I Was Not Going to Let Them Win
By Anne Glorioso, CEO · Solidarity Health Network, Inc. · Cleveland, Ohio
2006, something new came along called the Retiree Drug Subsidy — RDS, for those of you playing along at home.
For the uninitiated: the RDS program was a federal subsidy available to employers and plan sponsors who continued providing prescription drug coverage to their Medicare-eligible retirees. If you qualified and you filed correctly, the government would send you money. Real money. Money your plan was entitled to.
A client asked me to help them file for it.
There was one small problem: I had never done it before. Nobody at SHN had. The program was brand new and the guidance from CMS (the Centers for Medicare & Medicaid Services) was, let’s say, a work in progress.
So I learned it. From scratch. And then I submitted the files.
What “Submitting the Files” Actually Looked Like
I want to be honest about what this process was, because it sounds simple when I describe it and it was absolutely not simple.
It looked like submitting files and getting rejections. Reading the rejection. Fixing the file. Resubmitting. Getting another rejection. Reading that one. Fixing it again.
Repeat. Indefinitely.
CMS rejections are not friendly documents. They do not say “nice try, here’s what went wrong.” They are terse, technical, and occasionally maddening. But every single one of them told me something. And I was not going to leave money on the table for our clients because I got frustrated with a pile of files and a federal process that seemed designed to wear you down. The frustration and the paperwork were not going to win.
We also didn’t have a large staff at the time. So in those early years, a lot of this work happened at night — after the phones stopped ringing and the office cleared out — just me, the rejections, and a very patient cup of coffee. You do what the job requires.
The Part That Still Makes Me Laugh
Here is something I did not expect to learn while reconciling retiree drug subsidy files: a surprising number of retirees had fibbed about their birthdays.
Not recently. Decades ago — when they first immigrated to the United States. They had shaved a year or two off their age so they could turn 16 “earlier” and get their driver’s license sooner. Completely reasonable at the time. Completely forgotten about by the time they retired.
Until CMS kicked back a rejection on their date of birth.
I would call the retiree to sort it out and they would pause, think for a moment, and then very quietly admit that yes, their actual birthday was a little different than what was on file. No big deal. Just a small adjustment made forty years ago that nobody had thought about since.
I thought it was hilarious. They were usually a little embarrassed. We fixed it and moved on.
This is the kind of thing that happens when you actually do the work instead of just processing files.
$158 Million
Over the next ten years, SHN collected over $158 million dollars for our clients through the Retiree Drug Subsidy program.
I’ll let that number sit for a second.
$158 million. For plans that were already covering their retirees. Money that was available to them — that they were entitled to — that they simply hadn’t known how to access, or hadn’t had someone willing to chase down every single CMS rejection to claim.
That was us. That was me, obsessively following up on every file, every discrepancy, every date of birth that didn’t quite match what CMS had on record. Because I knew the money was there and I was not going to let a technicality stand between our clients and what they were owed.
Nobody else was going to do it for them. So we did.
We Also Stopped Doing It the Hard Way
After that first year, we didn’t just keep grinding through it manually. We built a program around it — a systematic process for tracking, reconciling, and submitting RDS filings so that nothing fell through the cracks and nothing had to be chased down at midnight if we could help it. Once the program was built and running, what had been a late-night solo operation became a clean, repeatable process that our team could manage without heroics.
What started as one client, one program, and one very steep learning curve became a refined operation that ran smoothly year after year. That’s how $158 million happens. Not in one heroic effort — but in ten years of showing up, building something better, and doing it right.
Where RDS Stands Today
The RDS program still exists — but it’s a shadow of what it once was. Changes to Medicare Part D under the Inflation Reduction Act have made it increasingly difficult for plans to qualify, and many sponsors have migrated to MAPD (Medicare Advantage Prescription Drug) and EGWP (Employer Group Waiver Plan) arrangements instead. Utilization has dropped from covering roughly 20% of Part D enrollees in 2010 to a projected 1.5% by 2032. The program that once represented a massive opportunity is quietly fading out.
But if you are a plan sponsor who is still participating in RDS — don’t leave before we talk. Our experience running this program for over a decade means we know exactly where money gets missed, where reconciliations go sideways, and where plans consistently leave dollars on the table. We can review what you have and help you recover what you’re owed. Email me directly at aglorioso@shninc.org and let’s take a look.
What This Says About How We Operate
The lesson the RDS program taught me is one I’ve carried into everything SHN does since.
There is always money being left on the table somewhere. There is always a filing that didn’t get submitted, a subsidy that wasn’t claimed, a contract term that wasn’t negotiated, a benefit that was priced wrong. Finding it requires someone who is willing to go line by line, rejection by rejection, and not give up when it gets tedious.
That’s what we do. Not because it’s glamorous — it is absolutely not glamorous — but because it’s the job.
And because the frustration and the paperwork were not going to win.
Anne Glorioso is the CEO of Solidarity Health Network, Inc., a full-service healthcare third-party administrator based in Cleveland, Ohio. SHN has been serving union funds, employers, and retiree populations since 1989.
www.shninc.org
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