CCSMedical and Medicare Part B deductible

Type 1 and LADA
1

I’m having a problem with CCS Medical regarding my yearly Part B deductible. In January, my first order for pump parts and my first prescription for insulin appear to have hit the Medicare system at approximately the same time. The effect was that, when I picked up my insulin prescription in January, Medicare was showing that my deductible had not yet been paid, so I was charged $203 when I got it. I understand enough about insurance to know that, when the deductible is owed, the consumer pays. The problem is that CCS Medical is insisting that the Part B deductible is rightly theirs, and that I still owe them $203 dollars, regardless of the fact that I already paid it to my pharmacy. They maintain that it was wrong of my pharmacy to collect the deductible.

I spent a goodly part of yesterday on the phone with both CCS Medical and Medicare. What Medicare told me is that it appears that CCS Medical’s claim was received after the pharmacy claim.

Here’s where, to me, it goes sideways. The Medicare rep I spoke to appeared to agree with CCS, that the pharmacy shouldn’t have collected the deductible. In the end, after several frustrating conversations, I was advised to ask my pharmacy to refund the deductible I had paid them two months earlier, so that I could pay it to CCS instead. Sounded kinda like bllsht to me, but I went to my pharmacy anyway and asked them if this was how this is supposed to work. They told me that “that’s not how ANY of this works!”

Now, my question for the Great Collective Intelligence here assembled is this: Is the actual equipment covered under Part B privileged for payment over the essential supplies? It seems to me that, in this context, a pump without insulin is useless, while insulin without a pump in inconvenient, but not impossible.

CCS Medical has told me that, until I pay them another $203, they will not fill any more supply orders for me. I’m not in desperate straits yet but I’d like to get this cleared up.

Has anything like this happened to any of you? Also, where is it written down that the equipment distributor is owed the deductible, and how was I supposed to know this?

Thank you all for any light you can shed.

2

Did the Medicare rep know that your insulin was for insulin pump, and therefore correct to process under Part B, and get deductible applied? Maybe they assumed insulin would be Part D.

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3

I explained that, but I can’t say that I’m sure he understood. However, he was looking at a list of my past claims, where insulin was approved every 90 days, so there was at least precedent. What flabbergasted me was the suggestion that the pharmacy would refund the deductible that was paid over two months ago, just so I could pay it to someone else.

I edited this missive and sent it as an e-mail to my regional Medicare office. I have tomorrow off from childcare, so I may just call them, and see if I can get a clarification.

4

That’s great!
It could also be a system/computer problem that would likely take longer for them to figure out. He probably needs to get additional help to solve.

5

@MamaB1

While I am late to this discussion, last year I did a different Medicare 3-way dance with my pharmacy, Medicare, and, in my case, my Medicare supplement.

Have you been able to download and carefully study the relevant Medicare EOBs from both the pharmacy and CCS “events”? That should allow you to confirm that Medicare didn’t, in effect, charge you two deductibles … and is the starting information for any further discussions with any of these 3 parties.

While I’m not a Medicare expert, I don’t believe that any one provider has a greater priority for collecting first-of-year deductibles.

Good luck,

John

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6

John, it’s not that Medicare charged me two deductibles; it’s that CCS Medical wants me to pay them a second one, because they didn’t receive the one I paid to the pharmacy.

7

Ask CCS med if they have resubmitted your claim. If not ask them to do it. It appears to me, to be a Medicare problem. Hope this helps. Good luck.

8

@MamaB1

While I don’t know whether you have traditional Medicare, a Medicare Advantage plan, and or a Medicare supplemental plan, I think that starting with the “official” Medicare documents. To that end, I would ask:

Have you been able to download the relevant eMSNs from my medicare.gov?
And the EOBs from any supplemental Medicare coverage?

Those should clearly show how Medicare applied the $203 deductible. They also include the MAXIMUM that you can be charged. If your eMSN for the Medicare claim does NOT show any applicable deductible being “withheld” (in other words, another claim such as your Part B insulin, consumed the deductible), then CCS would be bold indeed … and be risking their Medicare privileges … if they tried to charge you a second deductible when Medicare already thinks that you have paid another provider the $203.

Good luck,

John

9

I got a very pleasant surprise today. I received a call from a very courteous and knowledgeable CCS Medical representative. She understood exactly what the situation was, and how to handle it. She also understood how and what Part B covers for diabetics on pump therapy. My order has been approved and will ship at the end of the week.

I haven’t heard yet from the investigator assigned to my case by my regional Medicare office, but if that’s what lit the fire at CCS, I’m grateful. The difference between the two reps I spoke to was like night and day.

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10

@MamaB1

Hooray!!! Yes, I’d bet that if Medicare called CCS, your case got escalated and resolved very quickly. For a company like CCS, few things could be worse than getting their Medicare “license” revoked.

I’m pleased to hear that your problem has been resolved.

Stay safe!

John