Pharmacy problems

[Kooks and Bay Bay]

Nope. I specifically told my doc's office I needed a pre auth BEFORE they ran a specialty blood test. Told them during the blood draw - and again after. Tried to do the pre auth myself and my insurer rejected me: has to come from doc's office. Doc's office sent blood draw out to specialty lab for processing. (I even emailed the lab and said to "HOLD until preauth is received from insurance"!)

Reminds me of a surgery I had a few months ago.
My doctor discussed that they would need to get approval from the insurance company so I would be called to schedule after they got it.
2 days later I was called and put on the schedule for about 6 weeks later.
3 days after I had the surgery I got a letter from my insurance company saying they needed xyz info before they would approve the surgery.
Well its a bit too late for that lol.
The doctor's office did take care of it but jeez the failure in communication is shocking and we are left in the middle.

 

[Mackenzie Click-Mickelson]

Old insurance wouldn’t cover the newest iteration as it was expensive.

Did the name brand change their formula?

I had to try three rounds of the generic. Relief now takes 45-60 minutes instead of 15.

Generic is required to be the same.

Way back when (before birth control was covered) I was on ortho-tri cyclen which cost $30 per month back then, eventually we got me on the generic which was $30 for a 90 month supply but it was the generic of orthocyclen (mononessa) not of the tri version (trinessa). Although I adjusted just fine you may want to double check that you're actually comparing the generic version of the older iteration of your migraine medicine.

New insurance said it won’t even cover the generic.

Kicker is, they actually do seem to cover the generic!

So your new insurance would or wouldn't cover the generic version? Would they cover the generic of the old iteration but not the new one?

 

[Cannot_Wait_4Disney]

We got a $1500 bill for out of network. Should be a $50 charge. But you know how it is, they bill for 1500, the insurance says uh uh, that's a $300 item of which the customer pays $60. But the doctor's name isn't anyone I saw, nor is that name even listed where I went for my scan which is totally in network. We're "appealing" Yeah that's the way they worded it. The way I worded it is I'm not paying an out of network charge for a doctor I can't even verify exists or is licensed to even practice in this state. Either someone got a name wrong, or someone has some splainin to do. So if this appeal fails, I'd better see this guy, and his license, at this location BEFORE I pay that bill. Well you agreed. Um no. I didn't agree to pay someone that doesn't exist. It is most likely someone got the name wrong.

 

[VandVsmama]

Nope. I specifically told my doc's office I needed a pre auth BEFORE they ran a specialty blood test. Told them during the blood draw - and again after. Tried to do the pre auth myself and my insurer rejected me: has to come from doc's office. Doc's office sent blood draw out to specialty lab for processing. (I even emailed the lab and said to "HOLD until preauth is received from insurance"!)

1. Lab replied to my email 1 week later- "sorry - we already ran your test last week." Then a couple of weeks later, wrote me to say "your insurance company never responded to us".
2. Insurance rejected payment because they said a preauth was never done.
3. Tried calling insurer, doc's office and lab. Got nowhere. Doc's office insists they sent any needed info. Insurance claimed they didn't. Lab says they're not responsible and just ran the tests that were requested by doctor.

This was not a cheap test. It's maddening - there's really nothing I can do except pay the bill. I'm just too tired to waste any more time on this.

I've run into this sort of nonsense before. With one doctor's office, it was maddening enough that I switched to a different medical provider because the doctor's billing mess ups resulted in me having to spend over $1000 on labwork instead of about $100.

 

[SteveH]

We've had very few issues with Costco's Pharmacy. When they've run out of some meds like others have they've worked with my wife to transfer the prescription.

 

[lanejudy]

We got a $1500 bill for out of network. Should be a $50 charge. But you know how it is, they bill for 1500, the insurance says uh uh, that's a $300 item of which the customer pays $60. But the doctor's name isn't anyone I saw, nor is that name even listed where I went for my scan which is totally in network. We're "appealing" Yeah that's the way they worded it. The way I worded it is I'm not paying an out of network charge for a doctor I can't even verify exists or is licensed to even practice in this state. Either someone got a name wrong, or someone has some splainin to do. So if this appeal fails, I'd better see this guy, and his license, at this location BEFORE I pay that bill. Well you agreed. Um no. I didn't agree to pay someone that doesn't exist. It is most likely someone got the name wrong.

That sounds like a contracted radiologist. Many hospitals use them now. Supposedly you can't be charged as "out of network" if you went to an in-network facility to have the scan done - so fight that through your insurance because you have no choice but to use whatever radiologist the in-network facility contracts. But no, in most cases you won't physically "see" the radiologist who reviews whatever scans/pictures were done. That report goes to your doctor, but you should also get a copy (usually through your portal).

 

[Cannot_Wait_4Disney]

That sounds like a contracted radiologist. Many hospitals use them now. Supposedly you can't be charged as "out of network" if you went to an in-network facility to have the scan done - so fight that through your insurance because you have no choice but to use whatever radiologist the in-network facility contracts. But no, in most cases you won't physically "see" the radiologist who reviews whatever scans/pictures were done. That report goes to your doctor, but you should also get a copy (usually through your portal).

The person listed doesn't even show up as having a license in my state at any level. I'm not making any accusations here. I think the wrong name was listed and that's the problem. Fingers crossed.

 

[tvguy]

Interesting how health insurance has changed since the late 1980's and early 1990's. Prescriptions weren't covered at all, that was all on you. Doctor's visits the same. It only covered hospitalization. My wife was pregnant with our first child in 1986 when we got our first HMO. $10 co-pay for the Doctor, but still no prescription coverage until 1992.

 

[RedAngie]

I just ran into the same issue. Last week my doctor prescribed a new to me medication and sent it and refills for other meds electronically to my pharmacy. When i went to pick them up on Saturday, the tech said the new med “needs prior authorization to say it’s medically necessary.”

Supposedly the cash price is about $1500 for a 90 day supply.

I’m supposed to call my doctor and have the office either submit paperwork or prescribe a cheaper alternative.

Lokelma-for high potassium. No generic available.

 

[lanejudy]

The person listed doesn't even show up as having a license in my state at any level. I'm not making any accusations here. I think the wrong name was listed and that's the problem. Fingers crossed.

Could be an error. Just sharing what I know because you mentioned it was a “scan” made me think radiology. My local hospital uses an out of state radiologist; radiology techs are obviously local to take the pics but it’s all electronic and sent for final review to an out of state radiologist.

 

[Scotgirl]

Reading these threads make me realise just how grateful I am to have our NHS. It might be a bit broken but at least when I get a prescription I can just go to the pharmacy and collect the medication. Our pharmacy will even collect the prescriptions from the Doctor's surgery for us. And because we're in Scotland we don't have to pay for prescriptions.