Pharmacy Won't File Medicare Part B Claim

[somarco]

Client is insulin dependent diabetic. According to Medicare, insulin for a pump is a Medicare Part B claim. New client tried to get Rx filled but pharmacy wanted to file under Part D. Cost would be over $200 vs $0 with her supplement plan.

Client wanted to know if they misunderstood the way her Medigap plan works.

Nope. Part B covers insulin for pumps if medically necessary. (I had covered this pre-sale complete with links to Medicare so there was never any question of interpretation).

Turns out the pharmacy (part of a large grocery chain) is not equipped to file Medicare B claims. This is a corporate decision to "save money".

Client is doing battle with corporate while I suggested finding another pharmacy that will file the claim properly.

Anyone come across this before? How did you handle it? Is there a way to find pharmacy's that WILL file B claims?

 

[kgmom219]

Client is insulin dependent diabetic. According to Medicare, insulin for a pump is a Medicare Part B claim. New client tried to get Rx filled but pharmacy wanted to file under Part D. Cost would be over $200 vs $0 with her supplement plan.

Client wanted to know if they misunderstood the way her Medigap plan works.

Nope. Part B covers insulin for pumps if medically necessary. (I had covered this pre-sale complete with links to Medicare so there was never any question of interpretation).

Turns out the pharmacy (part of a large grocery chain) is not equipped to file Medicare B claims. This is a corporate decision to "save money".

Client is doing battle with corporate while I suggested finding another pharmacy that will file the claim properly.

Anyone come across this before? How did you handle it? Is there a way to find pharmacy's that WILL file B claims?

Most chains will not file the claim.

A "mom and pop" pharmacy MIGHT do it, but that will take some research.

I have several clients (including family) using libertymedical.com for diabetic supplies and they are very happy. I've spoken with them and have been very pleased how they handle things for my grandad. Its been 3+ years now and I have no issues.

 

[kstein]

Walmarts tend to bill Part B most consistently but it is a pharmacy by pharmacy decision.

 

[sman]

Most chains will not file the claim.

A "mom and pop" pharmacy MIGHT do it, but that will take some research.

I have several clients (including family) using libertymedical.com for diabetic supplies and they are very happy. I've spoken with them and have been very pleased how they handle things for my grandad. Its been 3+ years now and I have no issues.

Liberty Medical doesn't fill prescriptions for insulin, does it?

 

[kgmom219]

Liberty Medical doesn't fill prescriptions for insulin, does it?

I dont think so, but insulin is usually covered under Part D, anyway. I send people to Liberty for the supplies, including pumps, strips and glucometers.

 

[somarco]

Had a hunch Joe's Pillbox would be more inclined to handle this vs a chain.

Anyone know how to find par pharmacy's for this situation?

 

[kstein]

Pound the phones! I just do a pharmacy Google search around their house and have call their preferred ones. Almost most always find one that bills B in the first 5 calls with Walmart being the most common.

I've found that a Walgreens on smith st will say no but a Walgreens on Jones St says yes.

 

[kgmom219]

Had a hunch Joe's Pillbox would be more inclined to handle this vs a chain.

Anyone know how to find par pharmacy's for this situation?

Try this

https://www.medicare.gov/SupplierDirectory/

You might need the specifics on what they need, though.

I would call one of these

http://www.medicineshoppe.com

 

[sman]

I dont think so, but insulin is usually covered under Part D, anyway. I send people to Liberty for the supplies, including pumps, strips and glucometers.

Yes, insulin is normally covered under Part D, but when used in an insulin pump, it's covered under Part B.

 

[somarco]

Local WM indicated they would do it. We will see.

I wonder if a hospital owned pharmacy (that serves the public) would file a B claim.

Jen, thanks for the links. Will try that if WM flakes out.