This morning I went to Walgreens to get a flu shot. Easy. I waited five minutes, and Mathew gave me a shot in my left arm. I owed nothing; Medicare came to the rescue.
He then said, “Your file flagged for never having a pneumonia vaccine. He explained people over sixty-five are recommended to have the high powered dose. He continued by saying I would then get a booster in thirteen months, around Christmas next year.
Since I usually struggle through some lung infection throughout the winter, I said, “Okay. Let’s do it.” He left the room.
When he came back, he said Medicare wouldn’t cover the shot. My supplement would pay 20% so I would owe the remainder of, $189.27. He continued by saying if I went to my Primary Care Physician, (PCP) maybe Medicare would pay, but often the doctors don’t have the vaccine in stock. My PCP is in Denver, and with all the unknowns involved, I decided to have Mathew go ahead and stick my arm again. I said, sarcastically, “It’s only money!” I paid my bill and left.
Once I was home, I wondered why Medicare would pay for the flu and not the pneumonia vaccine, and why my supplement would pick up anything if Medicare did not cover the procedure? I called the number on my Medicare card. Twenty-five minutes later I spoke with Martha. She said Medicare covered pneumonia vaccines and I should have Walgreens resubmit the invoice.
I called Walgreens, and after listening to their recorded female voice asking me far too many questions, I connected to the pharmacy and Mathew. He mentioned something about Part D (prescription drugs) Medicare, and I thought maybe that was the problem. So, I called Silver Script, my Part D provider and spoke with Alex. She said Silver Script covers nothing unless it is a CVS Pharmacy. She explained the situation: CVS and Walgreens don’t mix because of a domestic dispute. The husband owned Walgreens, and the wife wanted her own company, so she opened CVS. She was emphatic; my Part D only pays for meds from CVS.
I called Mathew back, (with no means to bypass the phone recording) and he said it is illegal for Silver Script to deny a person from choosing their pharmacy. He suggested I call back and opt out of the restriction. If they offer mail-order, I should opt out of it also.
I called Silver Script back, and, after ten minutes and another barrage of phone instructions, I spoke with Hillary. She said I needed to call another number. Ugh! Calling, I was immediately connected to Callie. She said, I can buy my prescriptions anywhere I want, and that Part D, like in David, does not pay for Vaccines; Part B, like in boy, does. Really?
I called back to Walgreens and spoke with Valerie. Mathew left for the day?!?!? I asked her to boot my account to see if my Medicare number was accurate. It wasn’t. I failed somewhere along the way to give them my new card.
I HOPE we solved the problem.
If you could not follow this story, welcome to my world; I couldn’t either.
I have NO idea how people who are older and less assertive or tech-savvy navigate all of this. Even with help from my sister who is an expert in all of this, I still want to scream, cry, or both. The solution is to stay healthy. Pay the premiums and never expect a benefit. I’m just kidding. But, we do need to prepare for secondary trauma (Insurance nightmares) when confronted with an illness. (or preventive vaccine)
The END of the story: I went back to the store in the morning when Mathew was again working. He was busy when I arrived, so Beth helped me. She tried my new Medicare card. No luck. She re-entered my old card number, and it was accepted. Ya. With the signature of the store manager, $189.27 went back on my Visa.
I have a happy face!
Tenacity does pay off once in a while!
(employee names have all been changed)
Geri Gittings says
Yeah for you. That was really something. I’m trying right now to get information on what ExxonMobil Medicare vision all covers. I spent at least one hour on the phone with different people I was told to talk to and even given a number no longer in service
Still have found out 0!
Lynda Compton-Derby says
Good for you.
Jennifer Goble says
Lynda, not sure it was GOOD for me:))) But, I did learn a lot and that is never in vain.
Jennifer Goble says
Geri, I feel your pain! How do people keep on top of it all?
Joan Luft says
This sounds incredibly frustrating! Such a waste of time for everyone–and a waste of money with all the employee time involved at the drugstore and the insurers. So glad I’m currently in a better (non-US) health care system that doesn’t have all this paperwork and rules too complex for people to deal with!
Jennifer Goble says
Hi, Joan. What is real estate selling for in Germany? You might have the perfect answer to our health system. Hope all is well, and hi to Michael:))
Norma Nab says
I’m glad you stuck to it. Sometimes I think they do all this on purpose so we just give up. I’m sure I would have listened to “Matthew” and just paid the difference. You will go to any lengths for a good story. LOL
Jennifer Goble says
Norma, I did have to laugh, because I had no place to rid my body of frustration other than to put words on paper. My logic just kept telling me something didn’t make sense about the whole story. “Mathew” told me Medicare is having trouble with all the new cards. Something about getting all the complex new numbers accurately, manually, and technically input. When I received my new card, they said to destroy my old card, so I did;( Remember the one with our SS#? Anyway…what else could I have done with that day?????
Marta Wells says
Oh my. Breathe.