If you or a loved one is in a medical facility, ie. hospital or temporally in a nursing, do not refill the Diabetic Test strips until they are out of the facility. Spent 3 hours on the phone between Medicare and the pharmacy today. Thank God my sister was here to do the talking. She has infinite patience. I had to walk out at some points between the Right to Privacy and the run around , Mom is very hard of hearing and they had to ask her the if she would authorize my sister to talk on her behalf. Handed the phone to mom and let them attempt to talk to her. Finally yelled at mom, "just say yes" I would have hung up the phone telling them " I hope no one around here gets impregnated from this screwing" a long time ago. Mom was in the nursing home until January 20th. Her meds are synced at the pharmacy and were ready to be picked up Jan. 15 . They texted us the drugs are ready for picked up. I went and picked them up. $135 more than usual. OK I paid it figuring her new issuance does not pay for it. Truth is Diabetic supplies are covered under Medicare part B and not part D. My sister discovered that and called Medicare. and the pharmacy. After 3 hours come to find out they denied it because the nursing home had submitted a claim for them and they paid that claim. Denied the drugstore claim because they already paid it. Bottom line. The nursing home got paid for 100 strip and I paid the drugstore for 100 strips. We should of received 95 strips upon discharge. We didn't. Nursing home received 100 strips and used 5. I paid $135 for 100 strips and received them. Drugstore is made whole, nursing home has 95 strips to use and I am out the $135. I should received the strips upon discharge. How in the heck do they warrant $135 for 100 test strips. Just a little warning if you or one of your parents are temporally in a medical facility. This may help you play the game. Done with my rant.
So why didn't talk get any from the hospital?? Can you submit for payment next month or when ever she needs a new prescription? Sent from my moto g(7) using Tapatalk
Getting refund from the nursing home would be another fight I will have to get into. Submitting payment will not work. The drugstore already did that and they have her test strips for this month paid for through Medicare but were credited against her March supply. My only coarse of action is to fight with the nursing home. I am not sure I want to go there. This is the second time and more than likely not the last time mom has been in there They have taken excellent care of her in the past. Don't know if I want to fight over $135.
Nursing home business is generally a crying shame. My mother is in one that I paid for private pay until her funds exhausted. They had their own pharmacy that they started filling her prescriptions from. She was only on a couple then her doctor wanted her on one other that was expensive. I got the bill from their pharmacy and about fell down. Called her normal local pharmacy and compared, which authenticated my suspisions. I called their pharmacy and told them they were gouging us and if they were charging the residents on Medicaid that much because the government was paying that was not ethical. The gal I was talking to said let me review this with management and I will call you back. They called back and said there was a glitch in their billing/pricing system and they would adjust Mom's cost which they did. Along with that they never sent another bill for the next 6 months before she went on Medicaid. My guess is they were afraid I was going to report their price gouging to the state. She does get good care from the staff though.
My aunt is an an assisted living apartment and she got bed bugs. The manager called and said I needed to come down and take care of the problem. I considered it their problem and let them know that. During the third call I said I’d come over with a local news crew and we could all discuss it . The lady said everything was just fine and they would handle it. I never heard another word.
We run into this often. Medicare will not pay claims while in a “skilled nursing facility” or snf. Even if the patient (pt) has a fractured back, I have had snfs call around for the cheapest place to provide a brace for a broken SPINE! Then they try to tell us to bill it, even though we all know they are billing medicare, so no other claims are accepted. Super annoying, and dishonest. Ends up meaning eating the cost for doing the right thing, not to mention the patient ends up waiting longer while the place shops around.
