Help, medicare , BC/BS and antirejection medicine

[catcare]

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

[cattlekid]

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.

[KarenInWA]

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

[catcare]

no  help  from  the  social  worker. bc/bs  has  it's  own  drug   coverage.  thanks

[smcd23]

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.

[catcare]

we have  fep  bluecross and  blusheild  as  secondary too.   so  for  tony's  antirejection medicine,  you  only  pay  about  50  dollars? thanks

[jeannea]

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.

[Rerun]

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!   

[KarenInWA]

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

[smcd23]

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.

[jbeany]

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.

[catcare]

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

[smcd23]

Do you have standard or basic option?

[catcare]

standard

[catcare]

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

[smcd23]

I am going to log in and check.