As the office manager for 2 family physicians, I enjoyed the article on shingles (“Stop shingles in its tracks,” J Fam Pract. 2009;58:531-534). But the sidebar about why more people aren’t receiving the herpes zoster (HZ) vaccine was of particular interest to me. We administer the vaccine daily; we try to catch patients before they go on Medicare because most private insurers cover the vaccine.
The decision to cover the HZ vaccine through Medicare Part D has made it very difficult to vaccinate people age 65 and older. We’ve found a way to overcome this barrier that some of your readers may not be aware of: a Web site called eDispense (http://edispense.com).
At eDispense, a physician or staff member can input a patient’s name, date of birth, and the last 4 digits of his or her social security number and check to see if that individual has Part D coverage. If so, you can check to see whether the patient’s Part D plan covers the vaccine. If the plan participates with eDispense, as many do, you can also find out how much the insurer will pay for the vaccine and how much of the fee the patient will be responsible for.
You can then administer the vaccine and file an electronic claim through eDispense. By doing so, the physician is agreeing to accept payment from the Part D plan, and the payment will be sent directly to the doctor’s office. Granted, this requires a bit of staff time, but it is not cumbersome. We check benefits the day before a patient comes in. When we run across a plan that is not affiliated with eDispense, we print a claim form from the Web site and submit it by mail. (When paper claims are submitted, the payment usually goes directly to the patient.)
Jean Williams
Stone Mountain Family Practice
Stone Mountain, Ga