Not too long ago, my extended family enjoyed getting all the cousins together to watch “The Wizard of Oz” every year. We loved watching Dorothy follow the yellow brick road to Oz. It was a great bonding activity. Now those same family members are calling to ask for help with Medicare. Where did the time go?
Recently, a relative called about a letter from his Medicare plan. It explained that a medication he takes regularly was covered as a courtesy but would not be filled again. My cousin was as shocked and disappointed as Dorothy was when she pulled the curtain back and found that Oz the Great and Powerful was not what she expected. My cousin blamed Medicare, the insurance plan and the sales agent. Here are the steps I offered.
Step One: Call the plan to determine if the drug requires prior authorization, is subject to quantity limits or step therapy rules.
Step Two: Contact the prescribing doctor’s office and have them call the plan to provide additional documentation based on the drug coverage rules.
Step Three: Contact your plan to file an appeal and if necessary, ask for an expedited review.
My cousin learned his medication was subject to prior authorization rules. The doctor contacted the insurance company and it will be covered.
With a little help along the way, everyone should be able to follow the Medicare road and resolve any bumps along the way.