I have been prescribed a very common medication which is undergoing a severe supply shortage, especially for the generic. My prescription is for the generic but my pharmacist informed me that they were out of stock, hadn't had stock recently, and didn't expect to have any generic soon due to marketplace supply issues -- did I understand that the name brand (which was in stock) was $$$?
I'm not certain I'd pay the name brand cost most years, but this year I was injured and my hospital/follow-up bills have blown my out-of-pocket max for my HDHP. So I said yes to it, expecting my insurance to foot the bill.
The submitted insurance claim was for a small fraction -- the generic reimbursement rate, I think -- of the price I actually paid, which means the lion's share of that cost was not going to be reflected on my OOP expenses.
My RX insurance has been trying to resolve the billing issue and was told (on recorded line) that the pharmacists are "not allowed" to use the "generic unavailable" Dispense As Written codes (DAW 4 or 8) and have been instructed to use the "patient requested name brand" code (DAW 2) instead. This seems like outright fraud to me but that's a fight I'm unlikely to win.
My question is: Should I submit a manual claim to my insurance for the full amount I paid? Would such a claim be denied on the grounds of me "requesting" the name brand?
I'm not certain I'd pay the name brand cost most years, but this year I was injured and my hospital/follow-up bills have blown my out-of-pocket max for my HDHP. So I said yes to it, expecting my insurance to foot the bill.
The submitted insurance claim was for a small fraction -- the generic reimbursement rate, I think -- of the price I actually paid, which means the lion's share of that cost was not going to be reflected on my OOP expenses.
My RX insurance has been trying to resolve the billing issue and was told (on recorded line) that the pharmacists are "not allowed" to use the "generic unavailable" Dispense As Written codes (DAW 4 or 8) and have been instructed to use the "patient requested name brand" code (DAW 2) instead. This seems like outright fraud to me but that's a fight I'm unlikely to win.
My question is: Should I submit a manual claim to my insurance for the full amount I paid? Would such a claim be denied on the grounds of me "requesting" the name brand?
Statistics: Posted by desolationjones — Fri Oct 04, 2024 3:35 pm — Replies 0 — Views 90