I have a $1500 deductible health insurance plan (new as of Feb 2021) and pay about $300/month out of pocket in prescriptions. For one of those prescriptions, I have a savings card (basically a $15 off coupon) that brings it down to $275/month. It’s for ADHD, so it’s a controlled substance. I see my dr every 3 months about it, and I’ve been taking it for 11 years. Today I checked my deductible and found out that only $150 has been applied towards it. I called my insurance company, and they said they are waiting on prior authorization and the pharmacy should have requested it the first time it was filled, back in February.
I called my pharmacy. At first she said that they didn’t have updated insurance information, and I told them that they definitely did bc they were running other prescriptions and my Covid vaccine through it with no issue. Then she tells me no one in the pharmacy reached out to the dr for prior authorization and instead, were running my little coupon card like it was insurance. They never told me it wasn’t being covered under insurance or that they were waiting on anything; otherwise I never would have gotten it filled. Long story short, they have not been applying almost $1500 worth of funds towards my deductible because of their error.
Do I have any recourse here? Can the pharmacy apply the money I’ve already spent towards my deductible or am I out of luck?
submitted by /u/dadadawn
[link] [comments]
I have a $1500 deductible health insurance plan (new as of Feb 2021) and pay about $300/month out of pocket in prescriptions. For one of those prescriptions, I have a savings card (basically a $15 off coupon) that brings it down to $275/month. It’s for ADHD, so it’s a controlled substance. I see my dr every 3 months about it, and I’ve been taking it for 11 years. Today I checked my deductible and found out that only $150 has been applied towards it. I called my insurance company, and they said they are waiting on prior authorization and the pharmacy should have requested it the first time it was filled, back in February. I called my pharmacy. At first she said that they didn’t have updated insurance information, and I told them that they definitely did bc they were running other prescriptions and my Covid vaccine through it with no issue. Then she tells me no one in the pharmacy reached out to the dr for prior authorization and instead, were running my little coupon card like it was insurance. They never told me it wasn’t being covered under insurance or that they were waiting on anything; otherwise I never would have gotten it filled. Long story short, they have not been applying almost $1500 worth of funds towards my deductible because of their error. Do I have any recourse here? Can the pharmacy apply the money I’ve already spent towards my deductible or am I out of luck?
submitted by /u/dadadawn [link] [comments]Read Morer/HealthInsurance