Sandy Knoesel responds to Shirlee Zerkel

From Sandra Knoesel, January 16, 2008
Subject: RE: (no subject)

Dear Mrs. Zerkel:

I am responding to your e-mail regarding the coordination of Medicare Part B prescription claims through the Express Scripts Home Delivery program. I would also like to comment on some of the other statements you made in your e-mail dated January 12, 2008.

Why do you need to complete an Assignment of Benefits (AOB) form?

NationsHealth, as the new entity coordinating an STRS Ohio enrollee’s Medicare Part B benefit, needs to have a completed form that specifically authorizes NationsHealth to submit Medicare Part B claims for payment on your behalf. The form that an enrollee completed under the Caremark program cannot be used.

Why were Medicare Part B eligible enrollees not notified until 2 weeks into the new year? Will qualifying enrollees be subjected to a higher cost for the first 2 weeks and/or until they complete an AOB?

The program was effective January 1, 2008. From the beginning, Express Scripts has forwarded all potential Home Delivery Medicare Part B claims received to NationsHealth for NationsHealth’s determination as to whether they qualify for coverage under the Medicare Part B program. When necessary, NationsHealth will contact you and/or your physician to gather the information required to determine whether the prescription is covered under Medicare Part B. In addition, NationsHealth will start the AOB process for those who have a Medicare Part B claim or for anyone requesting an AOB form. In all cases, the first claim should be processed and shipped without delay. Enrollees will not pay a higher cost for the first two weeks or until they complete the AOB.

Ms. Zerkel, you also made several inaccurate statements that need to be corrected.

The previous program you refer to was established by Caremark in response to STRS Ohio’s request for a mail-order Medicare Part B coordination program. The program complied with federal Medicare regulations as enrollees’ prescriptions eligible for coordination with Medicare Part B have received either a check or credit. For each enrollee who has contacted us with a concern or question about a potential refund or credit, we have investigated the issue and in every case either the enrollee did not realize he or she had received a credit/check; or, the prescription claim did not qualify for Medicare Part B coordination. Enrollees who believe this is not true should contact STRS Ohio and we will investigate their concerns.

Sandy Knoesel