TL;DR'ing as best I can from the start of this post, because the full bulleted list of bullshit is 6 pages, no lie.
Plan A, through my employer (currently and forseeably employed full-time), should be the primary payor on all claims, as stated by the Centers for Medicare and Medicaid Services (CMS). Plan B, a Medicare Advantage plan, pays secondary on all claims.
The opposite has been happening for two years, with Plan B paying primary and Plan A paying secondary. I only discovered this discrepancy in June, but immediately began to work to get it fixed.
Medical was fixed a couple weeks ago with Plan A and B working out who owes what to whom between themselves.
Pharmacy, on the other hand, is still broken, despite relentless hammering from myself and my HR VP, and multiple assurances from the broker that it should now be fixed. Electronic claims submitted by my pharmacy either to Plan A alone or to Plan A coordinated with Plan B are being rejected by Plan A that the primary payor needs to pay first. This -twice- is now three times in the last three business days after the broker stated in no uncertain terms to my HR VP that Pharmacy coverage was flagged as primary under Plan A, and those claims would process.
I've contacted CMS; they advised I would need to call Plan B for COB assistance. Plan B's rep says that things are configured with Plan B as primary, Plan A secondary. I called Plan A; they said the exact same thing, despite the broker's statement to the contrary. I called the Medicare Benefits Coordination and Recovery Center — they reconfirmed both Plan A and B were wrong, and Plan A should be primary in all cases.
I don't know what I or my employer can do from here. I'm not picking up any medications now until this is absolutely confirmed; I'm not going to get into a situation where Medicare wises up and then I'm wrapped up in defending myself from a fraud allegation, so I'd much rather go on the offensive.
I'll accept any and all advice here, but I do have one specific question: If I end up having to sue Plan A and/or Plan B, am I obliged to name my employer as a defendant in the suit as well?