Problem Solver: Prescription Drug Plan Reimbursement

With high costs of prescription medications many of you rely on Medicare drug coverage plans to reimburse your claims. But when that reimbursement didn't come through a family was forced to turn to a local food bank for help. In the meantime they also turned to us. Dianne Derby tracked down the right person to help them through their drug plan nightmare. It's a 7 On Your Side Problem Solver.

Every other Monday Marilyn Barbrey drives to the food bank at Green Pond United Methodist Church in Gray Court to stock up on items she desperately needs. It's something she says she didn't have to do until her prescription drug plan, Caremark, denied her claims for reimbursement.

"It's rough," said Barbrey as she talked about her trips to the food bank. "You don't really want everybody in the world to know it but sometimes you have to ask."

She says every time she spoke with Caremark she got the run-around.

"We called them about a dozen times in one days time and they put you on hold for about an hour you know how that goes," she said.

When the Barbrey's called News Channel 7 we put them in contact with their pharmacy spokesperson Betsy Ross of Drug-Lo. She told us she spent 11 hours getting the issue resolved with Caremark.

"I think it was the right thing to do in this case understanding the circumstances," said Ross. "Unfortunately we can't invest 11 hours time for every patient."

Due to privacy laws Mrs. Ross couldn't reveal much about what Caremark told her but she did blame the mixup on them.

"There was data that was mis-entered in the computer apparently and that misinformation was being communicated to the patient regarding their insurance claims that were being processed," said Ross.

Caremark spokesperson Carolyn Castel would not comment about the possible data entry errors citing confidentiality issues but she did send us a statement via e-mail that said, "We have reviewed all of Mrs. Barbrey's pending claims, including receipts for claims that were not entered into our system. Reimbursement for Mrs. Barbrey's pending claims will be issued to her shortly. Due to confidentiality issues, we cannot provide specific detail as to the amount of reimbursement due to Mrs. Barbrey, however, we are in the process of communicating with her directly. We apologize for any inconvenience that Mrs. Barbrey may have experienced in obtaining her prescription medications."

Now Mrs. Barbrey finally has an answer that will give her the money she needs.

"I feel better now," she said. "I think things are beginning to look up."

Drug-Lo's Betsy Ross says you have to be your own advocate when dealing with your drug plan and never take "no" for an answer. She says you should consider several things when picking your plan:

--Find out from your friends and your pharmacy how the customer service department handles claims

--Check to see if your medications are covered under the plan

If you have a problem with your prescription drug plan you can register a complaint with the South Carolina Lieutenant Governor's Office on Aging by calling 1-800-868-9095 or send them an e-mail here.



Remember if you are eligible for Medicare you only have until December 31st to pick your drug plan for next year otherwise you may have to pay a penalty. For more information click here or you can call Medicare 24 hours a day at 1-800-MEDICARE (1-800-633-4227).