Insurance and antibiotics

[Plum99]

Has anyone ever heard of an insurance company refusing to pay for antibiotics? I'm not completely sure what is happening, but it has been almost a week of not being able to get a straight answer as to why. We switched pharmacies because the one we were going to was giving us a hard time. After we switched, the next pharmacy was very helpful, but after days of pharmacy-doctor-insurance company phone calls, they said they didn't know, and told me I had to keep dealing with my insurance to get them covered. Only today did we hear from the prescription service that our insurance company flagged one of the antibiotics sent in, after approving, then denying, coverage. Somehow I still have not spoken to the right person to give me details- it is ridiculous.

Has anyone ever had anything like this happen? I'm trying to figure out if this really has to do with anything, or it's just another game to delay prescriptions so we will pay out of pocket. There have been many other "mistakes" or miscommunications our insurance company has made in the past that resulted in hospitals, labs, and us being stuck with the bills unless we caught it quick enough to appeal. This time I'm not sure if something like that is happening, or if it's possible they can decide to stop covering antibiotics.

[Gpookie]

Are they not covering the entire prescription or just this month? We have to meet a medication deductible each year, so we pay out of pocket in January.

Also, if we pick it up a day or two too early, we have to pay out of pocket...

[MomWithOCDSon]

Yes, our insurance company is very rigid about refills and will only cover them pretty much immediately upon the heels of the previous prescription having run out. So if we order a refill too early, we can pick it up, but we have to pay for it out-of-pocket.

 

In our case, our pharmacy knows us and is familiar with this "game" by the insurance companies, so they'll let us know: "You can pick this one up on Friday and it'll be covered."

[Plum99]

For some reason we couldn't get the information from anyone this time. The pharmacies just kept saying our insurance doesn't cover this medication for you, but that happened again each time a replacement was sent in. They said it wasn't because of the deductible, but gave no additional information. Now this morning, after almost a week of this, our prescription service said we just need to have them send over a form to get signed by the doctor to have the medication added to what we are allowed to have covered. Strange it took this long to get that, and I believe we were told that the only forms we needed to have signed were between the pharmacy and doctor. I guess we'll see if this is it. I'm convinced there are a list of tactics to delay paying for things.