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[IP] RE: insulin-pumpers-digest V12 #79 - Medicare and Insulin Reimbursement



Diane,
Do you have Part B supplemental Medicare Insurance? That 20% you are paying
can be, and IS covered by a Medicare supplemental plan. You can call Medicare
and verify how Medicare handles that portion of part B, even if the Pharmacist
doesn't know. Medicare Plan B covers the insulin charge as an "accessory to
the Pump" as if it were a "DME" or durable medical equipment prescription. In
effect, if you have Part B and a supplemental plan, it becomes covered as
100%, excluding min. insurance copays and donut hole provisions. At first, I
was ordering insulin under Part D, and I did pay out of pocket, but only once.
So, check it out with a Medicaid representative. They do know the ropes.

Best of luck, Tom M




>
> Would the insulin for the pump be billed under durable since it's used with
a
> pump?  So far I haven't been able to do so and have to pay the copay of 20%
> which is $90 for me with part B under Blue Cross/Blue Shield of Michigan.
My
> durable strips and pump supplies seem to be fully covered, however.  It's
> true
> that the pharmacists don't seem to have the knowledge of how to bill in
this
> situation.  They seem to want to put it under medications with a copay.
> Walgreens seemed to have the knowledge but now they don't seem to be on my
> list.  :(
>
> Diane from Michigan
>
> Diane
.
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