January 8, 2010
Advisory Alert: Health Net Has Incorrect LIS Information for Enrollees
An urgent issue was recently raised by Medicare advocates that we want to bring to your attention. Beneficiaries with low-income subsidy (LIS) who are enrolled in Health Net plans have been charged incorrect cost-sharing at pharmacies since January 1. It appears that computer systems for Health Net do not have accurate subsidy information for enrollees, and as a result, pharmacies are telling beneficiaries enrolled in LIS that they must pay the full, non-subsidized cost of their prescriptions in order to receive their drugs.
While Health Net is working to address the issue, the plan has authorized pharmacies to charge reduced cost-sharing ($1.10/$3.30) for affected enrollees through January 10. CMS estimates that Health Net will have correct records within a week, but there are still a number of options for LIS recipients in the meantime. The pharmacy or the beneficiary may call Health Net (1-800-806-8811) to request an override of the incorrect copayment. However, please note that beneficiaries have reported wait times of up to one hour for the Health Net customer number.
If you have experienced problems with Health Net (or another plan) and LIS copayment information, please contact us. Questions we have for you:
- Are pharmacies and/or beneficiaries able to contact Health Net at 1-800-806-8811?
- How long is the hold time on this number?
- Is Health Net correcting the copayment information over the phone?
- If yes, how long does it take to correct the copayment?
- What impact, if any, does this issue have on your SHIP?
HAP will use the experiences you share with us as we follow up with CMS to ensure plans have correct subsidy information for all beneficiaries enrolled in Part D.
Sincerely,
The HAP Team
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