Shirlee Zerkel to Sandy Knoesel and Gary Russell re: Medicare Part B supplies

From Shirlee Zerkel, January 12, 2008
Subject: (no subject)

Dear Mrs. Knoesel and Mr. Russell:

I want to thank you for finally doing the honest thing about the Medicare B covered medications and supplies. I am not sure what prompted this change! Maybe Express Scripts wouldn't go along with your program, or you may have found out that Advance and Caremark took you for a ride, since those two PBM billed you first and then billed Medicare also. They also may have told you that we were credited on our accounts (never). Whichever way it happened, I am thankful that as of Jan. 11, 2008, it is being handled in the correct manner.

I spoke to the board and you beginning in September of either '03 or '04 about the fraudulent way the Medicare B meds. and supplies were being handled. You hurried to me as soon as my speech was finished to find the name of the retiree to whom I was referring. I told you to work with Advance and fix all of the retiree's purchases of Medicare B meds. and supplies.

We talked back and forth for many months with STRS telling me that you were working on the problem, then the next excuse was that you were too busy on other health matters, and finally you told me that all retirees using Medicare B with Advance/Caremark received their payment back as a credit on their Advance/ Caremark account. I know that was not the truth as I still know of two retirees who, to this day, have never received even a dollar back as a credit on their accounts.

I have records of my email exchanges and excuses for not doing it correctly. It was strictly against the federal Medicare regulations as stated in a ' Medicare and You' booklet: If a doctor, provider or supplier (you and Advance/Caremark) accepted assignment, they agree to the following conditions:

1. To be paid by Medicare;

2. To accept only the amount Medicare approved for their services, and

3. To only charge you ( the patient) or other insurance you have, the Medicare deductible or coinsurance (Medicare's) amount.

The plan as it was until Jan. 11, 2008 was unlawful because you and the PBM charged the retiree more than the Medicare copayment.

I especially enjoyed the statement in you letter that read: "...you no longer have to wait to receive a refund check because you pay the coordinated amount at the time of purchase" That is what I continually told STRS years ago, but it fell on deaf ears for some reason. Retail stores were using that method then, but Mr. Russell said that could not be done.

1. Why do we have to file another AOB statement, we, who are 65, did that when we first went on Medicare?

2. Why did we not know of this change until 2 weeks into the new year? It will take time for retirees to get this paperwork finished and Express Scripts to process it. In the meantime, we pay the higher cost!

Thank you once again for finally doing the correct thing for both the STRS retirees and the federal Medicare Program.

During these years, the Lima retirees have found a better Medicare B supply solution to our high copays with our STRS PBM.

Shirlee Zerkel