 1. After contacting Social Services, they made some changes to my account, including canceling "Part B" and transitioning me to a different program. However, subsequent adjustments have escalated my expenses considerably. As a permanently disabled individual on Social Security with Medicare primary and Alliance secondary, I am now exploring options like supplemental insurance to reduce my share of cost. I am worried about covering my medical expenses for August and considering appealing for assistance. I am open to any necessary steps to resolve this issue, as the current financial burden is overwhelming. Any guidance or support would be greatly appreciated. Thank you for addressing this urgent matter. Sincerely, E. S. [redacted] [redacted]

I am in need of a RoHo Cushion for a wound on my left thigh that has been troubling me for 11 months. It became septic in March, and I have been receiving care from Dr. D at St. Marks Hospital in Murray, Utah. Due to complications with Pancreatitis leading to diabetes and the need for regular hydration and insulin, I have had a challenging journey with my health, including a significant weight loss and a stay in the ICU and rehab. Despite not being wheelchair-bound, Medicare requires it for coverage of the cushion. I am seeking help to expedite my healing process and would appreciate any information on alternative cushions covered by Medicare. I am determined to heal and eventually support others in similar situations. Any assistance or advice would be greatly appreciated.

The state agencies in South Dakota, like the Survey Agency and the State Ombudsman's Office, have been ineffective in handling the issues at the Good Samaritan Nursing Home in Canistota, South Dakota, where Jeannette is suffering neglect and abuse. As Jeannette's best friend of 42 years and Social Security Representative Payee, I personally have witnessed the mistreatment she endures. Good Samaritan consistently violates Medicare regulations, such as sending Jeannette to her foot doctor in Sioux Falls with a soiled pad. These incidents have occurred multiple times, with complaints being met with dishonesty. Jeannette's health is at risk due to these neglectful actions, including the risk of infection and embarrassment. She has been denied baths for significant periods, left waiting hours before assistance, and is suffering from untreated medical conditions. The staff also subjects her to verbal abuse. These are just a few of the numerous distressing issues. You can contact me at [redacted] after 10AM CST, or reach Jeannette in room 103B on Wednesday afternoon at around 2PM at [redacted]. Thank you, Rick Lipary.

On June 8, [redacted], I underwent mammography and bone density tests as part of regular preventive check-ups. Initially, I was billed $[redacted], which I paid. However, upon questioning the bill, I was informed that these tests should have been covered at no cost to me. Despite numerous calls and being told it was a coding error, it took five months for a supervisor to clarify that the $[redacted] was indeed a co-pay. Additionally, I received a $[redacted] bill from Florida United Radiology weeks after the tests, with assurances it would be covered. Despite my efforts and visits to the testing facility confirming correct coding, I have not received any resolution. I was even denied the opportunity to file a grievance due to a 60-day limit. Your assistance in addressing these unresolved issues would be greatly appreciated. My name is Lillian Z., and my Well Care number is [redacted]7. Thank you in advance.

Subject: Concerns Regarding Medical Care I, Matild S.C., residing at [redacted] Anapalau Place, Honolulu, HI, Medicare Nr. 4W72-[redacted]-NQ28, recently encountered several issues with accessing timely and appropriate medical care in Hawaii. On my visit to the Straub Clinic’s Hawaii Kai branch on July 9, [redacted], seeking treatment for an acute ear infection, I faced a significant delay in receiving assistance due to my primary physician being unavailable. After visiting the emergency room and receiving antibiotic treatment, I experienced persistent pain and hearing loss, prompting a desperate request for a specialist referral. Despite my background as a physician, obtaining timely appointments with healthcare providers proved challenging, with significant waiting periods extending up to 8 months for routine care. This lack of immediate access to medical attention, coupled with difficulties in securing referrals and appointments, raised serious concerns about the quality of care provided. My frustrating experiences have led me to question the adequacy of medical services in the region, despite paying for Medicare and HMSA insurance coverage. The prolonged waiting times for essential medical consultations and the refusal of physicians to accept new patients highlighted systemic issues within the healthcare system that need urgent attention. I urge for prompt actions to address these issues and ensure that patients receive timely and appropriate medical care when needed. Your intervention in resolving these systemic inadequacies would be greatly appreciated. Sincerely, Matild S.C.

I am a person with developmental disabilities and a civil service employee enrolled in the old federal retirement program, SCRS. I have Medicare Parts A, B, and D but not Social Security benefits. I am struggling to obtain a replacement Medicare card as mine is damaged and unusable. Unfortunately, the Medicare representatives have been unhelpful, suggesting I contact Social Security, which has also been unproductive. Due to my disability, lack of transportation, and access to a printer, I am unable to visit the offices in person. I kindly request that a Medicare agent send me a replacement card application via regular mail to my address: Molly Ann Maloney [redacted] Gaskins Apt. E Road Henrico, VA. Any assistance with this matter would be greatly appreciated. Thank you for your support. -Molly Ann Maloney

I'm seeking information regarding the coverage timeline for a stay at a rehab/nursing facility. I was initially covered by private insurance when I was transferred from a hospital to the facility on April 2, [redacted]. I had both a trach and feeding tube during my stay, with the trach removed in late July and the feeding tube in early September. My Medicare coverage started on July 1, [redacted], after I retired, as my primary insurance. The facility has not billed Medicare yet but claims my [redacted] days ended on July 11. I find this confusing since Medicare wasn't billed during my initial period there. I believe they are avoiding billing Medicare due to potential cost limitations. I also have a Medigap plan to assist with expenses. We are experiencing billing issues with the facility, particularly related to this situation. I would like to understand the timeline for billing rehab/nursing facilities to ensure they are following the correct procedures. Thank you for your assistance in clarifying this matter promptly.

My wife recently had a severe stroke and is currently in a hospital in NYC, far away from our home. Unfortunately, she is unable to communicate or move one side of her body. While she usually manages her Medicare payments, the situation has left her unable to do so, resulting in overdue notices. I'm struggling to get in touch with Medicare since I'm not the account holder. I urgently need to understand her current status and how to bring her account up to date to maintain her coverage. It would greatly impact my family if her coverage were to be lost at this critical time. I have all necessary documentation to prove my relationship with her and provide her account details. Please assist me in this stressful time. Thank you.

I experienced two spider bites in October [redacted] and received inadequate treatment at a walk-in clinic. Despite my clear symptoms and concerns, only one issue was addressed, leading to severe complications like tooth loss, infections, and potential neurological problems. As a former pre-vet medicine student, I was well-informed about the risks but struggled to find a healthcare provider who took my situation seriously. Even after escalation to appeal to BFCC-QIO in Maryland, my case was dismissed without a clear explanation, leaving me frustrated and financially burdened. The lack of documentation about my complaints in medical records is concerning, especially when my health was at stake. Moving forward, I wonder if I can continue pursuing an appeal despite the initial rejection and the unanswered questions regarding my denial. -L.E.

In preparation for the New Year, my sister and I have been eagerly awaiting the Zostavax or Shingrix 2-part vaccine. Today, we received a call to schedule the first shot. However, upon contacting my Part D insurance provider, I was shocked to learn that they will not cover the cost. Each shot would amount to $[redacted], totaling $[redacted] for the full protection against the severe pain of shingles. It's disheartening that Medicare-mandated Part D insurance seems unhelpful, leaving seniors to bear the brunt of expensive medical costs. The insurer disputes coverage for essential medications and tries to influence our choice of prescriptions. So far this year, the drug company has not even covered a single premium, which feels unjust and deceptive. With meager Social Security benefits and high insurance expenses, it's a constant struggle to make ends meet while covering basic necessities like rent, food, utilities, and more. It seems like Medicare and the government are banking on seniors passing away early, but I am determined to fight against that. Barbara Wilson, Sparks, Nevada.

My husband, R.R., suffered a stroke on 05-16-[redacted] and developed a blood clot in his leg by 12-26-[redacted], leading to treatment with Eloquis. Unfortunately, Medicare did not cover it due to its tier level, forcing us to switch to Xerelto, which proved ineffective. Subsequent clotting required ER visits on 03-12-[redacted]. Despite the doctor's recommendation of Eloquis, we face financial strain due to its cost under Medicare. Seeking guidance to address this issue due to the financial burden from payments to Medicare, United HealthCare, and Walgreens. Any assistance would be greatly appreciated.

I have been dealing with back and hip pain for a while now. After receiving hip injections regularly, I was referred to pain management for back injections. My doctor recommended a Tens unit from Mobility Specialist in Winter Haven, Florida. Despite being told it was covered by Medicare, it was cheaper for me to pay $50 in cash, so I decided to do so. When I got the unit, I was disappointed by its quality, especially considering I could have bought it online for much less. Now I'm puzzled as to why Medicare would be charged $[redacted] for an item that costs significantly less, and why my co-pay would be higher than what I paid in cash. I'm also wondering if I can get any reimbursement for the TENS [redacted] unit since I had a prescription called in.

My mother, who is almost 85, has Medicare Part A and B. She is a Holocaust survivor and suffers from dementia and a risk of falling. Recently, she fractured her right wrist and her in-home care was reduced to 45 hours a week by the state of MD. Due to her fall, the state increased her hours to 63 until the first week of August, but they plan to reduce it back to 45 thereafter. Despite my efforts to explain her worsening conditions - asthma, dementia, balance issues, and frequent UTIs, they are pushing to move her to a nursing home, which I believe would be detrimental. I've heard there are additional in-home care options under Medicare. Will my mom be eligible for this assistance? Thank you.