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Ugh, annoyed by insurance rejection.

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May 14, 2008
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I really dont know if this is an other drug question, but if it isnt, move it where you want.

I'm gonna get right to the point. If an insurance company rejects a script, is this logged or mean anything at all? Also, can I just pay full price for the prescription and have them fill it? Basically what happened is I have one script on file, with 5 refills, and I just dropped off a script for the same drug, but from the ER and not my doctor. The quantity was 30 instead of 120, and the pharm tech said she tried to put it in the system as something else, and it still rejected. I'm not really worried or doing anything wrong, its just more or less annoying me. I'm from the US btw.
 
LightTrailz said:
Probably has to do with filling another script when you already have a multiple supply of it and arent in "need" to get more ..
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I can understand that, but is the only hurdle the insurance rejection? I asked the pharm tech how much it would be if I payed out of pocket. She told me, but does that mean that they would do it. Its not like I filled my script a week ago, it was near 3 weeks.
 
Im not exactly sure how it works in the states i just put out a hypothesis .. it works a little different in canada . ive never had issues with insurance actually paying for my scripts or bitching when i fill them .
 
If the script was legitimate then you have the right to have it filled. The payment via insurance or out of pocket is a separate issue AFAIK.

I recently ran into an issue where pharmacies are now refusing to dispense non-generic drugs even if the script says the name brand, unless it's specifically noted as DAW, which I think is BS if I'm paying for it myself.
 
You should be able to pay out of pocket. I am taking it this is for an opioid? You should be able to get it generic and will not be too expensive. You could also contact your primary care physician and ask her to discuss the matter with the insurance...

I used to take 2mg of lorazepam twice a day and I decided that I wanted to reduce it to 1mg BID so I called my Dr's office's new prescription center and explained that I wanted to go from 2mg BID to 1mg BID so 1 month would give me 60 pills instead of the 120 I usually got. They gave me 60 but only indicated 1 pill a day. I had refills and after the month, I went to the pharmacy to refill and the insurance rejected it. I explained the situation to the pharmacist, who seemed skeptical at first, but when he saw that every script I've ever receieved from this doc (which was half a dozen a month for over a year) was 1 month's worth, he believed me that it was err and not drug seeking. He told me he would contact my insurance provider and straighten it out, which he did. I was filling at night so the insurance place was closed but first thing in the morning he contacted them and had it corrected by noon. I did have the opportunity however to pay out of pocket and although it was only like $15 more, I didn't want there to be a notation in my file that I tried or did fill scripts early and I was pretty broke.

...sorry for the long story, I just thought it was applicable and hopefully helpful.
 
^ Thank god I live in the USA where doctors actually have an incentive to do a good job and patients with life threatening illnesses dont have to wait a year to get help.

william, yes you can pay full price for it and not have it rejected by your insurance.
 
william1985 said:
I really dont know if this is an other drug question, but if it isnt, move it where you want.

I'm gonna get right to the point. If an insurance company rejects a script, is this logged or mean anything at all? Also, can I just pay full price for the prescription and have them fill it? Basically what happened is I have one script on file, with 5 refills, and I just dropped off a script for the same drug, but from the ER and not my doctor. The quantity was 30 instead of 120, and the pharm tech said she tried to put it in the system as something else, and it still rejected. I'm not really worried or doing anything wrong, its just more or less annoying me. I'm from the US btw.
Click to expand...

If its the same type of script, like the one you have refills for, the pharmacy could call the doctor and tell them you are already getting meds from another doctor. and if they do that most doctors will tell the tech not to fill it and destroy the script.. They might also destroy your refills to.
They call this doctor shopping and its illegal..
Your lucky they didn't call the doc. or they might wait till you try and fill it.. Then your fucked.
So I would say the insurance is the least of your problems
 
sixpartseven said:
^ Thank god I live in the USA where doctors actually have an incentive to do a good job and patients with life threatening illnesses dont have to wait a year to get help.

william, yes you can pay full price for it and not have it rejected by your insurance.
Click to expand...

What's the point in having all those luxuries if people can't pay for it, the rich are getting treated like gods, no worries... while the poor are dying because they can't pay for the medical help they need or require too survive, or if they can they end up spending all their food/rent money on medical bills thus creating even more problems. Private healthcare backfires, not everyone is made of money.. believe it or not.
 
You may jeopordize your physician's ongoing script for hydro (from what I remember from past posts of yours). Hopefully, the pharm won't call your gp-take the er script to a small mom and pop pharm and pay out of pocket, if you want that additional 30.
 
Its only 20.00 dollars for my prescription, so paying it isnt a big deal.
My scripts are legit, from two seperate doctors (1 ER doc and 1 primary doctor).
Couldn't I just explain to the pharm people that I did go over my daily perscribed dose a little bit, and they may be able to work with the insurance company? I have had 7.5/750 and 10/325 hydrocodone perscriptions filled at the same time, with no hassle. I think the insurance system just looks at what the drug is in mg and kind, and rejects if theres a double dip. Im also kind of wondering if a pharmacist is allowed to say no to filling it.

swybs: What do you mean it could effect my doctors on-going script? Why would I get penalized for this, and are they expected to call my doctor? I really confused with this.
 
Yes, it is at the pharmacist's discretion-but, ask yourself if your physician (your gp) is going to be kosher with you "double dipping" or if you are even ready to have this discussion, under these circumstances. I think it would behoove you to discuss your need to up your daily doses on your terms, not the terms of a meddling, suspicious pharm tech.
 
william1985 said:
Its only 20.00 dollars for my prescription, so paying it isnt a big deal.
My scripts are legit, from two seperate doctors (1 ER doc and 1 primary doctor).
Couldn't I just explain to the pharm people that I did go over my daily perscribed dose a little bit, and they may be able to work with the insurance company? I have had 7.5/750 and 10/325 hydrocodone perscriptions filled at the same time, with no hassle. I think the insurance system just looks at what the drug is in mg and kind, and rejects if theres a double dip. Im also kind of wondering if a pharmacist is allowed to say no to filling it.

swybs: What do you mean it could effect my doctors on-going script? Why would I get penalized for this, and are they expected to call my doctor? I really confused with this.
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Sorry but your not getting it.. When a doctor gives you a script and you already have one on file, you have to tell the doctor, in this case the er doc. then he would have told you to use that script cause you already getting it from another doctor.
Dude this is illegeal.
That make them not legit and you can get in trouble for it.. Now if you told the er doc that you are taking the meds and its not working and the er doc changes it to something else, then that is legal cause your other script isn't working and the er doc can change it..
But what you did is get another script from another doc without him knowing about the other one.
AND THAT MY FRIEND REALLY PISSES DOCTORS OFF, Then they cancel all your scripts and label you a drug seeker. Then you will never get any scripts,
You are playing with fire
 
Sorry, if I wasn't more clear: If your gp gets an inconvient call from a pharmacy about you needing additional pain medications (on top of what he/she in their best judgement has prescribed), he/she is likely to take it personally, and also potentially have a knee-jerk reaction in our opiophobic current state of practice and label you as a "drug seeker."

Of course, I could be wrong but I've seen it happen and that would be quite unfortunate for a mere 30 pills.

Just my paranoid .02.
 
swybs said:
Yes, it is at the pharmacist's discretion-but, ask yourself if your physician (your gp) is going to be kosher with you "double dipping" or if you are even ready to have this discussion, under these circumstances. I think it would behoove you to discuss your need to up your daily doses on your terms, not the terms of a meddling, suspicious pharm tech.
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Hell, im on a high dose already. 1 pill 4 times a day = 3000mg of APAP. yeah, def not asking the doctor. Im just going to go in when the hot emo looking tech is working. She was the one who tried "loop-holing" the system. And it could be my ego, but she flirts too. Its the old 60 year old pharmacist who scares me.
 
Sportfisher39 said:
Sorry but your not getting it.. When a doctor gives you a script and you already have one on file, you have to tell the doctor, in this case the er doc. then he would have told you to use that script cause you already getting it from another doctor.
Dude this is illegeal.
That make them not legit and you can get in trouble for it.. Now if you told the er doc that you are taking the meds and its not working and the er doc changes it to something else, then that is legal cause your other script isn't working and the er doc can change it..
But what you did is get another script from another doc without him knowing about the other one.
AND THAT MY FRIEND REALLY PISSES DOCTORS OFF, Then they cancel all your scripts and label you a drug seeker. Then you will never get any scripts,
You are playing with fire
Click to expand...
Fock. I was also told too that the script is good for 6 months, so when I run out of refills, then this script is on file. Its only 6 days till I can fill one, but its kind of hard when A) Youve taken them for a year straight, and B) Are in pain. This blows!


And doctors can technically label you a drug seeker? And where does this go, your insurance record?
 
william1985 said:
Hell, im on a high dose already. 1 pill 4 times a day = 3000mg of APAP. yeah, def not asking the doctor. Im just going to go in when the hot emo looking tech is working. She was the one who tried "loop-holing" the system. And it could be my ego, but she flirts too. Its the old 60 year old pharmacist who scares me.
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^^ I can't wait till you come on here and say man "the fucking doctor cut me off" what an ass, I did nothing wrong my doc is an ass..
You can also get arrested for double dipping from doctors..
I would hate to tell you I told you so..
In your case all pharmists should scare you when trying to fill this script.
Cause there the ones that tell your doctor and fuck you
 
william1985 said:
Fock. I was also told too that the script is good for 6 months, so when I run out of refills, then this script is on file. Its only 6 days till I can fill one, but its kind of hard when A) Youve taken them for a year straight, and B) Are in pain. This blows!


And doctors can technically label you a drug seeker? And where does this go, your insurance record?
Click to expand...
I know this sucks, believe me I've been there.
But I don't want to see you get labeled a drug seeker.
Cause then you will really have problems
be fucking carefull
 
sounds like some ones trying to pick up some extra hydros or codeines
 
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