Follow
Share

Update to Jan 14 question - during the 1st 6 mos of 14, the pharmacy made another 4 errors in "billing." I tried to get another pharmacy, but they all refused service to that home. The last straw - the home had called the pharmacy to send a sleeping pill which mthr used to have "as needed" since she had not slept for these 2 weeks while I was out of town. The pharmacy called the doctor's refill nurse, who allowed LUNESTA, with a black box warning for elders at that dose, to go into her daily mix (it had been prescribed at one time by an on-call doc one weekend and d/c at once when regular doc noticed it)! The drug was about $200 a month cash pay, too, which really helps the pharmacy's bottom line.

I found out about this situation only 6 weeks later when I received the bill, and at the same time as Hospice came in and sent a discontinue order over for everything not covered by hospice and to bill covered drugs through Hospice benefit. I was told I would not have to pay but maybe one more bill. Then I got a second bill with Lunesta. I called pharmacy both times, had to get up with doc, and finally got it ordered d/c from him (I thought).

The Lunesta should have been covered on hospice's discontinue order, but I did not realize hospice was in charge then. I thought mthr had not been accepted for Hospice until after these deliveries had been made, and calls to the pharmacy assured me the drug was not in the mix anymore after the second month and calls to doc.

The THIRD pharmacy bill I opened after I signed hospice papers happened to be just before the hospice nurse called me with my weekly update. I asked her why they were still sending me bills, and she had a nurse at the facility go through my mthr's pills and pull the Lunestas. They were on the package drug list which the daily nurse checked, but that had not been compared to the orders in the hospice chart. No wonder mthr was falling so much and had broken her wrist! Nurse called pharmacy and they claim they did not get the d/c order for the non-covered drugs and policy is to bill family for the non covered. She stopped everything. That last bill was dated 10/14/14 and this was a few days later. Done, I thought.

Mid November, I get ANOTHER BILL for $5 of Benadryl PLUS a $25 delivery charge (on all of them) but dated on 10/14/14 and not included on the previous statement!! I wrote a nice letter saying this was a billing error, explaining the Fair Credit Act and how they are required to answer my letter in so many days, etc. (I don't know if that applies, but I thought it was worth a try). Sent it certified, return receipt. Received receipt, no reply, and ANOTHER BILL in December. It was as if they were trying to squeeze another small amount out of me, which really does not sit well with me.

On this new bill, I had a credit of $5 for Benadryl on 10/14, a second charge for the Benadryl for $5 also on 10/14, but all the other charges on that day were no longer showing up. The net change by that nice "credit" was 0 since they charged me again. I wrote them another letter showing the error they made and enclosed previous letter & said this letter was a curtsey to them since under Fair Credit I did not need to respond again. The $30 bill continues to come.

I know how to fix credit report errors. What bothers me is that the pharmacy is taking advantage of old folks and their caregivers who don't check bills that close, and like me, don't have time to deal with the problems. Should I copy all this onto a letter to the state pharmacy board? I don't want the home or hospice to be investigated, Just the pharmacy!! The way the pharmacy passed the buck with hospice and me has been awful. Every time I get a bill I get ticked, and there should be one in the mail tomorrow. I finally have time to address this issue.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
With any "black box" warning, you have to weigh the benefits and the disadvantages.
Helpful Answer (0)
Report

YouVe received some great answers here.

I just have a comment about the black box warning. One of the above posters said since the patient is terminal it makes the black box warning absurd.

How so?

Just because someone is under hispice care doesn't mean they're agreeing to take things that will most likely hasten their death. Most want to be comforted, not killed.
Helpful Answer (0)
Report

Hmmm, I'd look into seeing if any of the names of ownership of pharmacy, hospice or any other service providers that Medicare is paying for (either for hospice benefit or regular Medicare services) are the same. Could be same last name but wife owns pharmacy & husband is a MD or interrelated corporations with same agent or directors. You will have to put on your best Nancy Drew to trawl the net but could be interesting. These would warrant a Stark Law investigation by Medicare. Stark is pretty serious and to me it's like what the IRS was for Al Capone - they couldn't get him on murder but could on taxes. If there are cross over in services paid for and ordered by related family or related business interests to the detriment of the consumer those are federal Stark Law violations. The fines are huge and licenses can be pulled; plus the feds can run you through courts forever.
Helpful Answer (0)
Report

Thanks for the direction! I can't help but think that with all the billing mistakes I found before this that there is something wrong at the most basic level. AG office it shall be if they won't respond.
Helpful Answer (0)
Report

surprise, if there were double payments and they refuse to refund that, I would file a complaint with the state attorney general.
Helpful Answer (0)
Report

Right, but the point is that the pharmacy did not have Benadryl on the bill when they closed it out on 10/14, and it mysteriously appeared, along with a delivery charge for "the rest of" October, only after Hospice made sure they had the SECOND d/c order issued on 10/21.

The problem with Lunesta's black box status was that the original prescription for it was issued previous to Hospice being involved, and her doc specifically yanked her off it when he saw that she had been taking it from the on call doc. He was afraid of falls and breaks - and they happened! The refill nurse did not check to see why she'd been taken off the rx, just that she had taken it in the past. Doc had written rxs for a benzo-whatever for sleep several times in the past, but those are cheap generics and not as profitable for the pharmacy. The pharmacy was charging me only about $40 but Medicare pays about $200 on top of that.

I pulled all my pharmacy bills from the last 1.5 years today, including the medicare billing statements that show when Hospice prescriptions were paid. I now know they were paid twice, once by me and once by Medicare. Maybe I should just show the fraud to Medicare?
Helpful Answer (0)
Report

Actually Benadryl is non-prescription, so neither would cover it.
Most of the drugs Hospice uses all have black box warnings, but since the patient is terminal, the warnings are somewhat absurd. If the pharmacy had an RX, they will fill it until the home sends them the DC order. They have to.
Helpful Answer (0)
Report

i have a health insurance background and I used to work in a hospital billing department. The fact that this keeps happening is WRONG. Caregivers have enough on their plate without dealing with this. I would write the letter. keep a copy for yourself, follow up with them if no response, and stay on them until something is done.
Helpful Answer (1)
Report

It's not a Nursing home, just a personal care (board and care in some places). I think whoever called pharmacy was hoping she had something already ordered on "as needed basis" but kept at pharmacy because of addictiveness/street value. I don't think the home intended for the pharmacy to call the doc with a suggestion, and of course it would be the highest profit one!
Helpful Answer (0)
Report

This sounds AWFUL....I would have had a major tantrum and been thrown in jail by now (maybe)! Have you contacted your State Representative, somebody at your State Capitol or the Licensing Board for your state's Pharmacists? It sounds like the NH was a bit tardy, but the dispensing pharmacy is much worse. File a Complaint with somebody at the State.
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.
Subscribe to
Our Newsletter