PGPD Retiree's Ass'n Florida Chapter











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Health Care Items





Medicare D
Brother Sean Taaffe has persevered and dealt with the Social Security Administration and Medicare. His issue like many others is he has what he believed was a payment on his monthly SSA benefit check and yet he pays the county a monthly premium for Medicare D.
Sean went to the SSA office in Charlotte Hall and was told they have nothing to do with Medicare benefits. So, Sean went home and called Medicare and was on hold for 30 minutes. The Medicare representative could see he was with Express Scripts through Medicare D through the county. When questioned why he was being billed by the SSA he was told it is not a payment for Medicare D.
"It is a way to reduce your monthly payment based on your income. It is called Income Related Monthly Adjustment Amount". Basically, a penalty for making too much money. Vice President Salen mentioned this over a year ago. It appears the county doesn't know about this. Now there is nothing the County, FOP or the Retired Association can do about this federal regulation. Many thanks to Brother Taaffe for putting in the time and effort to get an explanation.

The Retired Association has received several complaints in reference to those members who are Medicare eligible being moved to Medicare D when they turn 65 years old. The first complaints came in concerning the cost of specific drugs. We were told that the co pay for Eliquis went from $20 to $100. Second we were notified that the price of co pays are based on the retirees income. Additionally there are some retirees that are not Medicare D eligible who maintain their prescription plan just as they are active. If you have a problem with Medicare D please put in writing by responding to this email. It is my understanding a retiree at 65 should pay the same as a retiree at 64 years old or an active member.
1-28-17
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



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.
1-12-15
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.



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
President
Retired Association
3-22-12