Pharmacy problems

[CFHockeyMom]

Ok, this is a little complicated but I'll try and keep it simple.

We live in Michigan and unti this year received Children's Special Health Care (like Medicaid) to help offset the cost of Sean's medical expenses. Basically, everything was billed through my or my husband's health insurance and whatever they didn't pay for CSHC picked up after we met the deductible. The deductible is determined on income and need so our is pretty high and we were on a monthly payment plan to pay the deductible. Anyway, once a year the state does an audit of everyone's account and we got a bill. There was a shortfall in our deductible versus what was actually paid out by the state. This is usually the case and it's not odd for us to owe them $1000 or so. Well, I was shocked to find that we owed them over $3000 for 2003. Sean wasn't hospitalized and our medical bills were pretty low that year so I asked for an itemized statement detailing everything that the state paid for. Come to find out, our pharmacy, which changed mid 2003, screwed up and was billing the state directly as our primary insurance instead of as our secondary. So the state paid for all of Sean's Rx's and none were billed to our insurance companies.

I contacted our pharmacy but of course since the Rx's were from 2+ years ago they can't help with any rebilling or reimbursing the state nor were they able/willing to give me any contact information at the corporate level. After some work I was able to contact their corporate offices and they've agreed to look into it.

I know this is going to be an uphill battle. Not to mention this is only for 2003, I still have to deal with 2004!

I just can't believe that pharmacies don't regularly provide you with any billing information like who paid for your Rx. It should be on the receipt. It makes me wonder how often/many times they bill the wrong party. You can bet I'm going to be asking a lot of questions every time I pick up an Rx from now on.

Has anyone else had to chase pharmacies or Dr's for incorrect billings that are 2+ years old?

 

[julie]

By LAW they errored in not billing your primary insurance first so it is their resposibility to rebill your primary, and then they will probably owe a refund to the state. You will HAVE TO be pushey, demand paperwork of everything, find out who was the manager of the pharmacy at the time, find out who did the billing (employees enter the billing infomration with a user code or must be logged in) there IS record of who errored.

And like you said from now on, I would get a weekly or monthly print out from the pharmacy of what they billed. Since I can imagine that your state, much like many others, doesn't send monthly activities of their insurance payments. IT would behoove all state programs to have an online viewing option instead of sending out bills/EOB's (which I see have the huge ability to add up!), that way you could view your charges every month/what they paid and match it to your primary. THey make things so difficult sometimes.

Let me know if you need help, I love this kind of stuff.

 

[anonymous]

CFHockeyMom

The same thing happened with our pharmacy. We live in Ohio so our ins. was primary and BCMH was secondary, well in 2003 the pharmacy billed BCMH as primary and they paid. We were contacted by the state and asked to get copies of all of Kaits meds and send them to the Ins. co. , well my husband isn't employed by the same company and i did as the state asked, well the ins. co never responded to me or the state and i have not heard anything else about the matter but you would think that after going to the same pharmacy for 9 yrs that they would know what they are doing. The bill was HUGH!!!!!

Kaitsmom<img src="i/expressions/rose.gif" border="0">

 

[CFHockeyMom]

Yeah, I suspect this is pretty common when people have some form of private insurance and medicaid. The solution seems so simple - list on the reciept who paid what - but the pharmacies just don't do it. I think I'm going to give our pharmacy, which incidentally is a large chain and should know better, time to "fix" this. When they don't I'm going to be contacting our local media about this.

What's sad is that our state funded health care programs are struggling/making cuts and in fact, as of this year, for us and hundreds of other families, the program is not longer worthwhile/feasible. I just wonder how much state money could be saved by proper billing?!

I'll keep you posted.

 

[anonymous]

I use Walgreens, and they always give you a prescription receipt stapled to the bag (it looks like the sticker they put on the medicine with your name, drug and dosage...) - at the very bottom of this, they list in abbrev. what insurance they billed.

So far I haven't had billing problems with them - just medication problems (wrong dosage, wrong quantity, giving me too large a bottle of refrig. meds that will expire before I can use them all...). It is my first experience with a chain pharmacy, and I am not impressed. I question everything and always look everything over.

--Wallflower

 

[CFHockeyMom]

Well, I just got off the phone with my contact from CVS and according to her there is nothing they can do for me. It seems they can no longer bill my insurance company because the claims are too old. I explained to her that there is no reason for CVS to bill my insurance company because CVS has already been paid by the state for the Rx's. Of course in the minds of CVS this is the exact reason why they cannot help me even though they are clearly responsible for the error, which BTW, they have admitted. So it seems that accountability is not a term they're familar with. I got the name of the next person up the chain and will continue to pursue this with CVS but in the meantime, I've contacted my insurance company and they've agreed to help me out by allowing me to submit the claims. <img src="i/expressions/face-icon-small-shocked.gif" border="0"> It's still a piss off though that I (and my insurance company) have to go to all this trouble because of someone elses mistake.

Needless to say, I'm no longer a customer of CVS! I wish we could use the CF Pharmacy. My insurance company no longer has them on their approved list.

 

[lflatford]

We have had mail-order pharmacy issues lately as well. You want to know what I think??? They don't care one bit whether they do things right when it comes to customer service because the only thing they want is MONEY and as much of it as possible. Why should they care where it comes from? One of the biggest industries in the country and it is so DARN CROOKED!!!

 

[CFHockeyMom]

<blockquote>Quote<br><hr>They don't care one bit whether they do things right when it comes to customer service because the only thing they want is MONEY and as much of it as possible. Why should they care where it comes from? One of the biggest industries in the country and it is so DARN CROOKED!!! <hr></blockquote>

I think you might be right. <img src="i/expressions/face-icon-small-sad.gif" border="0">

I've contacted my local media just to try and expose these jerks!<img src="i/expressions/face-icon-small-mad.gif" border="0">

 

[JazzysMom]

I would report it to the fraud department of your medicaid office. The fact that your insurance wasnt billed & now its too old is not your fault. They like all providers know that all insurances need to be exhausted before billing Medicaid. Medicaid even wants workers comp, no fault, home owners & any liability insurance to pay if possible. Medicaid is a "last resort" payment so to speak. I remember working at our local hospital and when we verified the Medicaid coverage on people, many times it would show insurances including income policies that had to be billed before they would pay. Not something new here!

 

[anonymous]

CFHockeyMom

How funny!!!! CVS is the same pharmacy that made the same mistake with the billing of Kaits meds!!!!!! Maybe i should change our pharmacy as well!!!!

Kaitsmom<img src="i/expressions/rose.gif" border="0">

 

[CFHockeyMom]

Well, as Julie and Melissa stated, CVS shouldn't have been billing Medicaid as our primary insurance when we had private insurance. I talked with some folks at Medicaid today and they were very helpful. In fact they mentioned that they have the ability to actually take money back from CVS. The woman I spoke with on the phone was going to look into that for me. I'm keeping my fingers crossed.

Thanks for the help.

 

[julie]

That is correct, they can do a few things. #1. they can demand a 100% refund from the pharmacy and make them bill your primary-which will be difficult because your claims are over 2 years old now but there are exceptions to every regulation. or #2, they can demand a refund based on what they calculate they should have paid after your primary paid, and request the difference based off of what they already paid. It sees like everyone is willing to work with you (except the freaking pharmacy) at this point, but I have no dobut things will get difficult when it gets down to it. We all have lives, busy ones, but this is one of those thigns I think you are going to really need to see thorugh and follow up on constantly. Best of luck with it and keep us updated!