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7% Saline Prescription and Medicare Part B payment quandry
MAC & Bronchiectasis | Last Active: Jul 25, 2023 | Replies (82)Comment receiving replies
Well, I am more confused than ever. My doctor sent in prescriptions to CVS for the Saline Solution and Albuterol Solution. I’ve had trouble for at least a year getting Medicare to consistently pay for both or either. At times, all is fine. Then it’s not. Today it wasn’t, again! I was told last year that Medicare Part D was how Medicare would pay. Well, today, CVS told me it had to be Part B, and that my doctor had not coded the prescription correctly. I can’t tell you how often I worked with my doctor’s office last year to get all of that straight. Add in the supply chain issues and back orders. I came home without what I needed, but with a promise that they’d deliver it tomorrow. But, I paid full price. Grrr. I’m not sure why pharmacies and Medicare haven’t gotten this worked out. I certainly am not the only person in this situation. No one seems to know the answer and I get a lot of shoulder shrugs from too many people.
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Please let me reiterate - if the doctor codes it wrong, the pharmacist cannot change them - it is not in their purview. In the "olden days" the really good pharmacists would call the doctor/clinic and explain. Then the doc would Fax a revised Rx, all would be good.
Fast forward to 2023 - understaffing, inexperience, lack of training, everything goes to voicemail...All of these are REAL issues. My local pharmacy used to have one full time and 3 part time pharmacists, 6 pharm techs and were open 12 hours a day, 7 days a week. Now the full time pharmacist has one occasional part-timer and 4 pharm techs and they are open 9 hours a day, 6 days a week.
My primary care provider watched her patient load balloon from 1500 to 3000 patients, lost her 2 RNs (replaced by 2 medical assistants) - and she QUIT!
Staff training? How, when and who can do it? And who will train their replacements in one-three-six months? Medicare and insurance providers are as frustrated as we are.
I am not trying to be an apologist, but only to point out what we all know - something is broken. The best way to help ourselves at this point is to take the document I cited above (https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52466 ) with you to the doctor's office and the pharmacy, with the items relevant to you highlighted.
Sue