Tuesday, November 06, 2007


There are some unhappy folks in West Virginia who after toiling away all their lives working for the state or as teachers have suddenly been told that their state-run health insurance isn't going to be quite what they've expected or quite what they've been receiving.

You see the state decided to switch their insurance (those covered by medicare) to Kentucky-based Advantra. Now the retirees find their insurance card isn't recognized by a number of states, and their coverage is costing them more out of pocket cash. A number of the retirees also discovered that because of the change tie in health insurance which they'd purchased was no longer acceptable. And, of course, the new insurance also limits the hospitals available to the lucky insured former state workers.

There's more.

In some cases, the new plan has threatened the lives of some retirees. For example, the cholesterol lowering drug Lipitor which many take is not on the new plans drug list. Lipitor has only received a No. 3 rating, which drastically raises the cost of the drug from $45 for a three-month supply to $50 a month for a one-month supply. The Register Herald writes: "A study due to be published soon by the British Journal of Cardiology shows that Heartland Institute found patients switching from Lipitor to a generic were 30 percent more likely to suffer a heart attack."

Once again the former and current state workers had no involvement in the change, hadn't been accurately informed in advance what it would mean, weren't listened to when they raised concerns, and aren't getting what they'd been promised.

Promises don't seem to mean much anymore.

Former Delegate Sally Susman, D-Raleigh, says the new plan is senseless and imposes penalties on retired teachers, school personnel and low-paid government employees.

“The state has forsaken those who have worked all their adult lives for West Virginia and deserve, in fact were promised, a comfortable retirement in lieu of a salary increase,” Susman said.

“The changes penalize the sickest and the frailest of our citizens.”

West Virginia citizen George Ballard of Bolt wrote the Register Herald recently:
"West Virginia was the first state to privatize Medicare and PEIA (Public Employees Insurance Agency). The finance board of PEIA, appointed by the governor, was the approving force in the privatization of PEIA and Medicare. Advantra gets all of the premiums retirees pay into Medicare and PEIA and it was stated that PEIA added some money to this premium. Put those figures in your calculator and you will see some real money. I know you have heard the statement “Follow the money.”

The finance board is appointed by the governor and confirmed by the state Senate. Of course, they listened to the governor when he said that West Virginia could save millions of dollars by going with this privatization route. But they forgot to look at how many additional dollars it would cost the retirees.

As retirees we got shafted by the finance board of PEIA and the governor who appointed them....

We were lied to by PEIA when they put in the 2007 handbook that we had nothing to worry about in Medicare Part D and we have constantly been lied to in every other publication that has come from PEIA. Remember that we received the notice of the change that took place on July 1 in a publication from PEIA on July 25."

Right on George!

Another West Virginian Charleen Bailey also wrote a letter to her newspaper in which she pointed out:

"Recently, Gov. Joe Manchin moved all state retirees with Medicare to a new program. First, I'll say this will allow all businesses to follow suit. I've heard one company is considering this plan also. I do not mean any harm to that company, but if this is true, everyone with retirement and Medicare, this could happen to you.

...We pay Medicare premiums and PEIA premiums. I now have doctor co-pays. This new plan refuses to pay on two medications I've taken for years, which I don't take anymore because of cost.

The new plan, Advantra Freedom, doesn't cover it. If this is not discrimination, I don't know what is! Your deal cost us more money. Isn't Advantra Freedom a form of Medicare? Why are we paying two premiums when you did away with our secondary insurance? You act like you still gave us insurance, but you did not.

Now my husband will be receiving Medicare in November. He was medically disabled two years ago. Social Security has you wait two years before you get a Medicare card. First, we had to wait six months before receiving a Social Security check; we did not receive back pay. Then we go to the retirement board and never received a full check. They said, "Sorry, but retirement was revised 30 days ago."

My husband has been going back and forth to the Cleveland Clinic for a heart transplant. We owe Cleveland thousands. We need PEIA now to become secondary to help us medically and financially. Now, it's all gone.

You don't even care about the stress that you have put on all of us. My husband worked for the state for 19 years. He had a retirement plan. He didn't make a lot of money. He stayed because of the retirement plan, not for the money. Governor, when you promote business for the state, you need to make money for the state. Your deals are as good as you. Stop trying to run the state like a business.

Slogan? You want to change everything. It's too bad we can't change you. You have the power to fix the mistakes. But we all know you're only for business and not for people."

Charleen, you've pretty much summed up the situation and you've done it in a much more human way then ever I could.

I hope somehow you and all those in your situation get some relief. It isn't right what is happening to you and it isn't fair that you have to try and deal with all this now that you've retired or been forced to leave work for health reasons.

Oh, by the way, the gov, Joe Manchin III, is a Democrat - the party of the working people. He'd make a fine Republican.

The following is from the State Journal (Charleston, West Virginia).

Angry Retirees Question PEIA Changes
Some PEIA subscribers are unhappy with changes in the state-run health insurance program

HUNTINGTON -- Hundreds of retired state workers are lashing out at the Public Employees Insurance Agency after the insurance provider changed carriers.

Between 175 and 200 retired and soon-to-be retired state workers and teachers gathered Oct. 29 at Huntington High School to learn why PEIA decided earlier this year to allow Kentucky-based Advantra to provide health care coverage for retirees who are eligible for Medicare.

One of the biggest complaints the retirees had is that the new card and provider are not accepted in some other states, including parts of Florida, North Carolina, South Carolina and Georgia. They also complained the new system was costing them a whole lot more and providing worse coverage than what they had before.

"I feel like PEIA sold us out," said Imogene Parrish, a retired Cabell County Schools worker.

The group was so bothered by the changes that attendees began bombarding the PEIA representative with questions as soon as the meeting started. And the questions continued, one after another, sometimes being asked directly over another, for two hours. PEIA's representative, Gloria Long, deputy director for insurance programs and services, tried to answer questions and calm people. But by the end of the meeting, people were just getting madder and blaming everyone from Gov. Joe Manchin to President Bush for the health insurance changes.

"The intention was never to stick you out there without insurance or to make you feel uneasy about your insurance," Long said.

She told the group the PEIA board decided a while ago to allow Advantra to handle insurance for all PEIA members who were eligible for Medicare. Advantra then set up a plan based on PEIA's requirements, as well as specifications Medicare demands. PEIA's board accepted the proposal, and the new benefits went into effect July 1.

She said PEIA has heard about problems, particularly with finding providers in other states.

"There are some pockets of the U.S. that don't accept Advantra," she said. "We are calling providers to ask them to start accepting (it). We are trying to help out."

She said every doctor or health care provider that accepts Medicare payments should be accepting Advantra as well. But some areas just aren't willing to accept the new carrier. She said that has caused lots of problems for retirees who travel a lot or spend several months in warmer climates. As a remedy, she said PEIA has agreed to let some retirees who do spend a lot of time out of state rejoin the old plan for the time being.

Another common complaint was that some retirees under the new carrier were losing the supplemental insurance they had purchased for themselves and their spouses over the years.

"I'm just wondering if you are aware how this is impacting other plans," one man called out from the audience.

"Painfully aware," Long said. "The issue there is Medicare considers any plan with a Plan D (or prescription drug coverage) as double dipping, and they kick you out."

That was not the answer the man wanted to hear.

"I paid for this insurance while I was working, and now I have less than before," he said.

Long told him one solution would be for him to maintain his PEIA life insurance but drop his PEIA health insurance and sign up under his wife's plan. She said if he did that, he could rejoin PEIA at any time.

The new coverage also is limiting where some people can go to the hospital. Long said she's heard of cases where hospitals have turned away patients with Advantra. Her recommendation to those in the group was to call the hospital before any planned procedures to make sure they accept that carrier.

Some of the biggest complaints, however, were about retirees having to pay co-pays, co-insurance and deductibles, something they didn't have to pay under the old system. That's a big change for some former state workers. And it's a bitter pill for them to swallow.

Long said while many people are blaming Advantra for the problems, she said Advantra designed a program to meet PEIA's requirements and specifications.

"The plan design we have to take credit for at PEIA," she said.

The plus side of the changes, Long said, is that it won't raise premiums. In addition, retirees will have a maximum out-of-pocket expense for health care per fiscal year of $500. However, she said retirees who make less than 250 percent of the federal poverty rate are eligible to have that maximum out-of-pocket amount reduced.

Money spent on prescriptions is not included in that maximum out-of-pocket amount.

She said despite the retirees' complaints, she believes the program is good and provides retirements with the same excellent level of health care. But she admitted that it's different, a bit confusing and that adjusting to the new system could take some time.

"I believe you have a good health plan; if I didn't, I wouldn't be here," she said.

Cabell County Delegates Kelli Sobonya and Carol Miller, both of whom are Republicans, called the meeting, which was attended by the county's two senators, Robert Plymale and Evan Jenkins, both of whom are Democrats. All four not only listened to complaints but also tried to answer questions, or at least help them find someone who could answer their questions.

"There were so many questions we couldn't answer, so we figured we'd bring PEIA here to answer them for you," Sobonya told the audience.

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