Shirlee Zerkel's response to Sandy Knoesel

From Shirlee Zerkel, January 16, 2008
Subject: Fwd: (no subject)

I am sending this forward to all of you so you can see the trail of my original, Ms. Knoesel's response and now my response to her. I do not believe that STRS/Advance Caremark were in compliance as stated by Ms. Knoesel with the Medicare Law as Paul Boyer complained long and directly to STRS about his lack of a refund for diabetic test strips. To my knowledge, he has never received anything.

The Medicare Handbooks state that "Doctors, and health care suppliers and providers must accept assignment. For example, ....Doctors, other health care suppliers, and providers have to submit your claim to Medicare directly...(this includes claims for glucose test strips.) from Medicare and You 2007. The following is from a 2004 handbook from Medicare entitled: Does your Doctor or supplier accept Medicare Assignment? Page 4: Medicare lets doctors and suppliers know exactly what Medicare sets as the payment amount for each type of service and supply. This payment amount is the Medicare-approved amount......The person with Medicare agrees to let the doctor or supplier request direct payment from Medicare for covered B services, equipment and supplies. Doctors or suppliers who agree to (or must by law) accept assignment from Medicare can't try to collect more than the proper Medicare deductible and coinsurance amounts from the person with Medicare, their other insurance, or anyone else.

The statement used in your email, Ms. Knoesel, was the same excuse used over two years ago to me. Paul Boyer was one who then and even last year had not received a reimbursement check or a credit. Yes, he did complain to STRS long and hard. It was wrong then to ask retirees on very limited incomes to pay a higher co-pay than requested by Medicare B. It also allowed for more mistakes to be made regarding the credit or reimbursement to the retiree. If that change in process can be made now, it could have been make in 2004 or even earlier but you always told me that it could not be.

I see you also stated that Caremark was in charge of the process. Passing the buck, I see. I have one more question. It was stated by your department that the PBM first billed STRS for the supply and then money was recovered when Medicare paid the PBM. Did STRS receive from Advance/Caremark the total amount you paid to cover our Medicare B supplies once Advance/Caremark received it from Medicare?

Just wondering,

Shirlee Zerkel