I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Transplant Discussion => Topic started by: catcare on July 18, 2012, 05:26:44 PM
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Hi, all
My husband has medicare a &B as primary insurance.Bbluecross and bluesheild says it does not coordinate with medicare part B drug coverage. I really does not know the meaning of " does not coordinate ". I contacted with customer service, different people gave me different answers.
I do not know how to order the medcine. we should get the medicine(prograf) through medicare b only by paying 20% or through BCBS only by paying 75 dollar for 3 month supply?
I prefer to get the medicine through BC?BS since the price is good. But scared that later now, BC?BS Will let us pay the full price of the medcine by saying that medicare B is our primary and we should get the medcine from Medicare B first. Get no help from the bc/bs customer service.
If anybody knows " does not coordinate" means what, please tell me. Thank you in advance.
Does it mean that we have the choice to get medicine (antirejection) either through medicare B or through BC/BS but not both although medicare b is primary ? thanks
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Hello!
I just went through my transplant evaluation today and this is something that the social worker cautioned may occur. I would definitely call your transplant social worker. He or she should be able to direct you through the maze.
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In my personal experience, my private insurance is primary. I would have had to shell out a few hundred $$ for my meds on Medicare due to me not meeting the deductable (I didn't sign up for it until right before my transplant, then I had to pay premiums from my eligibility date). So, since my private insurance is primary for now, that is who I go through. I decided this after talking to them, explaining my situation, and was told that since they are primary, yes, they will pay for my meds. Now, how that works when they're secondary, I have no idea. I'm willing to bed that they won't do that.
Now here's another question - is this your medical insurance or Rx coverage? For me, my medical insurance is through Anthem BC/BS, and my Rx is through another company that I have a separate card for.
Yes, this is all confusing, and talking to your SW is a definite must!
KarenInWA
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no help from the social worker. bc/bs has it's own drug coverage. thanks
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We had no problem with BCBS and Medicare Part B when we got Tony's drugs. The pharmacy had to run the drugs through Part B first, and they were like $56 and $65 each. Then they ran it through my BCBS (Federal, if that matters, I don't know) and it knocked them down to $50 each for a 1 month supply. They may not coordinate, but your pharmacy should know how to bill it so it goes through both.
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we have fep bluecross and blusheild as secondary too. so for tony's antirejection medicine, you only pay about 50 dollars? thanks
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This doesn't make a lot of sense to me. You probably need to call Blue Cross. But I don't get any drug coverage through Part B or Part C. I had to buy prescription coverage which is Part D. I have Part C with Blue Cross and Part D with AmeriHealth who partners with BC for drug coverage. Unless you're in a Medicare Advantage Plan the drug coverage is not included and I thought ESRD patients weren't allowed in advantage plans.
Not to be mean, but I suspect "does not coordinate" means you don't have coverage. I thought the only meds covered by Part B were the ones we got at hemo like epo and vit D. I could be wrong but you need to find someone on the phone with answers. Call BC and call Medicare.
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This doesn't make a lot of sense to me. You probably need to call Blue Cross. But I don't get any drug coverage through Part B or Part C. I had to buy prescription coverage which is Part D. I have Part C with Blue Cross and Part D with AmeriHealth who partners with BC for drug coverage. Unless you're in a Medicare Advantage Plan the drug coverage is not included and I thought ESRD patients weren't allowed in advantage plans.
Not to be mean, but I suspect "does not coordinate" means you don't have coverage. I thought the only meds covered by Part B were the ones we got at hemo like epo and vit D. I could be wrong but you need to find someone on the phone with answers. Call BC and call Medicare.
BINGO on everything..... thank you! :bow;
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This doesn't make a lot of sense to me. You probably need to call Blue Cross. But I don't get any drug coverage through Part B or Part C. I had to buy prescription coverage which is Part D. I have Part C with Blue Cross and Part D with AmeriHealth who partners with BC for drug coverage. Unless you're in a Medicare Advantage Plan the drug coverage is not included and I thought ESRD patients weren't allowed in advantage plans.
Not to be mean, but I suspect "does not coordinate" means you don't have coverage. I thougBht the only meds covered by Part B were the ones we got at hemo like epo and vit D. I could be wrong but you need to find someone on the phone with answers. Call BC and call Medicare.
Medicare Part B covers the anti-rejection drugs only when you have a transplant. "Does not Coordinate" means that BC/BS will not cover whatever Medicare Part B does not pay, I believe. At least, that's what I always got from it. For example, since my Medicare is secondary, you'd think they'd pick up any co-pays for my anti-rejection drugs, but they do not.
KarenInWA
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What Karen said is true - my Federal BCBS picks up 100% of what Medicare doesn't (so 20% of everything Part B covers) but in my experience with the immunosuppressant meds that Part B does cover, we still had to pay the copay amount of those drugs. Like I said earlier, after going through Part B the copay wa still more than what the drugs would have been if he was on BCBS alone, so the pharmacy then submitted them to my insurance to bring the copays down to the $50 mark which is what we'd pay without BCBS. Everything else though that goes through Part B first (hospital stay etc) gets picked up 100% by BCBS. I think the does not coordinate part just applies to the drugs because BCBS has pharmacy coverage. Does that make sense? It's really confusing. I spent a lot of time on the phone figuring everything out.
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I get mine directly from the transplant hospital's pharmacy. They bill part B and part D first, as far as I know, and I don't pay anything at all. I've got BCBS gap coverage as well, but I've never seen any drug charges on the "This is not a bill" statements.
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What Karen said is true - my Federal BCBS picks up 100% of what Medicare doesn't (so 20% of everything Part B covers) but in my experience with the immunosuppressant meds that Part B does cover, we still had to pay the copay amount of those drugs. Like I said earlier, after going through Part B the copay wa still more than what the drugs would have been if he was on BCBS alone, so the pharmacy then submitted them to my insurance to bring the copays down to the $50 mark which is what we'd pay without BCBS. Everything else though that goes through Part B first (hospital stay etc) gets picked up 100% by BCBS. I think the does not coordinate part just applies to the drugs because BCBS has pharmacy coverage. Does that make sense? It's really confusing. I spent a lot of time on the phone figuring everything out.
Hi, SMCD:
Do you mean "bring the copay down to the 50 mark which is what we'd pay without MEDICARE?"
my fep plan pays 70% for antrejection medcine if you get it from retailer.
so it is cheaper if you buy it through medicare B. The copay for getting the medcine from mailorder company is 80 for up to 3 month supply. May be your plan and mine are different . But it is strange since both of our plans are fep bc/bs.
I feel we are punished by having medicare b if we can not use mail order .
i do not think my situation is unique. Since medicare part B covers diabetic strip, anybody needs strip to test sugar and having medicare B as primary and fep bcbs as secondary, She or he will face the same problem. Can she or he order strip directly from BCBS mail order compay and just pay the copay for three month supply without using medicare B? Anybody has any input?
I cotacted the bcbs service already, but different people gave different answers. i I just gave up.
Thanks all for any advice and inputs. For me take care of my hubby is an easy thing, the insurance is the pain. THANKS ALL
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Do you have standard or basic option?
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standard
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Do you have standard or basic option?
Hi, SMCD23;
Did you see the eob that your pharmacy filed with BC/BS. basically one of customer agent told me that does not coordinate means that we can only use one insurance ( either medicare or bcbs) to buy the medicine. if the agent is correct,maybe your pharmacy just filed with BCBS alone without medicare for copay or pharmacy filed with medicare alone since medicare pay more than bcbs and gave you a break to pay bcbs copay( in this case the pharmacy gets more money). I wish all the customer agents told me the same thing or their word has guarantee. Thanks
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I am going to log in and check.