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Can a insurnce company under Plan D deny vacation coverage
Jul 5, 2013

I am going on vacation next week. I will be in Germany for six weeks. I called EnvisionRxplus to get approval for covering me until I get back. I am on a blood pressure medication and an antidepressant. I have been on my blood pressure medication for 17 years and am well controlled. During the first call I was told I am denied because I was given an exception in March (went to Egypt for 4 weeks). I called after re-reading the EOC. Found to support this statement. Called again and was told it is in the Summary pf benefits." I read that that one. No mention of coverage in this publication either. Called again. Ask to see it in writing. No one can find it in writing. During the last call I was told "because it is not specifically stated in these documents that they cover vacations it is not part of the plan and therefore will be denied. I did not believe at first what my ears where hearing. Isn't this a Federal program?

Response from Mr. Chambers

Medicare Part D prescription drug coverage is provided by private insurance companies, but is overseen by the Center for Medicare and Medicaid Services (CMS).

Although there is no specific exclusion to being out of the country, the plan is limited to persons residing in their "service area" which they list as "all states and the District of Columbia." This is in their Summary of Benefits. This is consistent with Medicare itself which is generally not available outside the United States.

Pharmacists outside the country also will not be able to be reimbursed by the plan since they are not "participating pharmacies."

If EnvisionRx is saying you have lost your entire coverage by "moving" outside their "service area", you should be notified in writing. If you are maintaining your U.S. residence, I doubt they can claim you literally moved away because of an extended visit.

You should first require notice of such disenrollment in writing if you have been totally dropped from coverage. Also, the Summary of Benefits plan provides information on appealing their denial, which you should do.

Hopefully, you can retain your U.S. address and Rx coverage, and a friend can pick up medications shipped to your U.S. address and forward them to you.

If you have further problems you can contact Medicare at 1-800-MEDICARE for assistance.

Good luck, Jacques

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