@Dalis Have you contacted the insurance company? They should be able to help at least get the RX released to you.
They won't do anything. They insist that I have a balance in the account that ONLY shows in their computer because I am looking at my account and it says "balance due: $0.00" . They also will NOT connect me with account payable under no circumstance, which I find very "fishy".
I had a HUGE reply typed out, but suffice to say: this can be so frustrating! I hope you get this figured out. If it's a claim company for the pharmacy, they may have their info wrong. (I have a story about a claims company that just didn't do their job--"it's a busy time of year," he said to me!--and so he just used my address instead of contacting the cops to find out who actually did some damage near my house. News flash: it wasn't me.) So keep fighting. Contact the pharmacy and tell them the claims company is wrong and you'd like to know what happened and to whom you need to speak within the pharmacy's hierarchy. Contact your insurance company and tell them you're getting fed up with the claims company, and is there anything the insurance company can do for you? The insurance company may have a lawyer's name for you, too. Also, if they won't connect you to their accounts payable, then maybe something is up. Where did you get their number? Does it match up with the phone number provided on the back of your insurance card (or if you're contacting the pharmacy directly, does the number match up with the phone number provided on their receipt--cuz you could call the pharmacy directly and ask them to connect you to their headquarters--or whatever number you need--directly)? And document EVERYTHING. Heck, have them call you and leave a voicemail detailing any info you spoke about (including WHY they won't connect you with Accounts Payable.) Or have them email you the info while you're speaking. I did BOTH those things with the claims company I dealt with. Ugh, that happened 2 years ago and I still want to rip my hair out. And if things still don't get worked out and you KNOW you're right, then contact your attorney general's office (or whatever gov't office takes care of stuff like this). Good luck!
The pharmacy claim company does not get paid by you. They get paid by the insurance company. The pharmacy submits the claim to the pharmacy claim company. You do not pay the claim company. You pay the pharmacy your RX copay. I used to work for Blue Cross. Your Health Insurance company needs to contact the pharmacy claim company. Do they use Express Scripts? I would suggest contacting the Health Insurance company and have them contact the pharmacy claim company. Perhaps it is an insurance thing that they did not get the monthly subscriber payment which has nothing to do with you. That is a Health Insurance to Pharmacy Company enrollment thing. Your payment of copays goes directly to the Pharmacy like Walgreens unless it is mail order. I am wondering if this is an enrollment issue.
Oh man, Dalis... we have had issues, but not with pharmacies. DH knew a personal lawyer that was trying to get a customer base, and word of mouth referrals, so he did it pro bono for us. He was only licensed in NJ. I can look for the name, but this was 10 years ago, and I think he started specializing in Workers Compensation cases. I would ask, like you are, to family, friends, maybe even some doctors that you have a relationship with. I hope it all works out. (Ours was when DH was super sick. He received experimental drug treatments at a hospital. We didn't know about the experimental part and we didn't agree to a price. It was $9,000 for each treatment, DH had 2 on his doctors recommendation. After a LONG drawn out fight, we ended up having to pay half and the insurance company paid half. On top of it all, the treatments didn't help him.)
This whole thread is full of so many confusing words... I hope whatever you have going on Dalis is figured out for you by someone who knows what is going on. Sounds like a huge headache.
I somehow am not sure if you're in the US, Dalis but most states have an Insurance Commission which has as part of its mission, making sure that consumers get what they're entitled to. I'd contact your own State senator if you are in the US with this problem.
Medications have finally been mailed to us! You wouldn't believe the stuff they did, but I stood strong and wouldn't hang up every time they said they would call me back I told them I would stay on the line. Apparently, every call that is longer of certain amount of minutes they get "screened" so everyone started getting really nervous that our call was "taking so long". Meds have been mailed but I do believe that there is a possible case for fraud and I will be contacting my insurance company on Monday. I think the mail order company is purposely modifying generic prescriptions to be the brand medicine so they can charge you more. This might get really ugly.
oh wow... that is not good. I do know that all insurance carriers have a mandatory generic policy. If you are allergic to the generic (one ingredient can do it) then your doctor can fill out the FDA form indicating allergic reaction. This will then allow you to obtain the brand name at generic pricing/copay. The form gets sent to the FDA as it is a Federal Drug Administration form. I don't know how they would modify a gen to be a brand.... good luck. Glad at least it is now being mailed out to you. I have been retired for 5 years now. I had never heard of the mail order you are using. Good luck Dalis!
not sure if this is about Bianca finger or else...but I would say, are they taggable in social media? the insurance? I would then post something that will make them react and help? not sure how it works there but it sure works here sorry to hear that more trouble is in your way, I know that feeling well, it seems like we never stop the fight LOve you, ad you know you are always in our r thoughts and prayers
I'm glad the medicine was mailed, but OMG! Our pharmacy here will ask if we want the generic, and has always been VERY clear when generic can't be used. I can't imagine having the pharmacy do the opposite, and like say "Actually, you need the name brand stuff," or to send it with issues like that. (Having said that, we have never used the mail medicine service because we don't have any recurring scripts, so all our medicine has been needed asap, like an antibiotic for strep, but I digress). I hope you can get this corrected so it doesn't happen again, and definitely contact your insurance company at the very least, if not the correct gov't agency. The gall of companies--and the people working there--to do something like that is astounding...so I hope it was just a weird error and it fixes itself!
Dalis we have been there with the asthma medicine! Darren's work has the medical and prescription insurance split, so we have a different company for each. We can get each prescription filled three times, but then we have to get it through the mail from the prescription company after that. I can think of two occasions where we could not get it filled at the pharmacy anymore but the prescription company did not mail on time. I was LIVID. Raileigh, like B, needs her asthma meds. One time, we got them to over-ride a pick up at the pharmacy but the other time we went a few days without. I hate feeling like I am at their mercy with something so important. However, since we have not had any new prescriptions lately it has been okay. We actually have a small stockpile of inhalers right now because they sent too frequently for a bit-- but better than having none! Our issues seem to come when we add new prescriptions and transition from pharmacy to mail order.
Desi, it drives up insane. She has about 8 inhalers here but they are all expired. She had been pretty controlled until this Fall where she is ALL OVER THE PLACE!
ugh. I'm so sorry you are going through all this. One thing @Dalis I remembered when you mentioned the expired inhalers ... my son had asthma but didn't need the inhalers all the time. I would make the pharmacist check the expiration dates of the meds before I bought them. If the expired less than 9 months from the time I was buying them, I asked them to go get me other ones. One of the drugs was about $50 and I (nicely) told them I wasn't going to spend that much for medicine that would expire before he barely used it.
My friend who is a nurse says the inhalers are good even after expiration .. I have them on an as needed basis as I have EIA I just threw out one that had lots of puffs left but it had expired a few months ago. I mentioned it to my friend and she told me they are still good for a whie after... anyway, glad you gt them to send. So sorry.
I thought so too, but she wasn't improving with the expired ones. I think they are expired over a year.
