One of my medications is on my insurance’s formulary and according to customer support, it is covered. However, my doctor has had to rewrite the script 3 times and each time they give me a slightly different reason as to why my claim was denied when I call and ask. The first time, they said the med requires prior authorization, so I called my doctor and she re-did the script. The second time, they said the script was written for the wrong quantity- I was trying to fill for a 30 day and it was written for 90 pills- so they said it be rewritten again. At this point my doctor said that it was written for a quantity of 90, for 3 times a day- which is a 30 day supply. I tried to explain this to them but they said they would only cover 30 in a month with prior authorization- OR 9 a month without it. The script was sent a third time and they claimed it didn’t have prior authorization AND it was written for the wrong amount. This is a lie because my secondary insurance (which I no longer have) filled the script no problem for 30 pills. The customer support rep I spoke with this time claimed that the prior authorization would allow me to fill a full 30-day supply (90 pills) and that the last rep was incorrect. I’m getting so much inconsistent information about what the problem is and how to solve it that it’s as good as getting no information at all!!
When I ask for written information about why it isn’t covered they dodge my questions or straight out refuse. At this point I’m considering threatening legal action because every ‘solution’ they recommend they turn around and claim that it was done wrong by my prescribing doctor. However I cannot see the back end requests/ prescription process to prove they are lying. I only hear their verbal instructions and claims.
Is there a way for me to formally request access to this information? If not, any advice on how to notate encounters with my insurance company and information to document during encounters would be helpful if I have to escalate this. As I cannot go without this medication and it costs ~500 a month out of pocket.
submitted by /u/annirosec
[link] [comments]One of my medications is on my insurance’s formulary and according to customer support, it is covered. However, my doctor has had to rewrite the script 3 times and each time they give me a slightly different reason as to why my claim was denied when I call and ask. The first time, they said the med requires prior authorization, so I called my doctor and she re-did the script. The second time, they said the script was written for the wrong quantity- I was trying to fill for a 30 day and it was written for 90 pills- so they said it be rewritten again. At this point my doctor said that it was written for a quantity of 90, for 3 times a day- which is a 30 day supply. I tried to explain this to them but they said they would only cover 30 in a month with prior authorization- OR 9 a month without it. The script was sent a third time and they claimed it didn’t have prior authorization AND it was written for the wrong amount. This is a lie because my secondary insurance (which I no longer have) filled the script no problem for 30 pills. The customer support rep I spoke with this time claimed that the prior authorization would allow me to fill a full 30-day supply (90 pills) and that the last rep was incorrect. I’m getting so much inconsistent information about what the problem is and how to solve it that it’s as good as getting no information at all!! When I ask for written information about why it isn’t covered they dodge my questions or straight out refuse. At this point I’m considering threatening legal action because every ‘solution’ they recommend they turn around and claim that it was done wrong by my prescribing doctor. However I cannot see the back end requests/ prescription process to prove they are lying. I only hear their verbal instructions and claims. Is there a way for me to formally request access to this information? If not, any advice on how to notate encounters with my insurance company and information to document during encounters would be helpful if I have to escalate this. As I cannot go without this medication and it costs ~500 a month out of pocket. submitted by /u/annirosec [link] [comments]Read Morer/HealthInsurance