Prescription Insurance Confusion

Earlier this week, we went to my husband’s favorite pharmacy to pick up his pain management medications.  The pharmacy tells my husband someone else picked his meds up earlier in the day.  Our sister-in-law beat us to the pharmacy.    

We find out later from our sister-in-law Marie, she paid $465.26 for the prescriptions. My husband was expecting our co-pay to be around $40. She said the pharmacy told her they need a copy of his new insurance card. He was frustrated because he had taken a copy of it in the previous week when he received it. There was even a copy of the card in the bag with the prescriptions. He was sure there was no way to get the money back. This is a huge deal because our monthly income is less than $650.

I called the pharmacy to tell them my husband has prescription coverage, a copy of the card was in the bag with the prescriptions, my sister-in-law paid for the prescription and at $465.26 there is no way the insurance was applied.  She told me the new card he provided was showing it isn’t in effect until 2/1/19.  She stated she would contact the insurance company and call us back.

I called the number on the new prescription card, the woman who answered told us to call the number on the paperwork we received indicating we’re going to receive help on prescriptions through 1/31/19.  I called that number and discovered there are two different programs and the one that’s in effect until 1/31/19 has a “card” that is a representation of a card on a regular sheet of paper in the letter they sent.  She explained we need to ask the pharmacy to rerun the prescriptions with the information for the current coverage and if that doesn’t work, we can fax in the receipt for reimbursement in 30 days.  She laughed and indicated she receives calls like this frequently. I called the pharmacy back but the person we were working with is on hold with the insurance company.  She’s going to call us back.

We hope.

Well, she didn’t call us back, but my husband went in today with a copy of the temporary prescription insurance card and a copy of the receipt. The pharmacy reran it with the correct information and our sister-in-law was refunded her money.

What can I say? We’ve received so many letters from the same places, we simply didn’t realize there were two different coverage plans. Sorry! Super thankful this was a mistake on our part that could be corrected easily and quickly.

Are we the only ones confused?