Finding new problems with Medicare Part D and B. Sound familiar?


Changes with how meds are NOT covered during hospital stay?.
Mom has chronic pain from bad arthritis in knees, spinal stenosis, cervical stenosis and hip replacement x3 on same hip. Can't take the opioids and Dr. wants her to try LIDODERM carrier (same one) covered these 2 years ago when we used them for her they won't because it is not medically necessary.
Needed to get new DWO form completed so mom could have albuterol for the nebulizer since she is on her second bought of bronchitis in 6 weeks...the new form (6 calls) actually is required because these meds have been switched from Part D coverage to Part B...then there are two more forms that mom had to fill out and return. Drives me crazy!!
She was in they won't let you bring in your own meds but MEDICARE NO LONGER COVERS regular medications if patients are in for diagnosis or observation. Are you kidding??? Medicare tells me I can bill to her part D provider...but they have NO IDEA how to process and the hospital will not bill Part D. OH MY...what a system...

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Mike, I don't know if the hospital is obligated to provide the information, but I think that bringing pressure to bear and making the line item breakdown and information you request should be a contingent of payment. In other words, make it clear to them that if you don't get the line item and backup documentation, you'll have to consider that the charges aren't justifiable...something to that effect.

Or send the form to them for completion and return to you; that puts the onus on them to do the legwork. My feeling is that if they were able to send you a line item bill, they have the documentation, or should have, so it shouldn't be that difficult to pull the specific details from the medical charts.

(But make sure you keep a copy of the form as the hospital may well "misplace" it and just send you another bill.)

Be prepared for a battle though. I'm guessing that the hospital provides meds from a central stock, with pills being dispensed for a number of patients. At this point in time, they probably don't even want to trace back the specific script number.

But go for it - I would in your place. It's outrageous for hospitals to be able to price gouge on medicines.
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I questioned the hospital about scamming us into paying drugs when admitted into observation and the Hospital said your prescriptions can be brought in and self administered if your Dr. approves. I also found out from my Part D insurer that there is a form for reimbursement, but the form requires the Prescription number as well as a copy of the label and the administrative cost. I am about to contact the hospital because my bill does not break down the charges. Would like to know if there is an obligation for the Hospital to provide this information.
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The difference between observational status and admitted status is not a new distinction. We encountered it about 3 years ago and learned after the fact that what we thought was an admission was only an "observation." Medicare refused to pay for the medications, and the hospital billed us.

I was livid, especially since the hospital staff admitted the overnight stay was due to action they took during surgery, which caused the need for an overnight stay and monitoring.

I took a firm but pleasant posture with the hospital and went as far up the chain of command as I could, reiterating what I had been told was their role in creating the need for overnight monitoring. I read from the notes I took, and caught them trying to squirm out of their liability.
I also appealed Medicare's decision. At the second level of appeal, Medicare asked if we wanted to continue with the appeal. I think they were hoping we would "go away". I advised we intended to carry the appeal as far as we could.

I never heard again from either Medicare or the hospital, which just dropped the charges. Medicare was technically in default of its obligations in handling the appeal since it failed to comply with its stated responsibility in evaluating at the second level.

Part D coverage didn't even factor into the issue as neither of us have it; his costs are so low that Part D would cost more than just the meds, and I have no medication costs on any regular basis.

You can learn more about these issues in the "Medicare and you" 2015 booklet, page 38, in the section "Are you an Inpatient?", and at these links:

Here's some history and information on the lawsuit filed on this issue:

(I haven't followed the case to learn of any disposition.)
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Medicare's comment is that you can bring your own "daily medications" to the hospital and take them yourself. Only problem is the hospitals won't let you do that. The Part D people sent me a form to submit charges but it had no information about how or who to send it back. They have no idea what to do with consumers sending this stuff in. You need to get a specific detailed bill with any of the (A9270 - I think that is the code) items not covered by Medicare B. If medicare doesn't cover, the secondary insurance won't either. What a racket.
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glasshalffull, thanks for the heads-up regarding "observation" and that my health insurance may or may not cover regular medications.

A few months ago I went to the ER after not feeling quite right a few days after having surgery. After the ER I was placed in Observation while the hospital waited for test results. Stayed two nights. It will be interesting to see what I will need to pay on the hospital bill.
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