The Quest

We got a letter last week that said SSI was no longer going to cover Shannon’s Medicare. They would be taking the premiums out of his future payments and taking the January, February and March premiums out of his next payment. The letter offered no reason as to why this action was being taken. It only had a couple of phone numbers to call for more information.

Nothing has changed about his circumstances, other than the rent going up, so I didn’t know what to make of it.

I was off work on Friday, so I decided to call for more information. I tried the local number first, but it was busy. So I tried again. Still busy. Tried again. Busy. Called. Busy. Called. Busy. And so on.

40 calls later, it was still busy.

I waited awhile and tried again. Busy.

So I called the toll-free number. I reached a woman who didn’t seem to understand the questions I was asking and who kept repeating the same things over and over in an increasingly loud voice. When I asked her to please lower her voice, she hung up on me.

I called back and reached a nice young man (I don’t if he was young, but he sounded young) who listened to me, put me on hold several times, then came back to tell me that I was dealing with state issue involving Medicare (which I already knew) and that his company only serviced Medicaid on a contract basis.

He gave me another number to call, so I called it. They told me that they only dealt with Medicaid, also, and gave me yet another number to call.

I called that number, and the person on the other end told me in effect that because Shannon had Medicaid he wasn’t eligible to have his Medicare paid for because Medicaid was outside help. I told her he doesn’t have Medicaid. They canceled that 2 years ago while he was in the hospital. And, besides, you can’t qualify for Medicaid unless you can’t afford the Medicare co-pays.

She kept telling me that she was relaying what her computer was telling her.

I gave up on the phone and went online to try and find what the qualifications are for Medicare be paid. I figured it would take less time than I had already wasted and give me some concrete information.

I’m pretty good at research. I’ve been doing it since college and grad school. Usually I can find what I need in a few minutes, max. More often it’s a few seconds. But I couldn’t find a thing.

I spent well over an hour, and the only thing I came up with was a document that said appealing within 10 days would forestall any action until the appeal was decided.

The appeal went out Friday afternoon, but I was so tired and frustrated that I called it a day on that issue.

I needed a break.

Saturday, I sent out letters to every legislator I thought might be able to help us: our state Representative and Senator, our former state Representative, our US Representative, our former US Representative and the President. Over-kill, I know, but I hoped that at least one of them could help us. All I asked was for a phone number that someone would answer where someone could answer my questions.

Monday was a holiday (Presidents’ Day), but Tuesday Shannon got a call from our state Senator’s office. They were going to look into it.

Wednesday, I got a call at work from a lovely lady from the Ombudsman’s office (it’s the highest level of complaint management in the state). She told me that she had read my letter and then started apologizing. She promised to pass it on to the appropriate persons.

Later that day, I got another call from Health and Human Services. The woman I spoke to apologized for all the mess and told me that all this was happening because Shannon didn’t file his re-application, but she could see that he probably never got one. I told her that we had gotten a letter stating as much and that Shannon requested the documents and that they had gone into the mail the week before.

For whatever reason, they seem to think that someone who actually qualifies for SSI will remember to remember that they haven't received renewal forms. Especially recipients who are mentally ill and taking butt loads of medication every day.

The assumption that everyone should be able to keep up with annual renewals when they can't even function well enough to work is patently absurd. It points to fundamental misunderstanding about the nature of illness, whether it's mental or physical.

The HHS lady checked and saw that the paperwork had been received. So she decided to request an immediate review and an answer within 48 hours.

She also told me that Shannon did not have Medicaid, but might qualify and that having Medicaid doesn’t disqualify one from Medicare paid for. It’s the other way around, actually.

We’ll see how it all shakes out, but I’m hoping for the best.

The moral to this story: never underestimate the value of being mouthy. It took a day on the phone and about $3 in postage to get what I needed: a simple answer to a simple question.