June 2016 - Imagine needing dialysis 3 times a week, not being able to drive, and your ride doesn't show up! A beneficiary called us after the medical transportation company failed him four times (or four missed appointments). There had been a number of problems - no shows, late, or the wrong kind of vehicle. The beneficiary had tried complaining to the transportation company with no results.
Fortunately, the member called our Ombudsman Hotline where the staff quickly initiated action with the insurance company. The insurance company found a new transportation company with the correct vehicle for someone in a wheelchair, and, instead of the beneficiary needing to call each time for transportation, the insurance company made it a standing appointment for the new company. The new system is working and getting the beneficiary to the appointments on time.
June 2016 - We received a call after 5 p.m. from a pharmacist in a Southwest Michigan Meijer store. He said that a woman whose insurance had been cancelled was in his drive-through and she hoped we might be able to help her. We were not familiar with the beneficiary's name but asked the pharmacist to have her call us directly.
The tearful beneficiary explained she was desperate because she had not had any medications to treat her bipolar and thyroid conditions for several days and she could not obtain them now because the pharmacist said her insurance was cancelled. She did not think she could wait until the next day to obtain the prescriptions. She was also concerned about burning through her few cell phone minutes trying to resolve this issue. After speaking with her briefly, staff at MEJI and CALL (our Ombudsman hotline) realized this person had likely been enrolled in MI Health Link (MHL). She did not understand that her Part D coverage had been cancelled because she now had prescription coverage through MHL. When we inquired, the client recalled she had received something from a new insurance plan but had not understood it. Working with the pharmacist and the state (luckily, the state contract manager was also still in her office after 5), we were able to confirm the beneficiary's coverage. The pharmacist then provided the very relieved and happy client with the medications she required. The issue was resolved in less than 15 minutes.