Thousands of people on Medicare (and other insurances) are still being affected by the hack and cyberattack on Change Healthcare, which happened, mind you, in February 2024 and which has resulted in pharmacies being unable to submit prescriptions and services such as vaccinations to Medicare (and, again, other insurances), and thousands of people across the U.S. having to either pay out of pocket for prescriptions and vaccinations, or do without. If you’ve had to pay out of pocket for a prescription or vaccination or booster because of this, here’s how to submit a claim for reimbursement to Medicare. It’s almost certainly the same for other insurance carriers as well, except they will have a different claim form and/or submission process.
If you need to submit the claim specifically to Medicare (versus a different insurance carrier) be sure to read the second part of this, which explains exactly how to submit a claim for reimbursement to Medicare because, like everything else associated with Medicare, they have made it needlessly and ridiculously complicated, so there is a plain English explanation of what you need to do for Medicare along with links to what you need.
What You Need from the Pharmacy in Order to Submit a Claim for Reimbursement Because the Pharmacy Couldn’t Submit Your Prescription to Medicare or Your Insurance Because of the Change Healthcare Hack
First, of course, you need an itemized receipt.
But second, and importantly, you need a note from the pharmacy saying the following:
Date:
Patient name:
Pharmacy name:
Please be advised that (pharmacy name) was unable to process this prescription or service to submit to (Medicare / insurance carrier) because of the inability to connect to the prescription processing system owing to the ongoing malfunctioning of the system resulting from the hack and cyberattack on Change Healthcare.
(signed, Pharmacist)
What You Need to Submit Your Claim to Medicare for Reimbursement of Your Prescription
First, a little bit of Medicare craziness: You may think that vaccinations would be submitted under your Medicare Part D (remember, D is for drugs). You would be wrong. Your friendly pharmacist has to submit vaccinations (such as a Covid booster) under your Medicare Part B. If you have, instead, an Advantage plan (Part C) well, all bets are off. (Read my Plain English Explanation of Medicare and How and How Not to Sign Up here for plain English explanations of all of the various parts, and why you do not want you or a loved one to sign up for “Advantage” plans here.)
To submit a claim for reimbursement to Medicare you need Medicare form CMS-1490S “PATIENT’S REQUEST FOR MEDICAL PAYMENT” (link to that form below, but read the rest of this first).
On form CMS-1490S you MUST check “The provider or supplier is unable to file a claim for the Medicare Covered Services” as the reason for submitting the claim for reimbursement. If you check either of the other two reasons, or if you don’t check any of them, your claim will be rejected.
Now, once you have form CMS-1490S filled out, you need to submit it. Here is something that may blow your mind: did you know that you don’t submit Medicare claims for reimbursement directly to Medicare? If you, like many others, have never yet had occasion to submit a claim for reimbursement to Medicare, then when you start reading the claim form (info on that in a moment) and come across the instructions which say “Send the completed form and supporting documentation to your Medicare contractor” you may, understandably say, “WTF?,” followed by “How the hell do I find that??”
Well, form CMS-1490S consists of three pages of actual form that you need to fill out and submit, and fifteen pages of advisements, instructions, and other information. Somewhere around page seven is a list of all of the various Medicare contractors who handle claims regarding vaccinations and other Part B stuff for all of the various states. That list is itself 5 pages long. In addition, you can find the actual list of Medicare contractors at the following link, because why trust a form that was printed a while ago when you can check the actual live list that, one would hope, is most up-to-date? Plus, the linked list will give you the contractors in your state for all Medicare services (Part A, Part B, and the Home Health and Hospice services contractor); the list attached to form CMS-1490S is only for being reimbursed for Part B issues.
Link to live list of all Medicare contractors by state
Where to Download Medicare form CMS-1490s
Download Medicare form CMS-1490s here:
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