S.O.S. Speaking of Seniors

HELP WITH ‘SELF-ADMINISTERED DRUGS’ 

Starting in 2010, some of this insurance agency’s senior citizen clients on Medicare began having problems with “Self-Administered Drugs” causing them to receive big prescription drug bills after staying in a hospital.

With each client present after bringing such a bill problem to me, I would make phone calls to Medicare to get help for the client.  But, each time, I got somewhat unclear and different information from the Medicare representative who answered the phone call.  It seemed like each client and I were getting “the run-around”.

During the week between Christmas 2011 and New Year 2012, our office was less busy than usual.  In between my other work, I started making phone calls and searching the Internet for information that would help me to help our clients with the “self-administered drugs” problem.

The problem happens when a senior citizen on Medicare with a Medicare supplement insurance policy and a Medicare Part D plan is in a hospital overnight but classified as an outpatient.  Most hospitals do not bill the client’s Medicare Part D plan for the prescription medicine that the senior gets while in the hospital.  Instead, the patient is billed for the medicine.

Whether the senior citizen can get some reimbursement from the Medicare Part D plan company is a complicated matter which involves filing a claim, presenting receipts or bills, and figuring the difference between the hospital charge, the Medicare Part D plan charge, the positioning of the medicine on a formulary list and some other factors.

It seems that the best possible source of help for a senior citizen who gets a bill for “self-administered drugs” is to contact the State Health Insurance Assistance Program in the senior citizen’s state of residence.

This insurance agency helps senior citizens with relatively simple medical bill problems.  I have helped our senior citizen clients to save more than one million dollars by correcting errors that were caused by mistakes in the Medicare system. 

What no Medicare personnel told me in past phone calls was that the federal government defines when a patient should be classified as “inpatient” or “outpatient”.  Both doctors and hospitals must abide by Medicare’s definitions.  When a senior citizen is classified as “outpatient” and gets prescription medicine while in the hospital, the “self-administered drugs” bill is incurred.

Unfortunately, the process to help the senior citizen get some reimbursement from a Medicare Part D prescription plan is too complicated and time consuming for this agency to be able to offer help to our clients on this problem.  The only way that we can help is to direct the senior citizen to the State Health Insurance Assistance Program.  Those people get paid with tax money to help.  How much help they can provide is something that I don’t know.

Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana.  That is the largest senior citizen oriented insurance agency in the Midwest.  For other articles by Wilcox, visit www.dakotavoice.com and search “Woodrow Wilcox”.