Anybody hear of press scripts

[Bummer Knees]

Congratulations Bronco, glad you were able to get them filled.

Early on I had several denials when I tried filling my meds.

I have never used my express scripts card. I have always used my personal health insurance to pay for my meds, I have to pay $40.00 out of pocket everytime I have a script filled.

[kate]

bronco54501 Wrote:Just thought I would update, I did go back to pharmacy the next day and sure enough they were filled and all covered. I guess sometimes not blowing to much hot air at the adjuster some times work. We will se at the next refill.

If you have a script that is for a certain amount of refills, they adjuster should authorized all at the same time so you don't have to worry until the doctor gives you a new one. However, depending on the type of med, (ie narcotics, etc) sometimes Express Scripts (and any other RX company I've ever worked with} will require a verbal or written auth from the adjuster even for refills. Sometimes, you come in, leave the script, they get busy, call the adjuster at 6:00pm before they leave for the night. The adjuster is probably already gone. Then the next day the adjuster calls. The person who left the message isn't there, won't be in till 4:00 pm. Etc. This can go on for days. Not because the adjuster doesn't want to approve, just the red tape.

Many I times I would get irate calls about why I didn't authorize a prescription that I know I had. I would call express scripts (and the other companies that prior companies I worked for used) and they would say "Oh yes, you did authorize it last week, I guess we never let the pharmacy know. In other cases, the pharmacy would try to enter the code # and use a "O" instead of "0" (O instead of zero) and it would kick it out. Instead of calling, they would just say WC denied this.

I think I've said this before but I'll say it again. Before you panic, get irate, or whatever. Sometimes it's not denied, it's not that the adjuster even knows. It's not that they aren't paying you the right amount on purpose, sometimes, the employer gave them the wrong information. Sometimes, they just make plain STUPID mistakes. But usually what happens is, someone says WC is out to "scr--, (Sorry, I meant) get you" and everyone gets crazy. Usually it's just a screwup.

Don't just assume because something doesn't happen right on time that there is a denial of your claim, your treatment, etc.

Sometimes you just have a biatch of an adjuster. Sometimes, they are just lazy, behind, etc. and will get to it, oh well, as soon as I can.

Sometimes it's beyond their control (as per the original post, they have to deal with an outside company who doesn't respond correctly)

Glad to hear that you got your meds. Sorry you had to wait.

[bronco54501]

thanks for your input everyone