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[IP] Re: insulin-pumpers-digest V13 #586



Medicare and Part B Insulin
 My doctor provided me with shall we call it a "cheat sheet" to assist the
pharmacy (Wal-Mart) in making the initial claim. The clerk was unfamiliar with
the process but she took the "cheat sheet" and a few days later I had my 90 day
supply of insulin and test strips. Wal-Mart has a centralized department that
handles Medicare, Part B and insulin. You might check with you local Wal-Mart
and get the contact information.

Why, Why, Why  does this have to be so difficult?

Mike Tinkler 


 On Tuesday, November 4, 2014 9:46 AM, insulin-pumpers-digest
<email @ redacted> wrote:
  



insulin-pumpers-digest    Tuesday, November 4 2014    Volume 13 : Number 586



PLEASE edit the subject line of your reply messages.
####################################################
This issue of the digest contains:
[IP] Medicare and insulin...You are NOT crazy
Re: [IP] Medicare and insulin...You are NOT crazy
Re: [IP] Medicare and insulin...You are NOT crazy
Re: [IP] Medicare and insulin...You are NOT crazy
Profile of Brad Retzlaff <email @ redacted>
Profile of Rae Howard <email @ redacted>
[IP] Re: Profile of Rae Howard <email @ redacted>
[IP] Perhaps some medical breakthrough for diabetes?
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------------------------------

Date: Sun, 2 Nov 2014 20:17:22 -0500
From: email @ redacted
Subject: Re: [IP] Medicare and insulin...You are NOT crazy

If you have a Kroger pharmacy near you after filling out the paperwork it  
will be covered.  I used Novolog for a long time.  My doctor switched  me to 
Apidra it has shorter tail than Novolog but pay nothing after my  
deductible is met, which doctor visits and the like.  Hope this  helps.
Jan Dxd 01/64
Pumping 04/02



In a message dated 11/2/2014 7:29:13 P.M. Eastern Standard Time,  
email @ redacted writes:

Hello  friends. I have returned to insulin-pampers after a long hiatus and 
since
I  began Medicare coverage. It has turned out to be a Nightmare to get the 
Part  B
benefit for my Novolog. (Pumping since 1995 and currently on Animas Ping.  
Live
in upstate NY)

First I called Medicare and was given the names  of several suppliers, none 
of
whom would supply insulin to this pumper.  Actually, several of the 
companies
were no longer suppliers so that shows  how accurate the supplier list that
Medicare "experts" have access to. I  believe I talked to at least 3 
individuals
at Medicare and about 10  suppliers and was on the phone for a good 10 
hours  all
together.

Next I went to my retail pharmacist who sadly informed  me that they could 
not
bill Medicare but that I should try a participating  Medicare pharmacist.

Off I went to Wegmans pharmacy, which in my  experience, offers excellent
customer service. The person I spoke with told  me how high my Part D cost 
would
be. Since I was used to paying small  co-pays through my employer's 
insurance, I
was shocked by the high cost and  fell to the floor. Fortunately, a 
pharmacist
saw me fall (in truth, she  simply overheard the conversation we were having
about my insulin) and  informed both of us that, since I'm on the pump, 
Part B
would cover my  Novolog and Wegmans would bill Medicare. Oh happiness! 
Medicare
and my  supplemental paid the entire cost. I was home free.

Until I went to  refill the prescription the next quarter. Wegmans informed 
me
that they  would no longer bill Medicare for my insulin because they were 
losing
too  much money on it. (They would bill my Part D which, is where, you  
might
recall, I fell on my knees--and I may just have to do  that!)

My doctor and I tried Walmart, the only other Medicare  participating 
pharmacy,
who initially said they would bill Part B but later  told my doctor, they
wouldn't supply Novolog so, if I wanted them to bill  Part B, I would have 
to
change insulin. This is not an option for me as  Novolog is truly the only
insulin that works well for me.

My  doctor's office, after calling Animas for some help, gave me three  more
suppliers' names but two sell only pump supplies, not insulin, and the  
third,
Better Living Now, seemed like my dream come true. Not only do they  bill
Medicare Part B for Animas supplies but they also sell and ship  Novolog. I 
noted
on their website that they listed the HCPCS code for use  in insulin pump 
so I
figured I was home free, until they called me back to  say that their 
contract
with Medicare doesn't allow them to bill them for  insulin. Furthermore, 
they
don't bill Part D.

Back to square one.  Other than my extreme frustration with trying to get my
Medicare Pat B  benefit, I do have a question for those covered by 
Medicare: If I
buy my  insulin and pay retail, will Medicare and my supplemental reimburse 
me
for  at least the 80% of the Medicare approved amount and the 20% (since  
I've
already met my Part B deductible)? If I can do that, I can compare  that 
amount
with what my Part D copay would be and may or may not have to  worry about 
the
donut hole.

Or, is there some other way to get a  vendor to bill Medicare for my Part B
benefit?

Annie Wall
Sent  from my  iPad
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