CMS Secret Shopper Question

[retread]

Question: If my aunt enrolls in your Medicare Advantage plan and she just received her entitlement letter from Medicaid, can she save money immediately by presenting that letter to the pharmacy?

Will the MA member get the LIS/Dual eligible low rx copay by providing the pharmacy the letter from Medicaid and the pharmacy will enter the info in their system that will subsequently notify the MA plan of the member's dual eligible status?

My reply would be: "Pharmacies go by what is in their computer at that moment. If the proper information has been entered by Medicare, they will get the subsidized co-pay for Medicaid, otherwise not. Health insurance carriers are different. Presenting your Medicaid acceptance letter to a health provider as proof of your status may or may not be accepted as the provider will take some time to process the claim."

If pressed for a yes or no answer, I would say "Depends".... and you can take that to the bank.

(Actually, I would say NO)

 

[Bob_The_Insurance_Guy]

Question: If my aunt enrolls in your Medicare Advantage plan and she just received her entitlement letter from Medicaid?

Let me stop you right here. I find out if they qualify up front, and if they think they do, I have them contact Social Security FIRST. Then I proceed with the appropriate plan for their needs.

For me, the point is moot.

 

[healther]

The pharmacist is going to charge whatever the computer tells them to charge, a letter will not sway them.

 

[retread]

The pharmacist is going to charge whatever the computer tells them to charge, a letter will not sway them.

I see you used to work in the Department of Redundancy Department, too.

 

[munda4545]

Just curious, at the end of the day... who having a less stressful day & pocket full of green ? Secrete shoppers or agents ??