BMA???
Prolia Shot Part B or not??
- Thread starter vic120
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BMA???
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I learned about this last year, while talking to people who were getting prolia, even at the Dr office. The prospect/clients told me although the shot was at the doctors office, the bill shows a local pharmacy.
I tell them now, the best way to get that under Part B is at an infusion center
I tell them now, the best way to get that under Part B is at an infusion center
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My clients that have Medicare as primary and a Supplement do not pay anything for the Prolia shot. The shot is covered under Part B.
Bite Me in the Ass?
Bite Me in the Ass
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- #16
Interesting I have always told clients it was covered B and never had anyone before have an issue this is the 1st time
This is why this forum is awesome
She is mailing me the bill I will have to tell her to talk to doc if he won't fix fin a doc who will bill under the B
I still am amazed how I get so many of these weird time-consuming problem AEP and not in say March somehow
This is why this forum is awesome
She is mailing me the bill I will have to tell her to talk to doc if he won't fix fin a doc who will bill under the B
I still am amazed how I get so many of these weird time-consuming problem AEP and not in say March somehow
Was told by a couple of the local docs that they don't like ordering Prolia because the Medicare reimbursement is so low they "lose money" so they send the patient to the pharmacy. Found out the large Orthopedic group in my area does a lot with Prolia so they always bill Part B and no problems. Wonder why they aren't "losing money"??
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I recall looking up information about this for a client. The Prolia website gave specific infusion centers where Part B would be billed. Prolia Finder™
Scroll down the page, there is clear labeling about infusion being Part B and pharmacies being Part D for billing.
I can imagine some custom retiree Medicare plans where they have mostly eliminated the coverage gap being more generous than the out of pocket for their coverages for in and outpatient services. I say this because it's possible that in some custom corporate retiree sort of MAPD situations the person could perhaps spend less if it's Part D and others where it's less on Part B. (Medicare supplements or the retiree version) Mostly not relevant for we retail agents, just pointing out some retiree plans I've seen to show it could be possible to prefer Part D, and I suppose, we need to be balancing out the 20% OOP on widely available MAPD's we sell vs Part D.
Scroll down the page, there is clear labeling about infusion being Part B and pharmacies being Part D for billing.
I can imagine some custom retiree Medicare plans where they have mostly eliminated the coverage gap being more generous than the out of pocket for their coverages for in and outpatient services. I say this because it's possible that in some custom corporate retiree sort of MAPD situations the person could perhaps spend less if it's Part D and others where it's less on Part B. (Medicare supplements or the retiree version) Mostly not relevant for we retail agents, just pointing out some retiree plans I've seen to show it could be possible to prefer Part D, and I suppose, we need to be balancing out the 20% OOP on widely available MAPD's we sell vs Part D.
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Black Male Adult
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