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Re: [IP] short deliveries of pharmcy supplies

All I know is that when I took my prescription into the local CVS pharmacy
(2 times now), they would come back and tell me the Ins. Co. would not pay
for 200, but they will cover 150 test strips within a 30 day period. I am
probably going to have to go through the same process I did to get my
Novolog approved.

----- Original Message -----
From: "Michael" <email @ redacted>
To: <email @ redacted>
Sent: Monday, June 24, 2002 10:11 PM
Subject: [IP] short deliveries of pharmcy supplies

> > Actually, my endo wrote a prescription for 200 test strips as my 30
> > day supply, but the insurance will only pay for 150 within a 30 day
> > period. Doesn't matter how the Dr. writes it, matters how the
> > insurance decides what you need. A little backwards, but that's the
> > way they work.
> >
> Actually, NO!  The insurance company may try this B.S., but legally
> they can not practice medicine. They will tell you it is there
> "internal policy", or their "rules", but unless it is spelled out in
> the contract of insurance in very specifically and in writing, they
> must dispense what the doctor orders. I've personally gone round and
> round with BS/BC about this, and I know others have done so as well.
> What it boils down to is if you test say.... 10x per day, you need
> 300 strips per month. If that's what the doctor orders, that's what
> insurance must pay for. You have a contract with them which they can
> not violate .... particularly since you got it as a take it or leave
> it proposition. The courts, insurance commissioners office, etc....
> all side with the consumer in these matters. If you let the insurance
> company say "NO" and don't contest it or fight for your rights
> basically they have stolen your money and not delivered the
> contractually obligated service. Don't assume that just because the
> strips were not shipped that you can't get them.
> Here's the game they play. The insurance company sub-contracts the
> pharmacy services to the XYZ mail order pharmacy. They tell the
> pharmacy that the max strips they can ship is 150 per month. Your
> order 200, XYZ ships 150, you call and complain and they say "sorry
> all we are allowed to ship is 150. It seems you are stuck but.....
> what you need to do is call pharmacy services for your insurance
> company and have them authorize XYZ to ship the balance due and to
> fix their internal records to reflect the correct number for the next
> shipment -- trust me it will work, but not without a fight. Proably
> you will have to fight the battle again, but the insurance company
> MUST dispense what the doctor prescribes. The may request a
> "physician overide" which means the doc must fax or mail them a
> letter that basically says the same thing as the prescription. It's
> another way to harrass you and try to avoid paying, but in the end
> --- the will supply the goods. BTDT
> Michael
> email @ redacted
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