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Prescriptions
#1
NYS-I had my permanent SCS installed yesterday and came home this afternoon. The hospital called in 2 scripts to my pharmacy one was Oxycodone and the other was an antibiotic. The carrier denied the antibiotic even after speaking to my surgeons office. My pharmacy won’t put it through my private insurance because they know it’s comp related. Anyone have this happen to them and any ideas what can be done ? I contacted my lawyer after hours so I will be without antibiotics for over 24 hours.
Thank you
 
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#2
Maybe find out from the surgeon if there could be complications or problems and what to look for. If you any concerns have it checked out at an emergency room -- they are far more expensive then the anti biotechnology CMS.
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
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#3
Edit: "antibiotics".
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
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#4
(03-20-2018, 07:34 PM)redsoxfan Wrote: NYS-I had my permanent SCS installed yesterday and came home this afternoon. The hospital called in 2 scripts to my pharmacy one was Oxycodone and the other was an antibiotic. The carrier denied the antibiotic even after speaking to my surgeons office. My pharmacy won’t put it through my private insurance because they know it’s comp related. Anyone have this happen to them and any ideas what can be done ? I contacted my lawyer after hours so I will be without antibiotics for over 24 hours.
Thank you

Interesting the pharmacy is deciding what your private insurance will and will not cover. You can try calling your private insurance and ask them for help.

I think antibiotics are important as you just had something implanted in your spine. One option is to just pay for them and try to get reimbursed later. Check the cash pay price.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
It's best to get any post-op prescriptions in your hands or pre-approval before any surgery takes place, the same thing happened to me to after open spine surgery. I ended up in the ER and admitted due to infection, if I didn't go to the ER it might have killed me.
 
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#6
When I was scheduled for my SCS, that surgeon had me get the antibiotic before the surgery..

Calif.... here in NYS, if anything is Workers Comp, no other insurance will touch it. Believe me... I had my own and if Comp refused to pay for it, my private ins. did too... When I lost mine and was put on hubby's.. his did the same. Just like Medicare and my supplementary insurance... They won't pay for a comp thing. I had a fight with them over appointments for my upper neck that is NOT comp...
 
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#7
I’m still waiting for my lawyer to respond to my email but I will probably just pay out of pocket and let my lawyer hash it out with the comp board. It just doesn’t make any sense why the carrier would deny it after they already approved the surgery. I was given an antibiotic before, during and after surgery through my IV so I should be fine till I can get back to my pharmacy later today. Thanks for the replies
 
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#8
(03-21-2018, 07:08 AM)tbear6410 Wrote: When I was scheduled for my SCS, that surgeon had me get the antibiotic before the surgery..

Calif.... here in NYS, if anything is Workers Comp, no other insurance will touch it. Believe me... I had my own and if Comp refused to pay for it, my private ins. did too... When I lost mine and was put on hubby's.. his did the same. Just like Medicare and my supplementary insurance... They won't pay for a comp thing. I had a fight with them over appointments for my upper neck that is NOT comp...

I am sorry tbear. I wonder why Medicare will not pay for denied treatments for WC. They have for many other injured workers as long as they submitted proof of the denial. Then they place a type of lien against the WC carrier. Maybe it is different in NY.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#9
Must be.... because whenever something was denied by Comp, the PA or surgeon would try Medicare and they denied too... saying this is a comp case..
 
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#10
(03-21-2018, 01:10 PM)tbear6410 Wrote: Must be.... because whenever something was denied by Comp, the PA or surgeon would try Medicare and they denied too... saying this is a comp case..

I wonder if they did not provide proof that WC denied the request? I believe you can submit it to Medicare too, the denials from WC. They only cover things that are normally covered by Medicare and if they are considered secondary to a spouses private insurance for example this can make things more difficult as your private insurance has to pay first. I don't know if this is your situation or not.

https://www.medicare.gov/supplement-othe...ments.html
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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