Health plan A paid for pharmacy claims for six months past when we were enrolled in the plan. They discovered this in an audit and sent us a letter with a list of charges to collect payment from us. They said we could get the pharmacy to reverse this and submit corrected billing or I could pay health plan A myself and submit the claims to the appropriate health plan. The letter is from Rawlings and apparently health plan A does this to people a lot which I don’t understand how they are getting away with making the end user go through all this trouble to correct their mistakes.
The local pharmacy is unable to go back that far in their system and this is what they told me when we first got this notice back in January. So they can’t reverse and resubmit those claims. I do not believe I should have to go through all this trouble when it was health plan A that made this mistake.
I have obtained a ROI from health plan A giving permission to speak to health plan B to coordinate these claims. I have told health plan B that I have given permission for the companies to coordinate amongst themselves. Health plan A has no right to make me do their admin work when it was their mistake to allow those claims to be processed, but how do I protect my rights and my credit report as I am forcing them to handle the nuisance of the situation themselves?
Also how do I protect myself from health plan B then charging me for some of these claims where health plan A’s preferred drugs were prescribed which are not health plan B’s preferred drugs? For example insulin is expensive whether it’s the preferred brand or not. I shouldn’t be responsible for paying the difference when health plan A processed those claims for several months and we were not given an opportunity in the moment to be informed by the pharmacy that the brand is not preferred by health plan B so we could get the doctor to write the alternative brand rx.
Also is this something that I can file a claim appeal about? Is there a governing authority that can help me fight them about them claiming I am financially responsible for their error? I did file a complaint with the state – Florida Dept of Financial Services Consumer Services division.
I have no problem with copays to cover these charges but I do not believe it is fair to be charged out of pocket cost or fair to be expected to go through all their legwork for them.
submitted by /u/Hrquestionbaby
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Health plan A paid for pharmacy claims for six months past when we were enrolled in the plan. They discovered this in an audit and sent us a letter with a list of charges to collect payment from us. They said we could get the pharmacy to reverse this and submit corrected billing or I could pay health plan A myself and submit the claims to the appropriate health plan. The letter is from Rawlings and apparently health plan A does this to people a lot which I don’t understand how they are getting away with making the end user go through all this trouble to correct their mistakes. The local pharmacy is unable to go back that far in their system and this is what they told me when we first got this notice back in January. So they can’t reverse and resubmit those claims. I do not believe I should have to go through all this trouble when it was health plan A that made this mistake. I have obtained a ROI from health plan A giving permission to speak to health plan B to coordinate these claims. I have told health plan B that I have given permission for the companies to coordinate amongst themselves. Health plan A has no right to make me do their admin work when it was their mistake to allow those claims to be processed, but how do I protect my rights and my credit report as I am forcing them to handle the nuisance of the situation themselves? Also how do I protect myself from health plan B then charging me for some of these claims where health plan A’s preferred drugs were prescribed which are not health plan B’s preferred drugs? For example insulin is expensive whether it’s the preferred brand or not. I shouldn’t be responsible for paying the difference when health plan A processed those claims for several months and we were not given an opportunity in the moment to be informed by the pharmacy that the brand is not preferred by health plan B so we could get the doctor to write the alternative brand rx. Also is this something that I can file a claim appeal about? Is there a governing authority that can help me fight them about them claiming I am financially responsible for their error? I did file a complaint with the state – Florida Dept of Financial Services Consumer Services division. I have no problem with copays to cover these charges but I do not believe it is fair to be charged out of pocket cost or fair to be expected to go through all their legwork for them.
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