[Diabetes-talk] Desperately Seeking insulin Supplier Under Medicare Part B

[Alan Lemly]

Geoff, thanks for the commiseration. Even though CCS Medical doesn't fill
insulin prescriptions under Part B, I had several informative emails and a
couple of phone conversations with very helpful managers from there who
explained why we're having such difficulty. Apparently, what Medicare will
reimburse the suppliers for insulin under Part B is so low to make it less
than profitable to them. This is particularly true for those winning the
competitive bidding mail order supply contracts since they don't do much
volume in this. And when basic economics is ignored by those setting
reimbursement amounts, those supplying choose not to participate.

Walgreens was suggested by one of the CCS Medical managers too so I'm having
my doctor send in the prescription with a 90-day supply amount and 4 refills
and I'm going to see what happens. Trying to manage all of this on the front
end is beginning to seem almost like a fool's errand to me so if Medicare
needs more from the doctor, I'll let them request it. I was encouraged that
the pharmacy rep at Walgreens I spoke with seemed to understand the Medicare
Part B issue, said that they did accept it for insulin, and recommended that
I simply have my doctor phone in the script.

I'll let you know what happens.

Alan

-----Original Message-----
From: Diabetes-talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Geoffrey Hester
Sent: Monday, February 24, 2014 8:31 PM
To: Diabetes Talk for the Blind
Subject: Re: [Diabetes-talk] Desperately Seeking insulin Supplier Under
Medicare Part B

Alan,  I feel your pain!  I have been working for weeks to accomplish the
same thing. I have spent hours at my local CVS trying to get United
Healthcare (Medicare Advantage plan) to talk them through the process.  No
one seems to want to submit the claim under part B which the plan(s)
clearly state insulin infused via pump is covered.  I have called 21 mail
order companies trying to get them to process under part B and non are
willing or able to do it.  United Healthcare suggested that I "try"
Walgreens...let frustrated that I am being asked to "try" when this should
be a fairly simple process.  I am sorry that all I am able to do is
commiserate with you with all of the frustration that this causes.  I will
let you know if I have any success with Walgreens.
Geoff


On Mon, Feb 24, 2014 at 4:40 PM, Alan Lemly <walemly at gmail.com> wrote:

> I really can't explain the number of hours and the hoops I've jumped
> through
> trying to get my prescriptions set up under Medicare. I was hoping to find
> a
> mail order supplier for my insulin but since as an insulin pumper, I'm
> covered under Medicare Part B, no mail order supplier will supply insulin
> under Part B due to the low Medicare Part B reimbursement rate.
>
>
>
> So my question is, where do those of you on Medicare who use an insulin
> pump
> get your insulin? If you could tell me any hoops you had to jump through
to
> get this set up under Medicare Part B so I can do it on the front end, I'd
> be most appreciative. I found a knowledgeable person at my local Walgreens
> but she mentioned something about the doctor needing to submit a
> certificate
> of medical necessity CMN form to Medicare and I'm having a hard time
> locating one of those forms on the Medicare.gov website. I found many CMN
> forms dealing with things like lift chairs and other durable medical
> equipment but I already have an insulin pump and just need to get the
> insulin to feed it.
>
>
>
> Thanks in advance for any assistance you can provide.
>
>
>
> Alan Lemly
>
> _______________________________________________
> Diabetes-talk mailing list
> Diabetes-talk at nfbnet.org
> http://nfbnet.org/mailman/listinfo/diabetes-talk_nfbnet.org
> To unsubscribe, change your list options or get your account info for
> Diabetes-talk:
>
>
http://nfbnet.org/mailman/options/diabetes-talk_nfbnet.org/geoffstaceyhester
%40gmail.com
>
_______________________________________________
Diabetes-talk mailing list
Diabetes-talk at nfbnet.org
http://nfbnet.org/mailman/listinfo/diabetes-talk_nfbnet.org
To unsubscribe, change your list options or get your account info for
Diabetes-talk:
http://nfbnet.org/mailman/options/diabetes-talk_nfbnet.org/walemly%40gmail.c
om