My husband's dr. prescribed IV ABX, and wrote an Rx for 3 months.
The insurance co. approved the treatment for 1 month - i.e. putting in the picc line, home health care, etc.
However, the insurance co.'s mail order pharmacy notified us that they are delivering 90 days worth of the ABX as written by the dr., and at our usual copay amount.
We don't know whether we should accept delivery since the ins. co. only approved 1 month of treatment. We are afraid they will discover the discrepancy and come back later charging us their cash price for the 2 months of ABX that we don't have treatment approval for.
We are tempted to take advantage of some broken link in their systems that didn't catch the difference between treatment length and the prescription length. But, we compared cash prices, and know that they charge a higher price for 2 months of ABX than we could otherwise find.
Anyone have have a similar experience?
Posted by InADaze (Member # 7711) on :
If you got your meds through a mail order company, does that mean your prescriptions are paid for by your medical insurance and not a separate prescription plan?
If it's a separate prescription plan, you're probably in the clear because they will usually kick back on the spot if it's not going to be approved.
If medical, it depends on your insurance company and how frequently they audit charts. But they can come after you for charges greater than they approved.
FYI, depending on your IV access and what medication you are taking, the syringes, heparin, etc. are a large part of your expenses, and they are usually under medical. So, you might have 3 months of drug, but only 1 month of supplies.
Posted by bettyg (Member # 6147) on :
i have no knowledge on this, but we have 5-6 PHARMACIST MEMBERS, who might be able to answer so up we go hoping to catch their attention!!
![[group hug]](graemlins/grouphug.gif)