This truly occurs on a daily basis at my clinic: when we call an insurance company on behalf of a patient, we are told that treatments X, Y, and Z are covered by the patient’s policy. We have submitted the services in good faith; nevertheless, we have been informed that they are not covered.
Naturally, we get in touch with the insurance provider and inform them that we were informed the treatments would be paid for in full. Invariably, they will deny ever having told us this, or they will assert that we were given incorrect information, or they will blah, blah, etc.
We are then required to send the cost for the treatments to the patient, who typically becomes angry with us rather than the insurance company, which is the true offender in this scenario.
However, the patient is ultimately accountable for any costs that are not covered by their health insurance provider. Both we and they will charge it as a courtesy to you. Your failure to pay is a matter between you and them.
My best guess is that the prescription you obtained was for a stomach acid reducer or something similar. When the pharmacy discovered that you had prescription coverage, they proceeded to send the charge and then waited for payment.
The insurance company responded by saying, “Hey, this same drug can be purchased over the counter.” We do not provide coverage for drugs available over the counter!’ And because of this reason, they did not approve the refund.
To boil it all down, you have the option of arguing with your own insurance provider and seeing if they would concede. In any other case, check to see if you can negotiate a reduction with the pharmacy since the only people who pay the full amount are the simpletons who do not have insurance. I can assure you that if they had made the payment, your insurance company would have paid out a considerably less amount.
This is the rule of law. If you simply bring the pharmacist one prescription, for example, oxycodone, they may not be able to fill it. A medication that has been prescribed to you, and the dosage that you are to take is one tablet to be taken orally, three times a day.
A refusal notice will be delivered to the pharmacy once the technician has entered the prescription and electronically submitted the claim to your insurance carrier. It will let you know that the quantity of medicine that your insurance company will pay for is capped to a seven-day supply at most.
You are only able to get #21 pills at this time. It is against the law for the pharmacist to allow you to pay for the remaining amount, despite the fact that you still have 69 pills left. Why? The fact that you initially just brought in one prescription means that you are required to have two different prescriptions in accordance with the law.
The following are some available choices: You are able to let the pharmacist know that your insurance company only allows you to have a seven-day supply of this particular prescription and that you intend to pay for it out-of-pocket. If the pharmacist has any concerns, all he or she has to do is check your prescription and fill history to see that you have only been given a seven-day supply of the medication.
If you are getting your prescription filled at a different drugstore that you have never been to before, the pharmacist at that pharmacy may contact either your insurance company or the pharmacy where you had your prescription filled previously. A scheme to monitor drugs obtained by prescription is available in the majority of states if not all of them.
Your pharmacy technician just has to log in to a state program in order to see a complete record of every restricted drug prescription you’ve ever been given. On it will be written the name of the physician, the drug, the amount that was distributed, the date that it was filled, and the pharmacy that filled it.
You also have the option to have two different prescriptions written by your primary care physician. One is written for the one week’s supply that will be reimbursed by your insurance company, and another is written for the amount that will not be covered by your insurance agent. Both prescriptions will need to be filled.
On at least one of the prescriptions, your doctor will almost certainly add a notation stating which one is intended to be paid for with insurance and which one should be paid for out of pocket. If you are not referring to a prohibited drug classified as a Schedule II product, then I am hard-pressed to think of a reason why the pharmacy would not let you pay with cash.
I was reading some of your other posts, and I noted that you mentioned how CVS does not accept cash payments for the full amount of a prescription. You have the right to be given an explanation on this matter. If the pharmacy is aware of the restrictions imposed by your insurance provider, then I don’t see the logic behind this.
It’s possible that the pharmacy has a policy that, if you have insurance, you won’t be able to pay cash for a restricted drug. I find this to be an absurd policy, but it might be the case. If you have prescription coverage, there is a possibility that state law prohibits you from paying cash for banned medications.
Regardless of the cause, I would recommend that you politely explain your predicament to both your doctor and your pharmacist. A lawsuit? Not a brilliant idea. As someone who has held the position of pharmacist in charge at CVS, I can guarantee you that they will have absolutely everything covered.
our best bet is to have frank conversations with the people who are responsible for your medical treatment; if you are not breaking the law, there is a way to address the situation. As a patient, you should get the very finest treatment that is practicable, and the choices I have laid out for you below represent the most realistic ways to guarantee that this will happen.
Meet Krishnaprasath Krishnamoorthy, a finance content writer with a wealth of knowledge and experience in the insurance, mortgage, taxation, law, and real estate industries.