PGPD Retiree's Ass'n Florida Chapter

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Health Care Items

From: Md Troopers Assoc.via:Bro. Gary Johnson.

Marine Corps Vets
Attention Marine Corps vets that served in Camp Lejeune between 1953 and 1987. Dept. of Veteran Affairs is looking for anyone that served during that time, if you have any of the following:
Adult Leukemia
Aplastic Anemia
Bladder Cancer
Kidney Cancer
Liver Cancer
Multiple Myeloma
Non-Hodgkins Lymphoma
Parkinson's disease
A Federal agency found several years ago that the water system at Camp Lejeune was contaminated with benzene and industrial solvents dating back to 1953.
Those effected may be eligible to receive compensation. This applies to surviving spouses also. This was printed in the local York Pa paper and the phone# given to contact is 717-771-9218. I know many of our members served in the USMC

The below link will take anyone to the open enrollment guide which has lots of information and the prices and price changes for the health plans
The below link is to OHRM. A side menu will take individuals to useful information
The below link is to the retirees connection. It is one of the side menu options in the above link. It has useful information and forms that retirees might need.

Brother Greg Peton and his wife, Shelly, wanted to notify the membership of a success they realized after much work with county benefits.
Brother Peton was going through a difficult time with a medical problem. The medication prescribed by his doctor was $100 for a three month supply for the generic brand. The doctor did not want Greg to take the generic brand and had the Peton family fill the prescription with the non generic drug which Greg took for 2 years.
Shelly spoke with the Retired Association who had Shelly call Benefits. Shelly began her diligent work in December of 2014. After many calls and delays they have received a letter from Benefits stating they will be refunded $5530.76.
Good work Shelly standing up for Greg.

Brother Tommy Blandford brought to my attention that on page 11 of the Health Benefits booklet that Cigna will start paying for hearing aids after January 1. I called Benefits and they made this suggestion: Go to a primary care doctor and get diagnosed with a hearing problem. Go to the specialist who does the hearing aid exam. This is a once in a lifetime deal. The patient only will receive hearing aids once. There is a co pay of $35. Benefits was not sure how Medicare would figure into this. Benefits also suggests as this is a new procedure call Cigna customer service to be sure it is handled properly.

Update - from the retiree's Jan - meeting minutes.
3) Benefits: Hearing Aids: CIGNA contracted with a company called HEAR P O. Members MUST go thru them. They set up the appointments with someone in their Network. You go for the appointment where you are tested and then they fit you for the hearing aid. You MUST set the appointment thru them 877-846-7074 and have your CIGNA ID # when you call.

Mar.14,2015 Thought I might share my experience with the New Hearing Aid coverage offered by the county. I started the process on Feb 15, by contacting Hear PO after first looking at their web site and finding a provider near my home. I spoke with a Very nice lady named Marie who after getting my Cigna Info. Advised that I was fully covered and she contacted the local hearing provider I had chosen from the website. The provider gave me and appointment on March 2. For the hearing test. After testing one hearing aid was found to be needed and was ordered, which I received on March 13. The overall process took about a month and was completely cost free. Bob Murphy
Follow-up On 3-16-15 I was contacted by a company AMPLIFON, who was doing a follow-up on my experience. It was explained that as of 3-15-15 Hear PO has changed their name to Amplifon.
From Brother Mike McGraw: Just back from vacation and found a voice mail from CIGNA requesting I contact them. The number is 877-391-9145. I Google unknown numbers before I call and this one is tied to a phishing scam. According to web hits they ask for you DOB, family member names etc. I called CIGNA's 800 number and verified that the above number wasn't theirs and they didn't try to contact me. Be wary of these scam attempts. -- Mike McGraw #766 (retired)

Last week the Retired Association was contacted by a member who was having difficulty ordering his diabetes supplies. The member contacted the county and was given this information. He called a company, Kholls Pharmacy in Omaha NE. Phone 1-877-733-7100 The member is a subscriber to MEDICARE. The company is sending him his supplies and there is no co pay.

Just a Reminder: A Brother called today to remind everyone that when you sign up for Medicare change your county insurance to the Senior or Senior plus one Plan.

Health Care Appeals

For several years now and through several Health Care Providers there has always been problems with coverage. At different times it has been the fault of the county, sometimes the provider and sometimes the employee/retiree. In the beginning, the provider was a company hired by the county that was full service and any differences were regulated by the Maryland Insurance Commission. Several years ago the county became self insured and relies on a third party administrator to pay the doctors, hospitals and such. The present company is Cigna. Cigna follows the protocol of a set of guidelines used by some but not all health care companies. There are many sets of these guidelines. Some of you know that when Cigna denies a service the participant may appeal to Cigna. If denied again the participant's doctor may file for a peer review. A peer review has Cigna doctors review the request and may confirm or deny the treatment, operation, or course of action.The question has been, If they have denied what to do? As it turns out the Maryland Insurance Commission does not regulate self insured plans. But the Department of Labor does. Some acronyms to be familiar with are DOL - ERISA( Department of Labor Employment Retirement Income Security Act ) and DOL - EBSA ( Department of Labor Employee Benefits Security Administration). This is who one appeals any lack of coverage by Cigna and the county. The most instant problem has been with PET scans for cancer. (Positron Emission Topography). Doctors are requesting these tests and Cigna is denying them. They are denied even at peer review. It would be beneficial for anyone denied a test to contact the Washington District Office of the DOL EBSA at 1335 East West Highway Silver Spring, MD 20910 phone 202-693-8700 Elizabeth Bond is listed as the supervisor.

Please keep the Lodge informed of any action attempted.

Phil Constantino
Retired Association