CVS - Newly Diabetic - Medicare and Plan G Supplement

[jj]

Relatively new to Medicare and newly diagnosed with Type 2 diabetes.

The prescriptions went to CVS which is the preferred pharmacist for the Wellcare part D insurance.

The blood monitoring meter and test strips are covered under Medicare Part B, so paid for 80% by Medicare and 20% by the Medigap policy, but CVS wouldn't take the Medigap card for the supplemental insurance - is this normal?

It wasn't a lot of money in this instance, but in principle shouldn't my Plan G pay? Do other pharmacies take the Medigap insurance to cover the 20% that Medicare doesn't?

I'm sure some knowledgeable person on here will have been through this before... thanks

 

[Dash man]

Do you have a Medicare Part D plan to cover prescriptions?

 

[jj]

Do you have a Medicare Part D plan to cover prescriptions?

Yes, a Wellcare Part D covers the drugs (metformin and statin).

The 'durable medical equipment' is covered by Medicare Part B and the 20% that medicare doesn't cover is supposed to be paid by the supplement - I think - is that how it works for everyone else?

I can't imagine being in my 80's and having to wade through this lot...

 

[Dash man]

Yes, a Wellcare Part D covers the drugs (metformin and statin).



The 'durable medical equipment' is covered by Medicare Part B and the 20% that medicare doesn't cover is supposed to be paid by the supplement - I think - is that how it works for everyone else?



I can't imagine being in my 80's and having to wade through this lot...

You did say that in your first post, and I for you the end of the post! Sorry about that!

My father-in-law has all of his diabetes equipment covered, but it’s a Medicare Advantage plan though his union. Try giving your carrier a call to find out why.

 

[PaunchyPirate]

Have you already met your $198 Medicare B deductible? If not, perhaps the amount you were forced to pay went towards that.

 

[jj]

Have you already met your $198 Medicare B deductible? If not, perhaps the amount you were forced to pay went towards that.

Thanks for replying, yes, already met the $198 with doctor visits earlier in 2020, (but I suppose CVS doesn't know that).

 

[youbet]

shouldn't my Plan G pay? Do other pharmacies take the Medigap insurance to cover the 20% that Medicare doesn't?

Something doesn't sound right here. Did they actually say they would not submit to your Medigap plan and literally refused to take your card when you tried to hand it to them? Or was it a case that you have not met your Plan G deductible yet (you said you were new to Medicare) and they could see the 20% would not be covered?

Sam's Club pharmacy provides my glucose monitor and test strips at zero cost to me. I have traditional Medicare and a Plan F BCBS Medigap policy.

Edit: it may turn out that when you get your EOB from Medicare they'll show themselves as paying the 80% and then submitting the 20% to your Medigap plan (which they do automatically).

 

[jj]

Something doesn't sound right here. Did they actually say they would not submit to your Medigap plan and literally refused to take your card when you tried to hand it to them? Or was it a case that you have not met your Plan G deductible yet (you said you were new to Medicare) and they could see the 20% would not be covered?

Sam's Club pharmacy provides my glucose monitor and test strips at zero cost to me. I have traditional Medicare and a Plan F BCBS Medigap policy.

I handed them all 3 cards - Medicare, Wellcare drug Part D, Mutual of Omaha Medigap Plan G (through Boomer Benefits as recommended frequently here). They gave me the Medigap card back looking at it if as if it was trash, said they knew nothing about it.

Relatively new to Medicare since end of 2019 so I've met this year's deductible.

I'm wondering if this is a problem with CVS Pharmacy. It's good to hear that Sam's Club can cope with it.

 

[MichaelB]

I handed them all 3 cards - Medicare, Wellcare drug Part D, Mutual of Omaha Medigap Plan G (through Boomer Benefits as recommended frequently here). They gave me the Medigap card back looking at it if as if it was trash, said they knew nothing about it.

Relatively new to Medicare since end of 2019 so I've met this year's deductible.

I'm wondering if this is a problem with CVS Pharmacy. It's good to hear that Sam's Club can cope with it.

Sounds like the person at CVS wasn’t familiar with Medicare Supplement plans.

The good news is, since these supplies are covered by traditional Medicare, you don’t need to shop at the Wellcare preferred pharmacy, you can shop elsewhere.

I’d go back to CVS, ask to see someone else, then request they reconsider the transaction.

 

[CRLLS]

Typically, a full bill gets sent to Medicare. Then Medicare determines their approved (negotiated) price. Medicare pays the provider. Then a miracle occurs! I am unclear on this part: either Medicare or the Provider sends the bill to the Medigap insurer. If Medicare approves it, then the Medigap insurer pays the provider according to the terms of your plan's coverage ( deductible, coinsurance, policy limits, etc.) If the 2 payments do not meet the Medicare approved amount, then a provider sends you a bill for the remainder.

Your situation is new to me, dealing with a retail location for DME. It doesn;t sound right to me. I have not yet run across a situation where I pay the Medicare 20% at the time of service. At the time of service, how do they know what Medicare will approve and pay? Whether you can send your CVS receipt to your Medigap insurer for reimbursement, there should be some provision for that.

 

[PaunchyPirate]

I'm not on Medicare yet, but I have confusion on the logistics of payment with Medigap. And it somewhat applies to this situation. So I'll ask...

I've read that most (all?) of the time you get a Medicare service, that Medicare pays it's part and then Medicare forwards to your Medigap supplement company to pay its part. I thought this was automatic and behind the scenes to the customer until they see it done on the statement. But how does that work when the medical provider (in this case CVS) wants the customer to pay for the Medigap part? It would seem there has to be a delay from when Medicare sends the claim to Medicap vendor to pay its part.

If that's the way it works, then why would a CVS ever need or ask for the Medigap card?

Or do I have this wrong? Do providers have to be responsible to send 80% of the bill to Medicare and 20% to the Medigap provider?

[Edited to add: the previous post was being written while I posted mine. So there is some overlap]

 

[jj]

OK. So, I'm just off the phone with the Mutual of Omaha rep - hey I'm retired so I have time for this...

He said that after the transaction was processed by Medicare it would automatically flow through to them and they would pay CVS the 20% that CVS has already charged me. In due course, I will receive an EOB from Mutual of Omaha telling me this and then I can go back to CVS and get a refund from them. He did say that different pharmacies do it differently, including differences between CVS branches.

It all sounds nuts to me.

 

[PaunchyPirate]

OK. So, I'm just off the phone with the Mutual of Omaha rep - hey I'm retired so I have time for this...

He said that after the transaction was processed by Medicare it would automatically flow through to them and they would pay CVS the 20% that CVS has already charged me. In due course, I will receive an EOB from Mutual of Omaha telling me this and then I can go back to CVS and get a refund from them. He did say that different pharmacies do it differently, including differences between CVS branches.

It all sounds nuts to me.

Glad to hear this, but it is silly. I hope it truly works out as they say it will. Keep that receipt! There's probably other pharmacies that you can work with. I'd be asking around before buying your refills.

 

[jj]

I’d go back to CVS, ask to see someone else, then request they reconsider the transaction.

I'm thinking about doing this... I could play one of John Cleese's characters from Monty Python, the one who's there for an argument

 

[Gotadimple]

Typically, a full bill gets sent to Medicare. Then I have not yet run across a situation where I pay the Medicare 20% at the time of service. At the time of service, how do they know what Medicare will approve and pay? Whether you can send your CVS receipt to your Medigap insurer for reimbursement, there should be some provision for that.

The pharmacy knows because they have a Medicare contract and there is a fee schedule for the DME. So they know exactly what will be covered.

The pharmacy clerk, however, sounds new. So step 1: go back to the pharmacy and speak to the pharmacist, not the clerk about the transaction. If they refuse, Step 2: Your Medigap policy should have info about submitting the receipts for reimbursement, and imbedded on this step is a call to your Medigap Customer Service to confirm how to get this paid, and report that the pharmacy refused their card.

- Rita

 

[CRLLS]

The pharmacy knows because they have a Medicare contract and there is a fee schedule for the DME. So they know exactly what will be covered.

The pharmacy clerk, however, sounds new. So step 1: go back to the pharmacy and speak to the pharmacist, not the clerk about the transaction. If they refuse, Step 2: Your Medigap policy should have info about submitting the receipts for reimbursement, and imbedded on this step is a call to your Medigap Customer Service to confirm how to get this paid, and report that the pharmacy refused their card.

- Rita

While they may know what Medicare will pay, I have seen where the DR's office somehow codes a submittal wrongly and it goes thru several back and forth efforts before settling on an agreeable proper code. I admit that I am naïve on how DME works. I would expect it to work the same as any other Part B covered expense. What if CVS chose the wrong price/code and overcharged the OP on his part of the copay? In any case, does CVS have a hotline to Medicare to determine if the OP's copay has already been paid? I would think not.

I agree that a call to the OP's Medigap insurer should clear this all up.

 

[jj]

In any case, does CVS have a hotline to Medicare to determine if the OP's copay has already been paid? I would think not.

Exactly, following this to its logical conclusion CVS should have charged me the full amount as they don't know that I've already met my $198 Medicare deductible for this year.

I should be grateful that I was only charged the 20%

The behind-the-scenes machinations of the Medicare system are a complete mystery to me.

 

[Telly]

The behind-the-scenes machinations of the Medicare system are a complete mystery to me.

The mills of [-]God[/-] Medicare, though they grind slowly, they grind exceedingly fine.

In almost all cases, waiting can be the best course of action.