Bill from prescription coverage

[HelpinMN]

What is the name of your state? AZ

Ok I quit my job as a manager at target on 9/1/07 I was under the impression that my coverage was in effect until 10/1. when my new coverage took effect. I went in on 9/16 and got a prescription I specifically asked the pharmacist to make sure my insurance covered it. He told me that if it went through my insurance was still good because if it wasn't they would reject it. (I know this was true because they had rejected a couple of drugs I had been prescribed in the past). Well fast forward 5 months and I get a bill from them telling me to pay them $175 for the drug. Is this something they can do after they authorized payment. If so what would someone do if they ok'ed payment for a drug that cost $500 and then denied coverage?

Edit: my other question was. What are my options, can I call them and say "screw you im not paying for your computer mistake", or can they force me to pay them?

 

[lya]

Your insurance company had not yet made the available to the pharmacy.

It is your responsibility to know when your insurance benefits expire.

You owe the bill; no doubt about it.

 

[HelpinMN]

re

I told the pharmacist specifically that I was not sure how long my benefits last and he said "we can just run it because if your coverage is expired it will just reject it". Is this something I should take up with the pharmacist. Because i think its ridiculous that I should have to pay this. If I had known my coverage was no good I would have just waited another week until my new coverage started.


The other thing that is fishy about it is that I called my old HR and she said my coverage ended the day I quit. well this was over 2 weeks later. The insurance company put my expiration date as the day before I made the purchase.

 

[ecmst12]

The pharmacist should not have told you that, obviously your benefits were cancelled retroactively to the day you quit (legal and probably required by the plan). The pharmacist should have known that was a possibility but his ignorance doesn't get you out of your bill. If your insurance doesn't pay, you are responsible. You should have asked HR on the day you left when your benefits would expire, so you would have known whether the medicine would be covered.

 

[lya]

The pharmacist should not have told you that, obviously your benefits were cancelled retroactively to the day you quit (legal and probably required by the plan). The pharmacist should have known that was a possibility but his ignorance doesn't get you out of your bill. If your insurance doesn't pay, you are responsible. You should have asked HR on the day you left when your benefits would expire, so you would have known whether the medicine would be covered.

re bold text: that's not true. It is common practice to "run" the information and if the insurance shows to be active, to process the prescription accordingly.

The pharmacy is not the "one" who updates the available insurance information; it isn't an option available to any pharmacy.

The pharmacist did know! The client, our OP, told the pharmacist there was a possibility of no insurance.

According to your methodology, the pharmacist should have made the poster pay the full amount. Chances favor the poster would then be on here seeking to benefit from having to wait for reimbursement when the pharmacy should have known his/her insurance was still in effect and you would be supporting the claim that the pharmacist should have known the insurance was indeed active and should have filed for insurance instead of charging the poster full price.

The point I am trying to make is this--pharmacies have no control over insurance information that is available to them. They have no method and no duty to review your insurance policy to see if your benefits ended when you stopped working or continued past that point. Pharmacies only have the information that shows up when they enter your insurance information into the system; that's it, nothing more.

THE PHARMACIST/PHARMACY DID ABSOLUTELY NOTHING WRONG.

 

[ecmst12]

The pharmacist implied that if the system said coverage was good, then there was no way for the insurance company to change things later. He really had no business commenting on whether or not OP had coverage and technically should have referred him back to his employer for coverage questions. What he should have said is, the system says that coverage is active, but that's not a guaranty of payment and you should check with your benefits dept if you're not sure. BUT his failure to mention the possibility of the system being wrong does NOT relieve OP of the bill or place any responsibility for the lack of coverage on the pharmacist. He didn't do anything wrong in running the script through and charging the copay; but I do think it was wrong of him to give OP false reassurance that everything would be fine if the computer approved the claim. A minor offense in the grand scheme though.

 

[lya]

You are being foolish in continuing to advocate that the pharmacist did anything other than check the status and proceed with filing the claim. With virtual 100% certainty, we know the pharmacist did not state or imply that if insurance did not pay, the prescription was free.

Everyone should know that filing insurance claims does not equal insurance benefits being paid.

Anyway, continuing to follow this thread is aggravating me, so.....I'll take a break.

 

[cbg]

I'm going to address this from the employer end.

It is simply not possible to always have the insurance information updated the minute someone leaves. At my last full time contract, I was the one in HR responsible for updating the information to the insurance company. Sometimes it was two weeks, or longer, after the employee's last day of work, before I was even notified that they were leaving. (This is true particularly if the employee quit with no notice and particularly if they were at a different location than I.) So even if I then dropped everything and immediately updated the insurance info to the insurance carrier (which would then take overnight to batch through, even though I did try to do that as often as possible, which wasn't always) that's a two week (or longer) window that the carrier would have incorrect information.

You ASSUMED that the coverage would last until 10-1. That was your big mistake. It was YOUR responsibility to find out when coverage would end. The pharmacist doesn't have to eat the bill because you didn't take the simple precaution of asking a question.

 

[ecmst12]

Some companies only send a batch to the insurance company once a month, too.