Blue Cross are the ones really at fault here, but my pharmacy has me pretty upset also.
I called last week to get a refill on a special order medicine that I have to get from a mail order pharmacy. They called back a day later to tell me that they couldn’t fill it because their computers show that I have two active insurance plans.
Some background: A few years back, I worked for Blue Cross and was covered under their associates health plan. When I left employment there I kept it under Cobra and paid monthly for the policy. During that period I was self-employed. Eventually my Cobra eligibility ran out and I got a policy, again with Blue Cross, through the local Chamber of Commerce.
Over the years, my doctor’s office has several times told me that their computer showed two active plans. The first time, I told them which plan to use and contacted Blue Cross to have the old plan removed from their computers which they said they would do. This has happened several time over the years and each time I contacted Blue Cross, each time they said that they would remove it, and each time they’ve failed to do so.
I finally gave up, figuring that it wasn’t my problem. They’ve actually sent me a card once or twice and I shredded it.
So now my pharmacy won’t fill the prescription and I’m back to banging my head against the immovable wall that is Blue Cross.
I don’t know what the pharmacy’s problem is suddenly. They’ve filled the prescription for years and now suddenly they noticed the second policy?
I just talked to a nice gentlemen at Blue Cross and explained the situation in full and he said that it would be taken care of. I wish I could believe that.
Don’t ask me. I can’t figure it out and the pharmacy guy on the phone was distinctly unhelpful.
I had a couple of other prescriptions filled at my local pharmacy recently with no issue. I hope this isn’t something that will suddenly be an issue everywhere. Maybe it’s something in the new health care laws and it just went into effect.
Wow! Blue Cross called back to confirm that the old policy has been removed. I called the pharmacy, they checked, and the prescription will be delivered tomorrow.
If it’s like the situation my mother had to deal with recently, he may not have a choice. It’s either Medco mail order or pay full price at the local pharmacy.
I can’t switch pharmacies. My insurance requires that I use this pharmacy for this medication.
Fortunately for me, the pharmacy is Caremark which is associated with CVS, so I can have it shipped to my local CVS, which is fortunate because it’s packed in ice in a big thermos carton and I wouldn’t want it sitting on my front step all day.
Yes, lots of people have two health insurance policies (perhaps one from their own employer and the second from the spouse’s employer) but I think normally one is designated as the primary. Perhaps in this case, it’s not clear which was primary.
While BX is somewhat at fault here, your pharmacy is just being stupid. Next time anyone tells you that you have two accounts, tell them that your active one (whichever it is, use the name/number) is primary and if anything is left over you’ll pay and bill the secondary (which to you is the defunct BX plan). That should take care of that.
With all of the cost cutting that is going on everywhere these days, insurance companies seem to be hiring the dumbest, most willing to work for nothing people they can find. I’ve been amazed at the number of times I’ve had to explain simple things to UHC reps like an active plan is always primary to a retirement plan, and since my husband is showing as active in their computer and my secondary is Medicare, guess which one should be prime? GAH.
I told them which one was the valid account and that they should just ignore the other one. It didn’t help.
Getting this prescription refilled is like pulling teeth. “We can’t find a supplier”. “We need a new prescription because the only supplier we can find doesn’t provide it in the same amount”. “Oh, you have two plans so we refuse to fill it”. Every couple of refills I go through this shit. Sometimes it really isn’t their fault, but it’s a pain in the ass.
Sounds like your pharmacy is doing the same cost cutting that the insurance companies are. Or maybe it’s just CVS - I need to go down and talk to them about being overcharged $25 and I’ll be happy if I get someone who speaks English well enough that I can understand them…:smack:
It’s unlikely that the pharmacy is at fault. IME it’s always the insurance company that denies coverage, or reduces the amount of meds you can get. The pharmacy is just the agent. Without approval from the insurance company, they won’t fill the scrip.
