KODAK, Tenn. (WATE) – Almost everyone who has a kidney transplant muct take anti-rejection medications daily for the rest of their lives. But a local transplant patient has received conflicting information from TennCare about her eligibility for pharmacy benefits.
Lisa Harnage says her life “changed” when she received a new kidney in May 2016.
Ever since, she’s depended on anti-rejection drugs to keep her immune system from attacking the transplanted kidney. For three years, she depended on Social Security of her benefits.
But after 36 months, the rules changed and she took action to make sure she wasn’t lost in the shuffle. However, at first, it didn’t exactly work out that way.
Lisa and Chuck Harnage pay close attention to her supply of medications. The two live on a limited income. Chuck has no health insurance.
Receiving a kidney transplant in 2016, Mrs. Harnage depends on a series anti-rejection pills or immunosuppressants. Under federal guidelines, Medicare pays for her hospital and medical insurance. However, at the end of the third year following surgery, Medicare stops paying for transplant drug therapy.
In early May, Lisa received a letter stating she would be removed from pharmacy benefits May 31st. Aware of the rules, she got in touch with TennCare to establish continuing benefits.
“I receive a letter from TennCare stating that my coverage was ending,” Lisa Harnage told WATE 6 On Your Side. “It’s going to end July 10th of 2019. The reason was they said they had sent me paperwork that I never received. So, there was nothing to send back to them.”
Her husband Chuck saying the notice was “heart-dropping,” but they filed an appeal.
Lisa appealed during the appeal, her hospital and medical insurance continued with TennCare. But not her pharmacy benefits, or so she thought. In early July, another correspondence changed everything.
A letter received July 2 stated, “you appealed AFTER your coverage ended or your benefits changed.” Lisa thought she no longer had coverage, even thought the TennCare letter had said the coverage ended July 10.
Then, on July 31, another letter came from TennCare.
“This letter says, ‘on June 27th we received your appeal. You appealed before your coverage ended, so you will keep your coverage during your appeal.’ So, at this point, I don’t know what is going on. Three different letters state three different things. So, I still have no coverage during this time to pay for my prescription. Every time I call they say, seven to ten days for almost three months now.”
On Lisa’s behalf, WATE 6 On Your Side contacted TennCare. We were told Mrs. Harnage did receive two appeals notices. Unfortunately, the appeal dated July 2 was in error stating her coverage would “end.” When caught, Mrs. Harnage was sent notice on July 31 correctly stating TennCare received her appeal before the coverage ended.
“[These medications] keep me alive basically,” Lisa Harnage said.
Over the weekend, Lisa received a decision about her eligibility. TennCare writes: “You now have TennCare Medicaid that will pay up to five prescriptions a month.” Mrs. Harnage is thrilled.
In that letter Saturday, Lisa Harnage was also told that with a doctor’s approval, TennCare will pay for more medication if needed.
Since Lisa’s husband has no healthcare coverage at his job, they’re dependent on Medicaid and their TennCare benefits.