MMAP Success Stories: Second Advocacy Tale:

MMAP Counselors are tenacious, persistent and look for alternative ways to reach a goal. MMAP Counselors know that by getting to the TOP in an organization (talking with people who can do something) you will be able to get to the BOTTOM of a situation to resolve an issue. When someone tells you they “can’t,” it means you are talking to the wrong person.
A MMAP client had a Humana Part D plan and had been using Humana’s mail order pharmacy. In July, she received notice that the pharmacy could no longer serve her because Humana was her secondary insurance and Express Scripts was her primary under BCBSM. We called BCBSM and talked to many departments with all saying they were not at fault. We called the local Walmart Pharmacy who said that they had billed her scripts through Express Scripts over a year ago and confirmed in their database that Express Scripts was her primary prescription insurance.
We called 800 Medicare who confirmed that Humana is her Part D plan. And, there was the dilemma. 800 Medicare suggested that we file a complaint with the state’s Department of Insurance and Financial Services in order to straighten out the situation, and we contacted them. A DIFS representative said we would need to file a complaint asking for a four-day Rapid Response and gave us the form’s web address.
First we called her Humana plan again and told them about the potential complaint and asked for a supervisor to discuss the situation. The supervisor told us they would conduct a case review (Friday) and that we would know the results in a week. My client called me on Tuesday to report that Humana contacted her saying that she could now use her plan again. She had tried to correct this situation on her own for over a month until she was close to running out of her prescriptions.
I still have her thank you card on my desk!

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