SEYMOUR, Tenn. (WATE) — The mother of a disabled man in Seymour has been fighting for a year to keep her son’s health benefits. If you’ve ever tried to correct mistakes made by the government, you know how difficult it is to navigate the paperwork required to get things right. That’s what Donna Peoples has been facing.
She’s been told several times that her son’s benefits are ending. Peoples shared that her disabled son’s health insurance company contacted her a year ago. She was informed that some of his federal benefits had been canceled. She won the appeal, only to be told at the end of last year that his entitlements were ending again. Well, she says the same pattern was repeated this year.
For a year, Peoples has been trying to resolve the confusing status of her son’s insurance coverage.
Her son John Darr is deaf and can’t speak. He lost his hearing as a child from Spinal Meningitis. John, who is 32, graduated from the Tennessee School for the Deaf. Until a few weeks ago, he worked full time at a home improvement store.
Now, however, he’s in the hospital fighting COVID-19. For years, John has qualified for Medicaid and Medicare due to his disability. His hospital insurance is with Humana. Because of his disability and low income, he’s also eligible for QMB benefits — that’s the Qualified Medicare Beneficiary program administered through TennCare. But Donna says there are ongoing discrepancies and it’s been a battle for her as she handles John’s insurance affairs.
She says, “It started out in August 2020, he lost his entitlement. I got it back, he lost it again, I got it back. He’s lost it a total of 6 or 7 times.”
In May of this year, she received a letter stating John’s entitlement issues have been resolved.
She says, “I had to do an appeal with TennCare before it went to court. TennCare said, ‘You are right, we are wrong. We made a mistake.’ So, I thought I had that straightened out. Then I get another letter from Humana.” That letter sent in June of this year states his coverage “will end soon,” contradicting what the previous letter sent a month earlier said.
At that point, she called Medicare and Medicaid services and asked what is going on? She was told John’s bills had not been paid.
“$1,387.50. Another bill for $2,007. And, I’ve been dealing with this since August. (I) can’t get it straight. And he (John) can fight this, I can barely fight this. I’ve got three rooms full of papers.” Donna also adds that the documents keep piling up, one contradicting the other. “I just want them to get it together and work this out because there has been a bad mistake. They have not communicated.”
The most recent bill states $2,600 is owed.
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“Medicare does not have it documented that TennCare Connect, QMB, is paying for John’s B premiums. This is why I’m getting these bills,” she says. “That’s what Medicare is telling me, he needs to pay or he is going to lose his entitlement.”
After we contacted TennCare, representatives from the state meet with Peoples virtually. She says basically the state informed her that they would intervene and talk with Medicare, Medicaid Services to bring an end to the confusion and help resolve the issues with John’s benefits.
“I have fought this long, I don’t give up very easily. Other people would have said, ‘okay, forget it.’ I can’t, he needs this. He’s deaf he deserves it.”
TennCare says the issue originates with Social Security and Darr’s eligibility for Medicare. TennCare says the Medicare-related letters issued by Social Security caused a lot of confusion.
Peoples says that a second virtual hearing with the state is scheduled for next week. We’ll continue to follow this story.