Gateway Health Medicare Insurance

This letter is in response to your March 9,letter regarding [redacted] .I spoke with Mr [redacted] on March l~, he stated that his concerns regarding hismedications have been taken care of and confirmed he had received his medication that heneededAt that time Mr [redacted] had no other concerns.However, [redacted] still investigated Mr [redacted] concernsThe records show on March4th Mr [redacted] went to the drug store to pick up his [redacted] ( [redacted] ), I mg, twice aday medicationMr [redacted] was prescribed pills per daysPer [redacted] ’s 2016formulary [redacted] ( [redacted] ) has a quantity limit of pills per days.If a medication has a quantity limit, the ordering physician can ask for an exception, whichcould take up to hours to completeThe records show [redacted] received an exceptionrequest from Mr [redacted] ’s physician on Friday, March 4th after business hoursOnMonday, March 71h, [redacted] approved the pills [redacted] ’s records show Mr [redacted] filled his [redacted] ( [redacted] ), day supply (pills) on March 7th~After review, the records show Mr [redacted] did speak with our Member ServicesDepartmentMr [redacted] was informed of the quantity limit for his medication and that [redacted] did receive an exception request from his physician requesting the additionalquantityMr [redacted] did state he was almost out of his medicationThe MemberService Representative suggested to Mr [redacted] to get his prescription filled with the 30pills until the exception request was reviewed

This letter is in response to your March 9,letter regarding *** ***.I spoke with Mr*** on March l~, he stated that his concerns regarding hismedications have been taken care of and confirmed he had received his medication that heneededAt that time Mr*** had no other
concerns.However, *** still investigated Mr*** concernsThe records show on March4th Mr*** went to the drug store to pick up his *** (***), I mg, twice aday medicationMr*** was prescribed pills per daysPer ***’s 2016formulary *** (***) has a quantity limit of pills per days.If a medication has a quantity limit, the ordering physician can ask for an exception, whichcould take up to hours to completeThe records show *** received an exceptionrequest from Mr***’s physician on Friday, March 4th after business hoursOnMonday, March 71h, *** approved the pills***’s records show Mr***filled his *** (***), day supply (pills) on March 7th~After review, the records show Mr*** did speak with our Member ServicesDepartmentMr*** was informed of the quantity limit for his medication and that*** did receive an exception request from his physician requesting the additionalquantityMr*** did state he was almost out of his medicationThe MemberService Representative suggested to Mr*** to get his prescription filled with the 30pills until the exception request was reviewed

This letter is in response to your March 9,2016 letter regarding [redacted].I spoke with Mr. [redacted] on March 1 l~, he stated that his concerns regarding hismedications have been taken care of and confirmed he had received his medication that heneeded. At that time Mr. [redacted] had...

no other concerns.However, [redacted] still investigated Mr. [redacted] concerns. The records show on March4th Mr. [redacted] went to the drug store to pick up his [redacted]), I mg, twice aday medication. Mr. [redacted] was prescribed 60 pills per 30 days. Per [redacted]’s 2016formulary [redacted]) has a quantity limit of 30 pills per 30 days.If a medication has a quantity limit, the ordering physician can ask for an exception, whichcould take up to 72 hours to complete. The records show [redacted] received an exceptionrequest from Mr. [redacted]’s physician on Friday, March 4th after business hours. OnMonday, March 71h, [redacted] approved the 60 pills. [redacted]’s records show Mr. [redacted]filled his [redacted]), 30 day supply (60 pills) on March 7th~After review, the records show Mr. [redacted] did speak with our Member ServicesDepartment. Mr. [redacted] was informed of the quantity limit for his medication and that[redacted] did receive an exception request from his physician requesting the additionalquantity. Mr. [redacted] did state he was almost out of his medication. The MemberService Representative suggested to Mr. [redacted] to get his prescription filled with the 30pills until the exception request was reviewed.

Review: I am a Diabetic and take the generic of [redacted] 1mg twice a day to keep my diabetes under control. Without it I get extremely sick. I found out when I went to pick up my medicine that they were not going to cover it and I'm out of my meds. I need them to stop from getting sick and ending up in the hospital. The pharmacy said that they were going to do a pre authorization to try and get me my pills. This I was told could take up to a week to get completed. Meanwhile I suffer or wind up in the hospital as a result of their negligence because they just don't feel like covering a standard prescription.

When I called in to talk to customer service they would not do anything to help me. Furthermore I asked for a supervisor and they would not give me one. There was one in the building but it is not "their policy" to let me to speak to one. They would call me back a day later while I suffer though I was told. When I called the corporate number the man operating the switchboard was extremely rude, cutting me off at every opportunity, and talking over top of me. He also cut me off at one point and transferred me to member services because he would not let me speak when I was looking for someone in charge to talk to. I don't think I have ever met a ruder individual in a "professional setting" ever in my life.Desired Settlement: I doubt it will happen but someone needs to address this right now. Not later, now.

Business

Response:

This letter is in response to your March 9,2016 letter regarding [redacted].I spoke with Mr. [redacted] on March 1 l~, he stated that his concerns regarding hismedications have been taken care of and confirmed he had received his medication that heneeded. At that time Mr. [redacted] had no other concerns.However, [redacted] still investigated Mr. [redacted] concerns. The records show on March4th Mr. [redacted] went to the drug store to pick up his [redacted] ([redacted]), I mg, twice aday medication. Mr. [redacted] was prescribed 60 pills per 30 days. Per [redacted]’s 2016formulary [redacted] ([redacted]) has a quantity limit of 30 pills per 30 days.If a medication has a quantity limit, the ordering physician can ask for an exception, whichcould take up to 72 hours to complete. The records show [redacted] received an exceptionrequest from Mr. [redacted]’s physician on Friday, March 4th after business hours. OnMonday, March 71h, [redacted] approved the 60 pills. [redacted]’s records show Mr. [redacted]filled his [redacted] ([redacted]), 30 day supply (60 pills) on March 7th~After review, the records show Mr. [redacted] did speak with our Member ServicesDepartment. Mr. [redacted] was informed of the quantity limit for his medication and that[redacted] did receive an exception request from his physician requesting the additionalquantity. Mr. [redacted] did state he was almost out of his medication. The MemberService Representative suggested to Mr. [redacted] to get his prescription filled with the 30pills until the exception request was reviewed.

Review: My issue is in May of this year Gateway was given false information by the Lawrence County Assistance Office That I was on Medicare, but I am not. I don't qualify for Medicare until November 1st of this year. So I contacted Gateway and informed them of my situation and they said it would take 6 weeks to get me re-enrolled in my health care plan and that has long passed. After several attempts to get this issue cleared up still no results. I contacted the Lawrence County Assistance Office and a supervisor talked to them and I also contacted Medicare and they said there records are right there is nothing they can do on their end. Called Gateway back AGAIN explained to them its on them to remove it from their system and as of now still not done yet so every time I need a prescription filled I have a problem. When I call them now they just coming up with excuses and switching me to other departments. Help me please!Desired Settlement: I want my coverage restored to normal.