All is not perfect in Medicare paradise......

[sdn1977]

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So...it appears it has only taken 13 days for the wheels to start coming off the new Medicare Part D drug benefit. Yesterday, the CA governor ordered the state to temporarily pay for medications for those folks who are dual-eligible because "computer glitches and burecratic snafus" are preventing them from obtaining their medications. This order is for the next 5 days and affects more than 1 million dual-eligible Californians. Next week, our legislators may extend it for an additional 10 days to give the federal govt time to sort out the issues. Apparently there are 10 other states as affected as we are...Illinois, Massachusetts, who else???. Medicare officials say the program is working well (hmmm...gotta wonder if they transferred from FEMA - ooops sorry - that was not nice!). This is costing CA up to $70 million for 15 days fix....what is happening where you live?

 

[bananaface]

I work 1-2 days a week. Last sunday I had to call and get infor for two people. That went smoothly. One was a patient transferring in. I heard later that she transferred all of her stuff to our sister store instead of picking it up at our store. 👎

Yesterday I only had one person to set up. She was formally on straight medical coupon, and the state had set her up automatically on a plan that didn't cover half of her things. You would think we would just bill them directly to the state, using a not covered code, which would allow her to get them w/o any copay, but noooo. She decided to switch to a plan that covered everything. In the meantime she had no card. The processer linked to her plan name was incorrect. I did get a bin number for her plan though, and figured out it who administered it. I called them for a group number and the guy at the helpdesk couldn't figure it out. He couldn't see the claims I was sending either. So, I ended up just fronting her meds. She is a regular, has leukemia, and is very kind and appreciative of everything we do. So, I didn't mind having to front her stuff. It just annoys me that the processor is unable to hire competent tech staff. I have also noticed that alot of the phone numbers and BIN numbers we are provided with initially for given plans/patients are incorrect.

 

[rxlynn]

So...it appears it has only taken 13 days for the wheels to start coming off the new Medicare Part D drug benefit. Yesterday, the CA governor ordered the state to temporarily pay for medications for those folks who are dual-eligible because "computer glitches and burecratic snafus" are preventing them from obtaining their medications. This order is for the next 5 days and affects more than 1 million dual-eligible Californians. Next week, our legislators may extend it for an additional 10 days to give the federal govt time to sort out the issues. Apparently there are 10 other states as affected as we are...Illinois, Massachusetts, who else???. Medicare officials say the program is working well (hmmm...gotta wonder if they transferred from FEMA - ooops sorry - that was not nice!). This is costing CA up to $70 million for 15 days fix....what is happening where you live?

Well, I'm working in an area that is not a large Medicaid or Medicare population. We have seen a lot of the AARP and Humana plans for Part D - most of these people seem to have cards or letter with the needed info. to process. We also have a fair amount of the dual eligibles, most of whom seem to have NO IDEA this is going on. When you suggest that they might have a new card, they just stare at you. Fortunately, we have been able to resolve most of those problems with the look-up function condor code and then a bit of searching with bin numbers. I'm sure we have it easier than most. And, I have to say that at least so far the "regular" January insurance changeovers seem to be much smoother than last year, and I'm not sure why. Maybe people are getting used to having a new card every single year.