Monday, December 9, 2019

Texas’ Retired Educators Begging for Affordable Health Care Part I – The Prescription Nightmare and a Letter from CVS Caremark


            Talk to retired public-education employees in Texas, and ask them if they expected to spend their retirement years begging for affordable health care.  Regardless of whether we expected it or not, that is exactly what we are doing today.
            When I retired in 2013, I had affordable health care through the Teacher Retirement System of Texas (TRS).  I paid close to $300 per month for the high plan.  I had a $400 deductible and a co-pay of $25 or $30.  It was pretty much the promise I heard throughout my career, that even though my pay as a teacher was nothing to brag about, in retirement, I could expect a pension and affordable health care.
            Then the 2017 Texas Legislative Session happened.  During that session, Gov. Greg Abbott, Lt. Gov. Dan Patrick, and the Texas Legislature forced me--and all of my fellow public-education retirees under the age of 65--into a health-care nightmare.  Suddenly, that affordable-health-care promise was shattered.  My monthly premium went down to $200 but for a high-deductible plan.  Instead of a $400 deductible, we now have a $1500 deductible.  Instead of a $25 or $30 co-pay, we now have to pay 100 percent of our health care and prescriptions (except a list of standard, generic drugs) out of pocket until we reach our entire deductible, and for married couples, that deductible is $3000—not $1500 for each but the full $3000. Until then, Aetna does not pay one penny.  Not one, unless it a procedure from the short list of preventive care.
            However, the Texas Legislature kept the health care for themselves and all other retired state employees—except public-ed retirees—much more than affordable.  You see, they still have a $0 monthly premium.  Zero.  They also have a $0 deductible for their health care, and a $50 deductible for their prescriptions.  Imagine our retired legislators having a $0 deductible and forcing public-ed retirees (not just teachers but everyone who worked in public-school districts across the state) to live with a $1500 deductible and NO CO-PAY!  Think of our bus drivers, our cafeteria staff, our custodians, our maintenance staff, and others whose pension checks are definitely less than ours.
            Things have gone from bad to worse over the past two years since our nightmare began.  Then, a few weeks ago, I received a message from one of my close friends about a letter she received from CVS Caremark. CVS Caremark handles the prescription end of our high-deductible Aetna plan. Here is that letter, with my friend's name and address redacted:




            My friend called CVS at the number provided in the letter, but the individual who answered the phone had no idea what she was talking about.  How in the world do you send out a letter like that—certain to upset individuals who take medications because they have to, not because they want to—and not first train your employees to be prepared for the calls?
            Finally, my friend spoke to someone who had “some” information about the changes.  Since my friend’s doctor will NOT allow her to take a generic form of Synthroid, he said, she would have to pay the difference between the generic form and the brand-name form.  (God forbid a Texas public-ed retiree should get a brand-name medication!)  She asked how much that difference would be, and he said he did not know.  (And the difference between the two is NOT applied to her deductible or her maximum out of pocket!)  Again, how in the world do you send out a letter, certain to cause anxiety, without being ready to provide customers the additional amount they can expect to pay?
            My friend called me, beside herself with worry over this added expense.  I wanted to try to help her, so I called the number on the letter; however, because I did not have her account information, I could never get past the frustrating non-human on the line.  So I contacted the Communications Department at TRS to get to the bottom of this.
            Lucky for me, Meaghan Bludau, health care analytics and engagement director at TRS, is the one who responded. She listened carefully to my story about what happened to my friend and then promised to contact CVS and have them contact my friend directly.  She also promised to research the situation and get back to me, which she did—the very next day. 
            This is what every TRS retiree who received a similar letter from CVS Caremark NEEDS to know, information that was not IN the letter but should have been:
1. You or your doctor’s office can contact CVS Caremark at 1-844-345-4577 to start the request for the exception.  The Customer Care Representative can fax the questionnaire directly to the doctor’s office or mail you a copy.  You will need to notify the Customer Care Representative if this is an URGENT request so he/she can speed up the process.
2.  Ask your doctor to complete the “exception paperwork”.  It is a short questionnaire that explains why you need the brand-name medication instead of the generic.  The turn-around time is 24-72 hours.
3.  CVS will communicate with you and your doctor about the outcome of the request.  The doctor will receive a fax 15-20 minutes after the approval.  You will receive a letter in the mail in 8-10 business days.

            Now you know the rest of the story!

NOTE:  In Part II, I will share the shameful, horrifying health-care story of a TRS retiree over the age of 65.  In Part III, I will tell you the latest on what has happened to my friend who received this letter from CVS.  And there will surely be additional parts to this story about Texas public-ed retirees being forced to beg for something we were promised.

Chris Ardis retired in May of 2013 following a 29-year teaching career. She now helps companies with business communications and social media and works as a sales coordinator for Tony Roma's and Macaroni Grill. Chris can be reached at cardis1022@aol.com. (Photo by Linda Blackwell, McAllen)

4 comments:

  1. I'm retired over 65. I had to get out of TRS and go to Medicare. I lost the medical benefits I was promised for 34 years. I'm thankful I had the quarters to get into Medicare, but I should never have had to. We've been dumped.

    ReplyDelete
  2. I had to resort to paying completely out of pocket for my most expensive prescription. It is $140.00 thru insurance. Private pay is $ 83.00. I will never reach my deductible. Paid total cost for my mammogram because I didn’t reach my deductible. Colonoscopy canceled because I can’t afford it. I won’t advise people to go into teaching today. Way too dangerous to your health

    ReplyDelete
  3. These people are going to shorten our life span.I hope Patrick and Abbott are proud of their selves.I have block voted and called everyone I can think of to no avail.I believe in years to come that they our pension and so called healthcare.

    ReplyDelete
  4. I would love to have a phone number to call and find out why I cannot have back surgery. When you call member services I get the same response, it is listed in their Clinical Policy Bulletin as experimental. I can’t even appeal it. If I want to self pay, it is $18,000.00. This would take a huge chunk of our savings and pray nothing catastrophic happens in the meantime. I shouldn’t have to be dealing with this. I sent Brian Guthrie an email and his Assistant. I get no response. Aetna would rather people suffer and be on pain medication then try to fix the problem. Medicare will pay for this surgery, but I just turned 62. So, three more years of chronic pain and no quality of life.

    ReplyDelete