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I've been hearing about these new Medicare prescription drug discount cards but I don't know the details. What should I know about this?
A: As of May 3, 2004, seniors and disabled Medicare beneficiaries may begin to purchase Medicare prescription drug discount cards. These cards will be effective on June 1, 2004, and are intended to provide financial assistance before the Medicare prescription drug benefit goes into effect the beginning of next year.
You should make sure you know the details about any card you are thinking about purchasing. Find out whether the card, covers the drugs you take, and whether and how often the coverage can change. Also important to know are the savings from using the card and whether your local pharmacy will accept the card. For more tips and information on Medicare discount drug cards, please contact AG Reilly's Elder Hotline at 888-AG-ELDER and ask for our discount card brochure.
- I've heard that Medicare is going to make prescription drug discount cards available to seniors. Do I need to sign up for something now? How do I choose a card?
A: Medicare will be approving prescription drug discount cards that meet certain standards. The cards will be available for purchase beginning May 3, 2004 and take effect June 1, 2004. The cards will cost no more than $30, and will provide discounts of 10-25% off retail prescription drug prices.
Over 100 private companies have applied to provide Medicare prescription drug discount cards, so you will need to take care to buy the card that is best for you. Ask these questions before buying a card:
1. Has the Medicare program approved this card? Check the information from the Medicare program don't just rely on literature from the discount card provider.
2. Does this card cover the drugs you take?
3. Will the drugs covered by this card change? If so, how often?
4. How much will you save? To see how much you would save by using a particular Medicare card, list your monthly drug costs, and calculate the savings the card would offer on each drug.
5. Does the pharmacy where you shop accept this card? Ask your pharmacist don't just rely on literature from the discount card provider.
You can get a copy of the Attorney General's new brochure designed to help seniors understand the Medicare prescription drug discount cards from our website or by calling the Attorney General's Elder Hotline at 1-800-AG-Elder (1-800-243-5337).
- My health plan informed me that they now require tiered copayments for prescription drugs: $10 for generics, $20 for preferred brand-name drugs and $35 for other brand-name drugs. I'm afraid I won't be able to afford these co-pays, but I don't want to stop taking my medications. What can I do?
A: Make an appointment with your doctor to review all your medications. Ask your doctor whether there is a drug with a lower co-payment that would be appropriate for treating your condition. This is also a good opportunity for your doctor to review whether your condition continues to require all of your current prescriptions at the current dosages. Be sure to bring all your medications, including over the counter drugs, vitamins and herbal supplements to your appointment. You can prepare for this discussion by obtaining a copy of your health plan's prescription drug tier list by calling member services or by looking it up on the Internet. Your doctor has a copy of this list and can discuss the relative effectiveness of the various drug options for treating your condition.
- My new doctor is charging me a fee for a service that I had received previously from a former doctor for a smaller fee. Are there any regulations regarding medical billing?
A: Well, except for rules about fees for medical records, there are no regulations limiting what a physician may charge for a particular service, although they may not bill Medicare recipients for more than the charge established by the United States Secretary of Health and Human Services. Still, most consumer protection laws do apply, and it would be illegal for a physician to charge for services not provided or for services that were actually unnecessary. If you are having a billing dispute with a physician, you can contact our Office and we can see if we can assist you through our mediation service.
- I recently applied for a private long-term disability insurance policy. I'm in my thirties and in good health, but I just received a letter from the insurance company saying I was rejected. Do I have a right to find out why I was turned down?
A: Under a Federal Trade Commission rule, all insurance companies that are members of the Medical Information Bureau have to inform you if a credit report or other information, such as your driving record, criminal activity, or medical condition, played any part in denying you coverage or being charged a higher rate. If that happens to you, the insurance company must give you the name and address of the agency that provided the report, and you are entitled to get a free copy of the report from the agency within 30 days. If you believe information in the report is inaccurate, you have the right to challenge the information, ask that it be investigated, and receive an explanation of the findings.
- I had to cancel a doctor's appointment recently for reasons beyond my control, and the receptionist informed me that I would have to pay a cancellation fee. How can they do this?
A: Well, any business that sees its customers by appointment, including a doctor's office, does have the right to charge a cancellation fee. In fact, under the law they could charge the entire fee for the service in question. All of the fees, however, should be clearly disclosed in the vendor's cancellation policy to which you should have access before you receive the service. If you are a first-time "offender," you may also try to negotiate with the office and attempt to come to some resolution.
- Do I have a right to see my minor child's medical records?
A: Yes. The guardian of a minor can see the child's medical records. If you want to receive a copy of the records, however, the medical office can charge you up to $.25 a page and up to $20.00 an hour for the documents. If you are having problems receiving copies of your child's or your own medical records from a medical facility, please contact our Consumer Hotline for assistance.
- Aren't there any special rules relating to a physician's billing practices?
A: Actually, the government does not regulate most professional billing practices. There is a broad misconception that medical services must follow rules different from ordinary consumer transactions. There are no laws preventing a doctor from charging interest on unpaid bills, and these unpaid bills may be listed on your credit reports as well. Also, besides medical records, there are no regulations limiting what a physician can charge for a particular service, although they may not bill Medicare recipients for more than the charge established by the United States Secretary of Health and Human Services. Obviously though, most consumer protection laws still apply, and it would still be illegal for a physician to charge for services which were not provided, or for services that were actually unnecessary. If you are having a billing dispute with a physician, you can contact our Office and we can see if we can assist you through our mediation service.
- My 82 year-old father is sick, is on Medicare, and wants to stay at home as long as possible. I recently heard about a program called "Hospice" that sends trained medical people into your home to help. Is this a legitimate program and is this covered by insurance?
A: I am sorry to hear about your father. Caring for a family member with a long-term illness can be very difficult, and can even affect your own health. Hospice could be an excellent choice for you. They care for people who have life-limiting illnesses, who choose comfort, not cure. They are open to people whose physicians believe that their life expectancy is six months or less if the disease runs its normal course. There are 41 hospice programs throughout Massachusetts. All hospice workers and volunteers who see patients are first cleared through a criminal background check.
Hospice is a covered benefit in most insurance programs, including Medicare, Medicaid (Mass Health), and private health plans that do business in Massachusetts. This comprehensive benefit provides medical care, nursing care, social services, home health aide services, pastoral care, volunteer support and medications and durable medical equipment related to the terminal disease. Hospice also provides bereavement care at no additional cost to the family for up to 13 months following the death of the patient.
If you have no insurance, hospice may still help you. They also offer care on a private pay, sliding fee scale or charitable basis.
For more information on hospice care, call the Hospice & Palliative Care Federation of MA at (800) 962-2973 or check its web site at www.hospicefed.org. You can also call our Elder Hotline at 1-888-AGELDER (243-5337) if you'd like us to send you a hospice brochure.
- My sister was recently diagnosed with a degenerative disease. Right now, she feels fine, but we both know that at some point she's going to lose her ability to think and speak clearly. We want to make sure her family and her doctor follow her wishes for medical treatment. What's the best way to do this?
A: This must be a very difficult time for all of you. I would encourage everyone over the age of eighteen to think carefully about their preferences and values when it comes to medical care and life-sustaining treatment. They should also appoint a health care proxy who can make decisions for you after a doctor has certified that you've become incompetent. Your health care agent must follow your wishes, and if your wishes aren't known, must act according to what they believe are your best interests.
It is important that your sister does this while she is still competent. Make sure your sister keeps the proxy form/document in an easy to find place and gives a copy to her physician and agent. Even though she can use the health care proxy to express her wishes about treatment, I strongly encourage her to discuss this with her proxy agent, physician and her family. This will significantly increase the changes that her wishes will be honored.
If you want written information on health care proxies, call the Attorney General's Elder Hotline (888) 243-5337. For general information about resources on end of life issues, visit www.endoflifecommission.org.
- I attempted to make an appointment with my doctor recently, but the receptionist refused to schedule me because of a late bill I have not paid yet. So I then tried to get a copy of my records to try to go to another doctor, and they refused for the same reason. Can they do this?
A:If you do have a legitimate outstanding bill with any business in Massachusetts, the business, even if it is a health care provider, may refuse to continue to do business with you unless you come to an agreement about paying the amounts due. A health care provider, however, cannot refuse to treat you if you are in the midst of an acute problem for which the lack of immediate follow-up would be dangerous to your health. Unfortunately, this type of situation can depend on whether you are paying for medical care out-of-pocket or if you have health insurance.
Under Massachusetts law, consumers do have a right to receive copies of their medical records even with a past due amount, although your doctor may charge you a fee up to $0.25 per page and $20 per hour for administrative costs for producing the copies.
- Can your primary care physician refuse to see you in an emergency if you do not have an appointment?
A: Yes, if you do not have an appointment your primary care physician can refuse to see you. If it is an emergency you should immediately go to the nearest hospital.
- I picked up a prescription from my pharmacy today. When I went to take it, I realized that they were the wrong pills. Where can I register a complaint against a pharmacy?
A: To file a complaint against a pharmacy you can contact the Board of Registration in Pharmacy. The 33 individual boards of registration license certain professions and trades based upon statutory criteria and regulations. The Board of Registration in Pharmacy has the power to revoke or suspend a professional pharmacy or pharmacist's license after investigation of serious complaint. You can contact the Board of Registration in Pharmacy at (617) 727-9953.
- My HMO covers brand name prescriptions, but my pharmacy fills my prescriptions with generic products. Can they do that?
A: The answer to your question is yes. In 1976, Massachusetts enacted the Generic Drug Law to promote and regulate the use of generic drugs. In most instances, this law requires pharmacies to dispense generic drugs unless your doctor indicates on your prescription that a specific brand name medication be prescribed to you. So, unless your doctor has handwritten the words "no substitution" on your prescription form, the pharmacist is required to fill your prescription with a less expensive and reasonably available generic product.
- Is a pharmacy required to provide me with a receipt including the actual price of my prescription when I pay with an insurance co-pay?
A: No, there is no law in Massachusetts which requires pharmacies to provide patients with receipts that show the actual price of the prescription. If you have insurance which pays for most of the cost of the prescription, the pharmacy will provide you a receipt which shows the amount of the co-pay that you pay to the drug store, not the total retail cost of the drug. To learn more about the laws that regulate pharmacies in Massachusetts, consumers should call the Board of Registration at (617) 727-7406.
- I filed a 93A demand letter against a psychologist and she refuses to acknowledge it. What should I do?
A: The Consumer Protection Act, Chapter 93A, protects consumers from unfair or deceptive conduct in the marketplace. Before you take any action under Chapter 93A, you have to send the business a 30-day demand letter. This letter tells the business about the complaint and gives them an opportunity to settle before going to court. If the business does not respond to your demand letter, you can file for mediation with our Consumer Complaints division at (617) 727-8400. You can also take your matter directly to court to seek damages.
You may also want to get a copy of brochure "A User's Guide to the Consumer Protection Statute." You can contact our Consumer Complaint Hotline at (617) 727-8400 and they will send you one.