Insurance co is screwing me on a technicality!!!!

Hello,
I need advice on how to deal with an insurance issue.

I am supposed to be covered for 3 cycles of fertility medication under the PICA plan for NYC employees.

I am on my third cycle and now the insurance company is saying that I already used my 3 cycles (but I only used 2). So, I called them and they told me that the pharmacy in the first cycle put 2 different claims in on the same day (within 1 minute of each other) for the same med (follistim) and THEY ARE COUNTING THAT AS THE 2 CYCLES!!!!!

Meanwhile, there was only one prescription. So, they are telling me that basically the pharmacy screwed up and should have only put 1 claim in because they made a mistake. They are saying the only way to resolve it is to call Rockville Centre Pharmacy and ask for them to reverse the 2 claims and put it through as 1.

Are they even legally allowed to put through 2 claims on 1 script? Technically, they screwed me out of an extra copay.

Do you think it was just an error and they will do the right thing? From what I remember, the pharmacist at Rockville Centre was so nice.

Any advice??

Re: Insurance co is screwing me on a technicality!!!!

i don't know much about claims, but i would call rockville centre asap. they were really nice when i dealt with them. it could just be a stupid mistake.

good luck!!

Re: Insurance co is screwing me on a technicality!!!!

Thanks, I am going to do that.

I also go to Dr. Brenner. Do you think if Rockville Centre refuses to help, someone at the practice would call and explain that there was only one prescription and that there should only be one claim? Do they get involved with these types of issues? I know the practice sends a lot of business to that pharmacy.

Re: Insurance co is screwing me on a technicality!!!!

The RVC Pharmacist met me at 10pm in a Starbucks parking lot on a rainy night in Jericho to give me the HCG that I had to take that night and didn't have.

So.....I think they will do whatever you need. Good luck!

Re: Insurance co is screwing me on a technicality!!!!

I hope you are right!!!! I got that impression, too, but I have been getting screwed left and right, so it is hard to be positive.

Re: Insurance co is screwing me on a technicality!!!!

I would definitely call the pharmacy. They will see they put through 2 claims by mistake, I'm sure they have to keep the actual prescription on file for a certain amount of time.

Good luck to you!!!

Re: Insurance co is screwing me on a technicality!!!!

call the pharmacy. Insurance wqorks that way unfortunatly. The pharmacy will fix it. Speak to a manager, but make sure it gets fixed ASAP. Claim adjustments at insurance take time...so Make sur eyou get who at the pharmacy is calling to fix it...and then call the insurance and get the name of a person and tell them you want them to CALL you when its done, so you cant bug them if its not.

I work in insurance, if you need help with this, please FM me.

Re: Insurance co is screwing me on a technicality!!!!

Thanks!!!


Rockville Pharmacy is the BEST!!!!

It turns out that they did not screw up after all. I needed a total of 1500 follistim, so my dr. prescribed 2 600 ius packages and 1 300 iu. Since they were different dosage amounts, the pharmacy had to put it through as 2 claims and the insurance company is counting the number of claims NOT cycles (which is dead wrong according to how the benefits are laid out). Anyway, Rockville Centre reversed the claim on the 300 ius and paid $74 out of pocket. She was able to electronically reverse it, So, now my insurance co. is recognizing that I only used up only 2--so if they put it through again, it should be approved.