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RE: [IP] re: is this legal

> We too were declined when we went to refill ElaMax. I called our
> insurance company (The Guardian) and they called the company.
> ElaMax, according to the manufacturer, is prescription. The
> Guardian's computers had it wrong.
> Of course, the customer service rep was powerless to remedy the
> problem.

This sort of problem can usually be remedied by escalating the 
problem within the insurance company. Eventually you will get to 
someone that can solve the problem. Don't get hung up with the 
pharmacy company. Your CONTRACT is with the insurance carrier and it 
is their problem to recitfy the mistake in spite of what their 
customer service people may say. Contact the office of the 

"Medical Director" for the insurance company if you can't resolve it 
with their regular folks. Point out that they have a contractual 
obligation to you and you want the service that has been ordered by 
your physician. Given the choice of finding a means or having a 
complaint filed with the insurance commissioner, you can bet a 
solution will appear. Easiest way is to get them to fax you a 
letter that you can return with a claim then buy the stuff 
yourself and make the claims until they straighten out the 

I've used this technique. the ins co's don't like it, but when you 
won't take no for an answer and they realize you have them by the 
short hairs per the contract language, you WILL get results.

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