ClinCoach Inc

Dear Sir or Madam, We are in receipt of your correspondence dated August 17, The patient indicated: - The cost of oral medication -Medicare and Tricare denied the claim because the patient was under observation - If the patient is going to incur additional out-of-pocket costs,
patient should be made aware - Patient is requesting a refundFor a visit that is classified as an observation, self- administered drugs is not a covered benefit under the Medicare plan BMedicare plan D will cover these medications however, Honor Health is not contracted with Medicare plan DObservation services are hospital outpatient services given to help the physician to decide if the patient needs to be admitted as an inpatient or can be discharged homeMsF*'s visit to the emergency department was classified as an observation for her stayTricare will follow Medicare guidelines when Medicare is the primary insurerThe patient signed an "Are you a Hospital Inpatient or Outpatient?" from which gives a summary of the statuses, explains the self-administered drugs, and Skilled Nursing Care coverage the statusesHonor Health is obligated to collect from the patients any responsibility assigned by the insurance companyA refund will not be sent to the patient for the cost of the self-administered drugs.I explained Inpatient versus Out Patient status and the self-administered drugs guidelinesThe patient can submit a request to the plan F coverage and see if they will reimburse the patient for the self-administered drugsAttached is "Are you a Hospital Inpatient or Outpatient?" form, Medicare guidelines on patient status and a letter that the patient has been sent to submit to their plan F coverage.If you have any additional questions or we can be of additional assistance, please contact me at ###-###-####