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Fred Goes Back to JoCo DSS, Freddie's New Social Worker for Answers
Friday, January 10, 2014
Fred Goes Back to JoCo DSS, Freddie's New Social Worker for Answers
January 10, 2014

From: Fred Lempe
Sent: Friday, January 10, 2014 5:00 PM
To: Blackman, Debra
Cc: CONNIE WITHAM; PATREKA WORTHAM; STACIE ILKHANIZADEH; Nelson, Teresa
Subject: RE: Medicare Lifetime Reserve Day letter MR# 1948092

 
January 10, 2014


Hello Debra,

Let me take this opportunity to introduce myself; I am Fred Lempe, Freddie Lempe’s father.  I was unaware that you had  taken Freddie’s case until Monique informed me this week.

I really need some help with info about Medicaid, Medicare and Lifetime Reserve Days (LTR).  When I was notified by WakeMed  on the 26th about Freddie’s LTR days and that his Medicare was running out, I attempted to contact Monique on December 27th  2013 about this but she was not in the office and they put me through to her supervisor, Paula Johnson.  Who did answer my  questions after talking to WakeMed on December 31st 2013.  However, on the 30th and not hearing back from her, I informed  WakeMed that I wished not to use Freddie’s LTR days. WakeMed then in return on the 31st suggested that LTR days worked in a  different way than I had understood from Paula.

I think if I can get a clear understanding on a few things this will help me in being able to know what would be the best  for my son, Freddie’s interest.  I hope you can provide me with the correct information on these issues.

I understand it to be that Freddie had, still and will have Medicaid coverage since his last renewal in October 2013, until  his next renewal.

I understand that Monique added Medicare part D (prescription) as an added benefit to the already in place Medicaid.

I now understand that the Medicare part D plan has expired due to Medicare regulations that require Medicare, (which  Medicare part D stems from) to only run for 90 days while one is in a single hospital stay.  And Paula Johnson said that  the Medicare also pays some other stuff as well over the Medicaid however, she agreed that the Medicaid was still the  primary coverage as Medicare was only added as an additional benefit.

It’s my understanding and Paula told me that Freddie’s Medicaid would still be in effect after the Medicare part D expired  and that a decision to use or not use Freddie’s LTR days now or any time in the future wouldn’t have any effect on his  Medicaid coverage or his care in any way, either way.  This would lead me to believe that WakeMed would continue to be paid  by Freddie’s Medicaid regardless of them billing for Freddie’s Medicare 60 LTR days.

It’s my opinion that the LTR days are intended for the rare situation where one finds their self needing additional days of  treatment in the hospital to help to be able to improve to the point of recovery and being able to leave the hospital  safely in a healthy condition.  I understand that the LTR days are a onetime option and once used, they are gone forever  and will never be available again.  Freddie finds himself in an, what I would hope is an unusual situation where the  hospital has stopped and refuses to provide the treatments necessary that were helping him to improve to the point of being  able to leave the hospital in a safe and healthy condition.  I don’t think that the Medicaid or the Medicare programs were  intended for a healthcare provider to purposely prolong the patient’s condition in a manner as not to allow them to make  the improvements to their condition when possible.  While exhausting the patient’s entitlement resources unnecessarily by  willingly allowing the patient’s condition to deteriorate causing more risk of more health issues to arise.

I understand that WakeMed is required to notify and provide the necessary forms five days before Freddie’s Medicare  benefits run out.  I would assume if they didn’t meet those requirements that may very well be a problem for them, not  Freddie.  WakeMed notified me on the afternoon of 26th of December 2013.  I understand that Freddie’s Medicare benefits ran  out either on the 29th or the 30th, they have said both dates.  WakeMed only provided the proper, incomplete forms on the  8th of January, 2014 after I questioned them of the process and forms required on the 3rd of January, 2014.  To this date  they still have not answered my question of what the date is that this all has to be done by.

WakeMed is suggesting that Medicare is Freddie’s primary coverage and that Medicaid is waiting for Medicare to be exhausted  before it will be a payer of Freddie’s medical bills.  They are suggesting that if Medicare LTR days aren’t applied that  Medicaid won’t pay for Freddie’s medical bills until the LTR days are used.  They are also suggesting that if I make the  wrong decision on Freddie’s LTR days that they will come after me for Freddie’s medical bills.

Paula Johnson made the statement that DSS doesn’t handle Medicare.  However, Freddie’s previous case worker, Monique Utley  is the one who initiated and enrolled Freddie in Medicare.

Can you please help in this so as Freddie’s best interest will be protected?  These are the questions that I need answered  if you can.  If not, will you tell me who can?

1. Does Freddie have Medicaid?

2. Has his Medicaid changed in any way?

3. Will his Medicaid change in any way before it is time for its renewal?

4. Has Freddie’s Medicaid changed because of the Medicare being added?  If so, what has changed and how has it  changed?

5. Was Freddie’s Medicare that was added just part D (prescription) only or was it a complete change to Medicare to  replace Medicaid as primary coverage?

6. Why did Medicare become part of Freddie’s coverage?

7. What date did the Medicare start paying and how many days did it pay?  What was the last date Medicare was  available to pay for Freddie’s medical bills?

8. Was it Johnston County’s DSS office responsibility to initiate and handle the adding the Medicare to Freddie’s  case?  If so, what did Paula Johnson’s statement mean that JC DSS doesn’t handle Medicare?

9. Does the fact that WakeMed hasn’t performed to the Medicare requirements of notification and providing the  necessary forms by the required dates have any effect on this situation?

10. Will Medicaid pay for Freddie’s medical during the Medicare existence?

11. Will Medicaid pay after the Medicare has exhausted?

12. Will Medicaid pay if the LTRs are not used or will it only pay if the LTRs are used first?

13. When WakeMed continues to say that I will be responsible for Freddie’s medical bills if I don’t allow them to use  Freddie’s LTR days, are they saying that I, personally am responsible to pay Freddie’s medical that was not covered by  Medicaid, that WakeMed charged Freddie?  Am I personally responsible for Freddie’s medical bills that Medicaid/Medicare  doesn’t cover?


Please help clarify these contradictions that are lingering around this matter concerning Freddie’s LTR days.


Thank you very much for your help,
Fred Lempe








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