Copay Quandry

leslieinbham · 01-10-2008, 06:20 AM

Good a.m. Have lurked for awhile, but this is my maiden voyage into the forums.

Here's my question:

If I submitted a prescription to a pharmacy that had my up-to-date insurance info and THEY submitted it to an insurance I no longer have BUT that old insurance didn't blink and paid for it, who is responsible?
I didn't even know about the problem until I got a friendly "oops" letter from old insurance asking me to make this right. Remember, pharmacy had up to date info--nothing was withheld and then the old insurance covered it without even slowing down the pharmacy computer or requesting more info from me (standing right there w/migraine wanting to tap foot, but not willing to face resulting foot-tap pain). Seems to me that it is not my error or omission. I don't have the $$$$ to pay full amount for migraine meds (which is what the erring insurance wants) but I paid my end (copay) at the point of purchase.

I have a gut feeling that the old insurance is just giving it a shot, but I want to be sure.

Regards,
leslie

Michelle Dawn · 01-10-2008, 09:36 AM

Sorry, I don't have a clue. But welcome to the forums and good luck!

Mal Reynolds · 01-10-2008, 05:29 PM

Is there any way to get your current insurance company to pay for it? It seems like your pharmacy is the most responsible and they should help you sort this out.

Julie Rains · 01-10-2008, 06:02 PM

I would get the pharmacy to help you straighten this out; they did make the error but things are complicated b/c the old insurance company should be getting money back -- though I am unsure of the exact sequence of transactions. It would be nice if your new insurance company could cut you a check and then you could pay the old insurance company back (you might want to alert them to what happened and ask them to delay further billing for a while). The pharmacy could/should also update their records but it does explain why medical providers ask to see insurance cards so often.

Jon · 01-11-2008, 09:57 AM

I would have to say this is one for the pharmacy to be involved in at the least. You've done nothing wrong here, though the pharmacy and the old insurance company did so to your benefit. I'd get together with the pharmacy manager, explain the whole thing and ask them to refund the old insurance company and submit the claim to the new one. Inform the old insurance company that you've contacted the pharmacy and they're the ones who billed you in error, suggest they work with them to correct it. Under no circumstances would I agree to any out of pocket expenses in a situation like this.

farley2k · 01-11-2008, 10:55 AM

Quote:

Originally Posted by Jon

I would have to say this is one for the pharmacy to be involved in at the least. You've done nothing wrong here, though the pharmacy and the old insurance company did so to your benefit. I'd get together with the pharmacy manager, explain the whole thing and ask them to refund the old insurance company and submit the claim to the new one. Inform the old insurance company that you've contacted the pharmacy and they're the ones who billed you in error, suggest they work with them to correct it. Under no circumstances would I agree to any out of pocket expenses in a situation like this.

This seems like the most sensible plan.

purplefdu · 01-13-2008, 04:52 PM

I would have to say having the new company pay the old one is the simplest thing, kind of like when car insurance companies pay each other off. Having the pharmacy manager figure out why the wrong company was billed is important to keep it from happeneing again. They can then send the information to both companies showing the charges, etc so the insurances can deal with it amongst themselves.

Ronni · 01-13-2008, 06:47 PM

Quote:

Originally Posted by Jon

Under no circumstances would I agree to any out of pocket expenses in a situation like this.

Amen. Do not let them bully you into paying that money. It was out of your control.

Megan · 01-14-2008, 11:32 AM

This happened to me and I took it up with my pharmacy. I was working with a small, family owned pharmacy, rather than a big name chain, so that may have some bearing on my results, but they took care of the problem for me, as it was their error.

I do remember them saying something that there is a law that if they submit to the insurance company and the insurance company responds that they will pay, they are on the hook and can't take that back, even if it was in error. I realize that is vague, but it was a few years ago. Might be something you want to look into, however.

01-10-2008, 06:20 AM	#1
leslieinbham Junior Member Join Date: Jan 2008 Posts: 23 Thanks: 0 Thanked 0 Times in 0 Posts Reputation: (11)	Copay Quandry Good a.m. Have lurked for awhile, but this is my maiden voyage into the forums. Here's my question: If I submitted a prescription to a pharmacy that had my up-to-date insurance info and THEY submitted it to an insurance I no longer have BUT that old insurance didn't blink and paid for it, who is responsible? I didn't even know about the problem until I got a friendly "oops" letter from old insurance asking me to make this right. Remember, pharmacy had up to date info--nothing was withheld and then the old insurance covered it without even slowing down the pharmacy computer or requesting more info from me (standing right there w/migraine wanting to tap foot, but not willing to face resulting foot-tap pain). Seems to me that it is not my error or omission. I don't have the $$$$ to pay full amount for migraine meds (which is what the erring insurance wants) but I paid my end (copay) at the point of purchase. I have a gut feeling that the old insurance is just giving it a shot, but I want to be sure. Regards, leslie

01-10-2008, 09:36 AM	#2
Michelle Dawn Member Join Date: Jan 2008 Location: C-Town, PEI, Canada Posts: 68 Thanks: 0 Thanked 0 Times in 0 Posts Reputation: (10)	Sorry, I don't have a clue. But welcome to the forums and good luck! __________________ Meet me at FRUGAL PARENTING "A wise man should have money in his head, but not in his heart" (Jonathan Swift)

01-13-2008, 04:52 PM	#7
purplefdu Senior Member Join Date: Jan 2008 Location: Berwick, ME Posts: 645 Thanks: 0 Thanked 4 Times in 4 Posts Reputation: (32)	I would have to say having the new company pay the old one is the simplest thing, kind of like when car insurance companies pay each other off. Having the pharmacy manager figure out why the wrong company was billed is important to keep it from happeneing again. They can then send the information to both companies showing the charges, etc so the insurances can deal with it amongst themselves. __________________ MainelyCoupons \| HomeWard Bound Puppy

01-14-2008, 11:32 AM	#9
Megan Senior Member Join Date: Dec 2007 Posts: 319 Thanks: 0 Thanked 1 Time in 1 Post Reputation: (64)	This happened to me and I took it up with my pharmacy. I was working with a small, family owned pharmacy, rather than a big name chain, so that may have some bearing on my results, but they took care of the problem for me, as it was their error. I do remember them saying something that there is a law that if they submit to the insurance company and the insurance company responds that they will pay, they are on the hook and can't take that back, even if it was in error. I realize that is vague, but it was a few years ago. Might be something you want to look into, however. __________________ Counting My Pennies

Thread Tools
Show Printable Version Email this Page
Display Modes
Linear Mode Switch to Hybrid Mode Switch to Threaded Mode

01-10-2008, 05:29 PM	#3
Mal Reynolds Junior Member Join Date: Jan 2008 Posts: 16 Thanks: 0 Thanked 0 Times in 0 Posts Reputation: (10)	Is there any way to get your current insurance company to pay for it? It seems like your pharmacy is the most responsible and they should help you sort this out.

01-10-2008, 06:02 PM	#4
Julie Rains Wise Bread Blogger Join Date: May 2007 Location: North Carolina Posts: 406 Thanks: 1 Thanked 0 Times in 0 Posts Reputation: (197)	I would get the pharmacy to help you straighten this out; they did make the error but things are complicated b/c the old insurance company should be getting money back -- though I am unsure of the exact sequence of transactions. It would be nice if your new insurance company could cut you a check and then you could pay the old insurance company back (you might want to alert them to what happened and ask them to delay further billing for a while). The pharmacy could/should also update their records but it does explain why medical providers ask to see insurance cards so often.

01-11-2008, 09:57 AM	#5
Jon Junior Member Join Date: Jan 2008 Location: Philly suburbs Posts: 3 Thanks: 0 Thanked 0 Times in 0 Posts Reputation: (10)	I would have to say this is one for the pharmacy to be involved in at the least. You've done nothing wrong here, though the pharmacy and the old insurance company did so to your benefit. I'd get together with the pharmacy manager, explain the whole thing and ask them to refund the old insurance company and submit the claim to the new one. Inform the old insurance company that you've contacted the pharmacy and they're the ones who billed you in error, suggest they work with them to correct it. Under no circumstances would I agree to any out of pocket expenses in a situation like this.