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Re: [IP] RE: (IP) Medicare insulin and Part B

 PAM BROWN, YOU ARE A JEWEL! Thank you! I will follow up and let people know how
I fare!

Annie Wall
Sent from my iPad

 > On Aug 30, 2015, at 9:36 PM, Pam Brown
<email @ redacted> wrote:
> As I understand it, pharmacies are under state jurisdiction, not Medicare's,
> so I don't know that Medicare can actually do anything about it your local
> pharmacy refusing to bill it under Part B. However I do know that the big
> chains (Walgreens, Rite Aid, CVS, etc.) accept "assignment" which means that
> they agree to accept what Medicare pays and they are set up to bill under
> Part B, as you've found with Walgreens. If anyone has a problem with a local
> store from one of those chains, the chains can contact their headquarters
> Medicare Part B billing specialist for help. So unfortunately you may be
> stuck buying from a chain even if it means driving long ways or using mail
> order.
> That being said, the problem with the other pharmacies refusing to provide
> it should still be reported to CMS. I realize that the basic reps you call
> at 1-800-Medicare might not know or care, so the thing to do is to report it
> to your local region of CMS. The way to do that, at least here in
> California, is to work through your local SHIP program. We have access to
> our local CMS management people who are very instrumental in handling
> complaints and problems beneficiaries have if we don't get anywhere with the
> regular Medicare call center, as well as documenting issues that can
> potentially get passed up the chain and eventually dealt with (like
> reimbursement rates for Part B insulin). Nothing will ever change if they
> don't know about it. You can find your local SHIP contact info at this link:
> shiptacenter.org.  I do know that SHIPs in lots of other states aren't as
> well staffed or as proactive as here in CA, so they may or may not be that
> helpful. However, it's worth trying and definitely request to talk to
> someone on staff if one of the volunteers isn't helpful. Part of the mission
> of SHIPs is to advocate for beneficiaries to help them get the Medicare
> coverage they're entitled to and to report on problems and forward
> complaints, so they should be willing to help you, although ultimately there
> may not be anything Medicare can do about it in the short term.
> Pam
> <I'm especially interested in the research you just did regarding this
> Medicare issue with insulin.
> I have traditional M'care and pay $0 for insulin (after my Part B
> deductible.).
> I had a terrible time finding a pharmacy willing to bill Part B. None of the
> local pharmacies (all of whom are chain pharmacies) would bill Part B and
> all claimed their contracts would not let them. Finally, Wegmans (pharmacy
> within the grocery store) said that they'd bill Part B so I got a three
> month supply through them.
> I thought my journey was over. However, when it was time for a refill, they
> said they would no longer bill Part B because it was too expensive for them
> since they were charged more for the insulin than they received as payment
> from Medicare. I get that, why should they lose money to provide a
> medication for a client? However, I still had to find a supplier. After
> many, many phone calls, emails, (and angry tears), I found a Walgreens 45
> minutes away. Of course that means, twice that amount of time for the
> pharmacy visit and the round trip.
> Incidentally, during this entire journey, calling Medicare was a total
> waste of time. They knew nothing about insulin and Part B. It was very
> frustrating but I would much prefer to obtain my insulin locally.
> I would like to take this further with Medicare and wonder how you take the
> next step since I'm not appealing anything and am getting my insulin under
> Part B but would like to get it closer to home.
> What words of advice would you have, Pam Brown? No rush since you've
> already done so much for us recently, but when you have the time, you might
> be helping me and others who have the same struggle.<
> .
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