Sandy Knoesel responds to Shirlee's question......or does she?

The question: Did STRS ever get full reimbursement for the upfront costs paid to Advance/Caremark for Medicare B meds and supplies that retirees ordered?

From Sandy Knoesel, February 1, 2008
Subject: RE: question

Dear Mrs. Zerkel:

STRS Ohio receives a quarterly report of Medicare Part B claims coordinated through the mail order pharmacy. This report is reconciled by the Health Care finance staff against the quarterly payments deposited into the Health Care Stabilization Fund for the STRS Ohio portion of the Part B reimbursement received from Medicare. The enrollee’s portion is credited to his/her account.

It is important to remember that prescription drugs are covered by Medicare Part B only if they meet specified criteria such as a specific diagnosis. Not all drugs submitted will ultimately be covered even though they are on the list of potential covered drugs/supplies.

Caremark will continue to process claims for six months for claims incurred in 2007; consequently, STRS Ohio will not receive the final payment and reports from Caremark until sometime during the third quarter of 2008. Therefore, we have not received “full reimbursement” at this time.

Sandy Knoesel

From Shirlee Zerkel, February 1, 2008

Ms. Knoesel's answer is not a real answer. She is good at beating around the bush! This email does not answer whether STRS got full payment for approved Medicare B supplies for previous years from Caremark. She is just speaking for 2007. Approved Medicare B meds and supplies was what my question was about. It was such a complicated and odd process that Caremark and STRS used; one that allowed for many mistakes to happen. If they can do it the correct way now in a manner of weeks since Jan. 1, what was wrong with doing it the correct way years ago when I complained?

Shirlee