My mother has been receiving money from her CalPERS insurance through Blue Shield while she stays at her Skilled Care Nursing Home. This money covers half her room and board. It has been a blessing.

We recently found that her plan with Blue Shield only allows her to receive her medications through Prime Mail. Mom's medications come to me, I pay the co-pay, and deliver the required 90 day pill bottles to her Conv./Rehab, and they make note of the transaction. Most of the Rehabs/Convs Homes in CA have a contract with the Omnicare Pharmacy which is not paid for by Blue Shield. This way of doing things has worked so far; when the physician needs to make a change in medication he does so through the RN at the Conv./Rehab and she places the order with the Prime Mail Co. Is there an easier/less expensive way of doing things, or is this the best method of operation? When my mother was at her AL Blue Shield allowed the Safeway Pharmacy to deliver her meds, Safeway would bill them, and I would pay the co-pays, but there has since been a change to the way of doing things. My mother has Medicare for her other needs--they pay 80% and Blue Shield pays 20%. Do I have other options or is the way I'm doing things the best way to go?

Another question I have: My mother had a stroke a year ago. The Rehab ordered an updated walker for her and it was delivered from a medical supply company. We were told that Medicare would pay for part of the cost, and we would be billed for the rest. Six months went by and we received a bill for the entire amount. When asked, the supply company said they failed to request and send the required paperwork for the doctor to sign as well as the paperwork for Medicare. They wanted me to pay the full amount but said they would settle for a check for $116. How much of this bill are we required to pay? On good faith I sent in $116 to the medical supply co. which they said would be our cost, with an attached letter saying that is all I thought I needed to pay since it was their problem. A year has gone by so I'm not sure if Medicare will pay them at this point, but I have an appeal form I plan to submit to Medicare.For some reason the Medical Supply Co. does not want to send a revised invoice to me, nor do they want to send in a new request to Medicare.

I did not know about all these procedures before, but something I would encourage family members to do: Grab a cup of coffee and sit down and spend a few hours to familiarize yourself with your parent's insurance plans before issues come up rather than trying to go around putting out fires. Some of these books are HUGE but are worth reading and getting to know the protocol and way of doing things. (for example, I did not know on mom's plan that Medicare only paid for 2 wheel walkers not 4 wheel walkers until my mother was in need of one.

Another thing I learned: CalPERS missed a payment a few months ago so I sent in a couple of letters making note of it, and asking them to please respond to why the payment was not made. I did not hear from them, and when I called, the representative told me that she saw my letters in their file. She said I should've called. I thought I was saving both of us time by not calling, but apparently they prefer to talk to people. Sometimes one is on hold for 20 minutes, but now I know to always call if there is an issue,.

Thanks for allowing me to ask questions, vent a little at times and encourage others on this site.

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