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← Return to Entresto. Would appreciate any discussion, pros, cons.
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Entresto. Would appreciate any discussion, pros, cons.
Heart Rhythm Conditions | Last Active: Sep 17 10:33pm | Replies (66)Comment receiving replies
Medicare coverage for insulin depends on how it is administered.
Part B covers insulin used with a traditional insulin pump - a traditional, durable medical equipment (DME) pump. A 20% coinsurance applies after the Part B deductible is met.
Part D covers insulin used with other methods, like injections or disposable pumps. Copays for insulin under Part D are often capped at $35 per month,
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@abob
It is not Medicare where the issue is. It is the pharmacy not understanding that DRE equipment and insulin used specifically for that DRE is under part B medical. My wife has a G-7 and automatic insulin pump that she injects insulin into the pump and it automatically releases insulin into her body. That was put under DRE and part B by Medicare. Medicare would pay the 80% and then my insurance company BCBS will pick up the 20%. I should pay nothing.
Our issue is with CVS. They try to charge it to Part D which Medicare won't pay as comes under DRE. They try to charge it to BCBS. We ran into an issue with BCBS not recognizing the bill address from CVS as they use a bill paying service not their pharmacy location. So BCBS says the bill's address is not in network and won't pay.
I tried to get CVS to use another address, no luck. Tried to get BCBS to accept the bill payers address as it was still CVS pharmacy charge, but they use a billing company, no luck.
Contacted CVS, no luck. Contacted BCBS supervisor, no luck. So, we just pay the insulin costs charged to us by BCBS prescription which runs us $60.00 co-pay for 90 day supply.