Question
My husband is on Medicare plus a Medicare Advantage Plan (Evercare). He was recently approved for the Medicaid Medically Needy program; however, when the pharmacy tries to bill Medicaid for a medication he needs it defaults to Evercare as the primary and won't allow them to bill the secondary Medicaid. Both we & the pharmacy have contacted Evercare to update their system to show that he is eligible for low income subsidy assistance copays and they are dragging their feet. What can we do to get them to update their system to open it up so Medicaid can be billed? The medication costs over $1297.00 since we are in the "donut hole" and we can't afford it!
Answer
Hi Barbara
It appears that there has to be an appeal made. Also since you are a dual eligible and should be paying about $5 for each medication This is too complicate to be done by e-mail, so I am referring you to my counterpart in your State. look at the center of the of the MEDICARE AND YOU 2010 that you just received and there will be the number of the SHIP office close to you for your State. Call them and request to speak with an experienced counselor. They will meet with you, assess the situation, and assist you in getting it straightened out. They will also help with any appeals. Also ask them about the Medicare Savings program.
If you want to change the Advantage plan, the can help you make an informed decision.
You can also get the SHIP number by going to Medicare.gov=====click on find the SHIP number in your State======click on your state, and you have it
John
