Breaking the Health Exchange Mold

Posted:May 18, 2016

In Skip’s second part to his ongoing column, “Bean Counters: A multipart saga of dealing with the Medicare Part D Rx insurance industry”, he explains how his Part D provider was sanctioned by Medicare. Reasons for this sanction included failing to approve covered drugs, not allowing transition supply fills, and failing to process drugs in a timely manner. Most importantly the letter gave all current members the option to switch to another prescription provider as part of a Special Enrollment Period.

Skip experienced firsthand what this provider was failing to do. They denied a prescription he had been on for years and tried to put him on an alternative that he previously tried without luck. After facing other additional problems, he decided to take advantage of the sanction and called Medicare to enroll into a plan with a different Part D provider.

Labor First understands that Medicare Part D plans can be confusing and frustrating. The primary responsibility of the Retiree Advocate is to eliminate the issues Skip faced for their members. They help members who have ran into prescription denials, prior authorization requests, appeals, and other Part D stipulations. They take on all responsibility for the member and work between the insurance company, the pharmacy, and the prescribing prescription to make sure members get their prescriptions without hassle. Labor First is focused on alleviating stress for members as they know that many Retirees can relate to Skip’s experience.