Insurance Covers Medication But Forced To Pay Cash?
(Newest replies first)

Yesterday, I had an appointment with a brand new doctor that is in another state. He wrote me a prescription for a month supply of my medication and after stopping at and calling approximately 35 different pharmacies attempting to get the medication filled, I was given the name of a pharmacy by a very kind gentleman that had experienced the same problem. The medication I take is unfortunately very hard to get a prescription filled for if your doctor is not within your state and I live basically on the border of two other states, MD and PA. I called the pharmacy I was given the name of and indeed they did agree to fill the prescription. I inquired about acceptance of my insurance before going to the pharmacy and they stated that yes they did accept insurance and they would run the medication through it and if it was accepted, he could bill the insurance. I already knew the insurance would cover the medication I've been on it for months.

After driving nearly THREE HOURS to this pharmacy I hand over my prescription and insurance. After a few minutes I returned to the pharmacy and was called to the counter by the pharmacist and at that time he informed me he had the prescription filled but he was not going to bill my insurance for it and I would have to pay a whopping $365.00 CASH for my medication! I questioned this. He said yes, we do accept the insurance and your insurance does cover the medication and your copay is $1.20 but I am not going to run the prescription through your insurance because we lose too much money that way. It is a LEADER pharmacy, which is a nationally known name. Is it even LEGAL for a pharmacy to refuse to accept your insurance for a specific medication because they lose money, although they have agreed to accept the insurance and accept it for every other medication EXCEPT the medication that keeps me alive and functioning? Basically the pharmacist knew that he was not going to bill the insurance before I went to the pharmacy unless my insurance copay was more expensive than the out of pocket cost. I am disabled and I live on a minuscule amount of money each month as it is and I have to pay $250 every month out of pocket for my doctor and $365 yesterday for my medication (WHEN MY COPAY IS ONLY $1.20) on top of that left me in a position where I'm not going to be eating this month and the medication is necessary. What do I do about this, who do I contact?

REPLY

REPORT

What??? This is not legal at all. There is something very wrong here.

REPLY

Was this helpful? 0

I'd like to know the name of the pharmacy and pharmacist. He needs some attention by the state's Pharmacy Board and, more effectively, the state Attorney General. Most people don't know that you are better off filing against a doctor or pharmacist through the State Attorney General. All the Pharmacy and Medical Boards are interested in is collecting their fees. Unless the pharmacist or doctor is killing people, they really don't want to be bothered.

Better yet, there is a thing called "Continual Harrassment". It is very legal very satisfying. You need to read up on the many ways you can harass the pharmacist.

That is all I can write about it. Like I said, unless they are killing people AND you have positive proof, forget about the useless Medical or Pharmacy Board. They and the doctors and pharmasicts are best friends.

REPLY

Was this helpful? 0

Usually if you send a copy of the bill to the insurance company they will re-imburse you. At least that's how my insurance handles situations like yours. Good luck.....

REPLY

Was this helpful? 1

ToAV304: I have not had this particular problem but if this happened to me I'd be on the phone with LEADER CORP OFC and ask for a manager immediately!!! You would be surprised how fast U get your meds mailed to you at the $1.20 price w/ an apology. This will happen after U tell this person U intend to POST this experience WITH their NAME on Facebook, Twitter, Pinterest etc and I bet U will get action. I have done this over hostile employees at Walgreens Pharmacy. U go gal!!!

REPLY

Was this helpful? 0

Re: Isabella (# 3)

I have to take thyroid meds every day. I take it as soon as I wake in the am, along with my multi and potassium and magnesium citrate. After three hours - I can take my calcium and all other food necessary supplements - after I eat food. Never take calcium with your thyroid med. Never take soy - at all - it so messes with your thyroid/iodine level. I used to take 150 mg for hypothyroidism. Now I take 135mg. Look at when to take the other meds you need - according to how to take it. Pretty straight forward. You'll find a schedule. It will work.

REPLY

Was this helpful? 1

I take several meds in the morning, including Levothyroxine (.88mcg 5 days per week). I know I need to take it an hour before eating, and three hours after food. I've been taking it in the morning because it is just easier, I wait an hour before I have breakfast. I take two other meds in the morning (Felodipine and Hydrocodone), I am concerned about the efficacy of the Levothyroxine when I take other drugs with it. Is it okay to take it at night, since I don't eat too late in the evening or during the night. Will it still be effective?

REPLY

Was this helpful? 0

I'm on some unusual drugs but my pharmacy will order it for me. I use the same pharmacy every month. They can get it from their supplier in a day or two. I would contact the national office of the pharmacy and complain! I would also contact your insurance and tell them what's going on. Especially since it's a well known, national pharmacy, they can contact them and put pressure on them. How would it be if their pharmacy (all of them) was off the list of pharmacies that your insurance allowed? They'd lose quite a bit of money. The pharmacy is making money-- maybe not a huge amount, but they entered into an agreement with your insurance company.

REPLY

Was this helpful? 1

Look elsewhere in the World. You will find what you need out there. Be always looking to solve your problems yourself. Be well on your journey. You will find what you need. Out there. Beyond the gates of bloated over-regulations.

REPLY

Was this helpful? 1

I was laid off from my job after 18 years!!! I have been taking OxyContin 60 for over 5 years now for chronic pain. I ha...

27 REPLIES

I live in PA. Tomorrow i go to the Dr. to get my Xanax prescription. It's technically too early if my insurance cove...

4 REPLIES

if it is dangerous to completely stop taking 2mg of coversyl because of side effects.it is my first time ever to take hi...

2 REPLIES

I am an addict who has successfully utilized Suboxone & Subutex as a means to keep a handle on my addiction. Medicar...

4 REPLIES

Hi all! I had Florida blue health insurance and they inadvertently dropped me yesterday. I turned 26 in June but my mom ...

13 REPLIES

I. need a pain dr that will prescribe pain medication without insurance. I had been going to a pain dr for 6 years becau...

5 REPLIES

I have a weak bladder and as a result have bladder urgency recently started coversyl plus and was wondering if contribut...

1 REPLY

hi my name is eric i just lost my job and insurance wat help can i get to pay for a pain doctor or is there any govermen...

5 REPLIES

trying to get a comprehensive list of Ins. companies that cover Opium tincture (so far Cigna does). ## i live in los ang...

3 REPLIES

Please help me find a subutex Dr. That accepts tenncare medicare for office payment. ## im lookinmg for a subutex dr in ...

9 REPLIES