Congressman: ‘Life-Threatening’ Mix-up Stalled Cancer Patient’s Medical Coverage

By Jano Tantongco

  Rep. Steve Israel, right, stands with Andy Lord, 65, of Melville, in front of the Social Security Administration office in Melville on Friday.

Rep. Steve Israel, right, stands with Andy Lord, 65, of Melville, in front of the Social Security Administration office in Melville on Friday.

Rep. Steve Israel (D-Huntington) has denounced both the Social Security Administration and the Centers for Medicare and Medicaid Services for what he called a “life-threatening problem” that a Melville cancer patient was faced with earlier this year.

Andy Lord, 65, owner of a recruiting firm, stood outside of the SSA office in Melville on Friday with Israel to tell his story.

When Lord turned 65 on April 9, 2016, he looked forward to “one of the few benefits of getting older:,” coverage under Medicare.

A week after his birthday, Lord was diagnosed with stage 1 prostate cancer with a Gleason score of eight, an especially aggressive form of the disease. Lord said he sought treatment options as he got even sicker by mid-June.

“I was really in agony for the better part of a month,” he said. “And, during the middle of that whole process. I got a letter from Medicare and Social Security saying that my insurance had been cancelled because they never received the check that I mailed them in April.”

Lord said he went back to the SSA office in Melville to personally deliver a check to have his insurance reinstated. He was given a receipt for the transaction and told his insurance would be renewed in two to three weeks, Lord said.

However, after the third week, Lord said he checked back in with the SSA office, only to discover that the insurance was still not reinstated. He was told the issue was with CMS and was redirected there.

So, Lord went to CMS, which looked into the case. He was told there was nothing the agency could do, but he could reapply for Medicare in January 2017 and his coverage would then start the following July.

Lord said he told the CMS representative: “If that were the case, I would either be dead by then or the cancer would have spread.”

On a suggestion, Lord reached out to Israel’s office. The congressman soon pressed the agencies to fix the issue.

“Thankfully, at least in Andy’s case, both agencies, heeded the warning,” Israel said. “They very quickly worked with us to reinstate Andy’s Medicare.”

But, Israel added, “It shouldn't take a member of Congress to fix a life-threatening problem as a result of a bureaucratic mix-up.”

Israel called on both agencies to step-up communication in order to prevent this from happening again. This wasn’t an isolated incident, Israel added. He said he’s heard from constituents of similar situations before, but added that this was the first time he’s heard it put a life in jeopardy.

“Medicare cashes the checks, but the Social Security Administration is responsible for enrollment,” he said. “And, very clearly, there is a perilous communications gap between the two.”

In a statement emailed Monday, New York Regional Communications Director John Shallman, said he can’t discuss individual cases with the media due to privacy laws. He explained the SSA’s “limited role” in the process.

“For those who receive Social Security benefits, the Medicare Part B premium will be automatically deducted from the monthly benefit payment. For those who do not receive Social Security benefits, CMS will bill them for their Medicare coverage,” Shallman stated. “Additionally, Social Security procedures allow local offices to accept premium payments from those Medicare beneficiaries where termination of Medicare coverage is imminent.”

Further, Shallman said, the SSA office provides a receipt and forwards the payment to the Medicare Premium Collection Center.

CMS did not respond to a request for comment before deadline Tuesday.