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PHLP & APPRISE Work Together to Get Essential Diabetic Testing Supplies Covered
For someone living with diabetes, having the right supplies to monitor blood sugar is crucial to well-being and safety.
"Lisa" is a 23-year-old living in Fayette County who is a dual eligible (a person who has both Medicaid and Medicare). She tests five times a day to manage her diabetes. Typically the supplies for testing are covered by her Medicare and Medicaid insurances. However, in July, when she went to pick up her testing supplies at the pharmacy, she owed a $200 copay! Lisa’s monthly income of $743 made that co-payment impossible, and her insurance should have made the co-pay for those services much smaller.
Lisa’s family contacted APPRISE, who referred Lisa to PHLP. We discovered Lisa was enrolled in a Medicare plan with a high deductible that had not been met, so the Medicare plan was not paying anything toward the test strips. In addition, the pharmacy was not using the correct codes when it billed Medicaid, so Medicaid was not paying as her secondary insurance. We persuaded the pharmacy to call the state Medicaid Pharmacy Unit to get an override so Medicaid would pay for the diabetic testing supplies while Lisa was still in her Medicare plan’s deductible period.
After PHLP’s intervention, Lisa was able to get her diabetic testing supplies for a small co-pay of $1. She and her family were thrilled and thankful. PHLP referred Lisa back to APPRISE, who then helped her to find a Medicare plan that better met her needs given her limited income and dual-eligible status.
To help clients like Lisa, consider donating to PHLP today.
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