Re: EGHP plans--no cob w/Mcare for Immunos

[Guest guest]

We have some similar problems esp w/mail order, so we try to find out ahead of time who the mail order pharm can bill - we use Procare and Amber mainly. We're worried b/c thanks to the AWP-15, our local pharms who will bill Medicare are drying up.

EGHP plans--no cob w/Mcare for Immunos

Hi all… We seem to be running into some difficulties lately with EGHP's (secondary to Mcare) not coordinating benefits with Medicare for Immunos. Has anyone else been having this problem? We only have 1 reliable local pharmacy & 1 mail order co. willing to bill Mcare for immunos and secondary insurance for the balance to begin with. The EGHP's state they don't have a system in place to COB w/Medicare…they have been asking the patient to pay the balance after Mcare and submit a receipt to them. Of course, not all patients have the money. I have been telling patients to work with their employer's HR department to get resolved. One patient actually told me when he spoke to EGHP rep. they told him not to let the pharmacy know he has Mcare & they will pay no problem! I believe it is fraudulent to do so. Thanks!

Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center

[Guest guest]

I seem to run into the same problem with the bigger retail pharmacies. There is a pharmacy her in the Las Vegas area by the name of Statscripts, that has been good to our patients, and easy to work with.

J. Garay Transplant Financial Coordinator University Medical Center of Southern Nevada

EGHP plans--no cob w/Mcare for Immunos

Hi all... We seem to be running into some difficulties lately with EGHP's (secondary to Mcare) not coordinating benefits with Medicare for Immunos. Has anyone else been having this problem? We only have 1 reliable local pharmacy & 1 mail order co. willing to bill Mcare for immunos and secondary insurance for the balance to begin with. The EGHP's state they don't have a system in place to COB w/Medicare...they have been asking the patient to pay the balance after Mcare and submit a receipt to them. Of course, not all patients have the money. I have been telling patients to work with their employer's HR department to get resolved. One patient actually told me when he spoke to EGHP rep. they told him not to let the pharmacy know he has Mcare & they will pay no problem! I believe it is fraudulent to do so. Thanks!

Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center

[Guest guest]

We use ProCare (Pharmacare)...we are located in Massachusetts. EGHP plans--no cob w/Mcare for ImmunosHi all... We seem to be running into some difficulties lately with EGHP's (secondary to Mcare) not coordinating benefits with Medicare for Immunos. Has anyone else been having this problem? We only have 1 reliable local pharmacy & 1 mail order co. willing to bill Mcare for immunos and secondary insurance for the balance to begin with. The EGHP's state they don't have a system in place to COB w/Medicare...they have been asking the patient to pay the balance after Mcare and submit a receipt to them. Of course, not all patients have the money. I have been telling patients to work with their employer's HR department to get resolved. One patient actually told me when he spoke to EGHP rep. they told him not to let the pharmacy know he has Mcare & they will pay no problem! I believe it is fraudulent to do so. Thanks!Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center

[Guest guest]

Miami Florida - UNOS

From: Chaney, Sent: Thursday, May 06, 2004 9:19 AMTo: 'TxFinancialCoordinators 'Subject: RE: EGHP plans--no cob w/Mcare for Immunos

Miami Ohio right?

[Guest guest]

Mailhander's will not coordinate pharmacy benefits. It is in their contract that they will not cooordinate. I called Washington and spoke with a person there and was told they did not know that Medicare covered immunosuppressive drugs (i.e. drugs of any kind). That was unbelievable to me but that was their response.>>> Sherri.Sbalbi@... 05/05/04 12:09PM >>>

Hi all… We seem to be running into some difficulties lately with EGHP's (secondary to Mcare) not coordinating benefits with Medicare for Immunos. Has anyone else been having this problem? We only have 1 reliable local pharmacy & 1 mail order co. willing to bill Mcare for immunos and secondary insurance for the balance to begin with. The EGHP's state they don't have a system in place to COB w/Medicare…they have been asking the patient to pay the balance after Mcare and submit a receipt to them. Of course, not all patients have the money. I have been telling patients to work with their employer's HR department to get resolved. One patient actually told me when he spoke to EGHP rep. they told him not to let the pharmacy know he has Mcare & they will pay no problem! I believe it is fraudulent to do so. Thanks!

Sherri Sbalbi Financial Counselor Transplant Services Baystate Medical Center