Joined my employer’s Cigna plan in Jan2021. Doctor prescribed a monthly shot for my 13 year old in February. It needed to go to Accredo Specialty Pharmacy instead of our prescription provider (ExpressScripts). Accredo rep phoned me to schedule delivery, confirmed my home address, and send injection kits/medicine. We take the kits to the doctor’s office to have them injected in March, April, and May.
By late Feb I see a claim that we owe $997, or 10% of the prescription cost, because it was billed as “medical” instead of “pharmacy” and hit brick wall after brick wall. Accredo suggested I have my doctor’s office confirm they performed the injections, and Accredo told them it doesn’t matter, I would have to work with Cigna to have Cigna authorize a change from medical to pharmacy.
What do I need to say to Cigna to get this recoding authorized?
Note: Just ordered a refill of same med and had it delivered to the doctor’s office, citing this billing issue to the Accredo rep as why, and she confirmed it would be billed at the $50 or whatever copay, not the 10% medical copay.
submitted by /u/sbitto
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Joined my employer’s Cigna plan in Jan2021. Doctor prescribed a monthly shot for my 13 year old in February. It needed to go to Accredo Specialty Pharmacy instead of our prescription provider (ExpressScripts). Accredo rep phoned me to schedule delivery, confirmed my home address, and send injection kits/medicine. We take the kits to the doctor’s office to have them injected in March, April, and May. By late Feb I see a claim that we owe $997, or 10% of the prescription cost, because it was billed as “medical” instead of “pharmacy” and hit brick wall after brick wall. Accredo suggested I have my doctor’s office confirm they performed the injections, and Accredo told them it doesn’t matter, I would have to work with Cigna to have Cigna authorize a change from medical to pharmacy. What do I need to say to Cigna to get this recoding authorized? Note: Just ordered a refill of same med and had it delivered to the doctor’s office, citing this billing issue to the Accredo rep as why, and she confirmed it would be billed at the $50 or whatever copay, not the 10% medical copay.
submitted by /u/sbitto [link] [comments]Read Morer/HealthInsurance