This is coming from a doctor's office. We mostly have elderly patients.
Medicare Part D is the prescription coverage for Medicare patients. Prescription Solutions is a pharmacy plan that covers Secure Horizon and United Healthcare patients (and probably many others).
Zostavax is the "new" shingles vaccine.
One of our patients got the vaccine and we billed Prescription Solutions, just like we have billed many other Rx plans. When we got no money after 3 months I called Prescription Solutions.
Their representative, after checking with, he said, a supervisor and two other co-workers, told me that the patient must pay us for the vaccine or purchase it from a pharmacy ($180.00) and then submit a DMR for reimbursement.
The representative said it took many weeks to pay patients for the DMR claims.
I explained that we had administered the vaccine from our own supply, we had billed Prescription Solutions, in good faith, and they should pay us. The representative kept repeating that the patient had to pay us and submit for reimbursement that would take "many" weeks to reach the patient. I explained that the patient was not able to pay us nor was he capable to apply for reimbursement due to his advanced age. The representative told me they had forwarded the patient the DMR form in response to MY BILLING and they had not received the DMR back from the patient. When I asked how was he to present a receipt for his reimbursement since he had not paid us, the representative kept repeating that the patient had to pay and wait for reimbursement.
I pointed out that this was not a reasonable expectation for many elderly patients as they frequently cannot afford to pay $180.00 out of pocket and then wait many weeks for reimbursement and they still refused to pay us.
It is our opinion that Prescription Solutions has deliberately selected this method TO PREVENT PATIENTS FROM CLAIMING THIER PART D vaccine benefits.
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