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Pharmacy Problems
#1
Hi Folks,

I need some advice please. California Claim.

Went to the pharmacy ( the one that the IC requires to be used) to pick up my scripts, total of three. Two of the scripts were denied one was deferred and other was lost to IMR a few months ago.

I asked the pharamcist and clerk both to use my private insurance through Covered Ca since these scripyts are denied. They said that was FRAUD ! and refused to run these through my private Insurance.

I said give me back my script .. they said no. I said it is common for Work Comp denials to be ran through an individuals private insurance. They were angry  ..Screaming fraud,  just unbelievable !

Because of this situation I was  "forced"  to pay out of pocket by the pharmacy the IC requires. Needless to say I am pretty angry at being denied the right to use my own insurance.

Any thoughts on this situation 

Thanks 

Shadow
 
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#2
request the carrier provide you alternative pharmacy services.
have the physician provide you the script so you can control the provider.
report the pharmacy to the licensing board. do it in writing with a copy to the pharmacist.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
You need to complain to CVS corporate. If your private insurance will cover a denied prescription, then it is not fraud. What is illegal is to charge a California injured worker for a prescription. This CVS can be fined by the CA State Department of insurance a fine for up to 3 times the amount of your prescriptions! I would contact the CA department of insurance and file a complaint.

 I would also switch your pharmacy (and everything else 1171 suggested). I go to CVS and they automatically fill my prescription using my private insurance card when there is a delay with work comp, even when I do not want them to.

I also recommend having your pharmacist run the prescriptions through a few times a few days apart as it can take a few days to get approval from the claims adjuster. A denial does not always mean it is denied, just not approved yet. Some of the CVS pharmacies are not very educated in work comp, and it sounds like you have one of those.
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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#4
(10-19-2015, 10:25 PM)California_Help Wrote: You need to complain to CVS corporate. If your private insurance will cover a denied prescription, then it is not fraud. What is illegal is to charge a California injured worker for a prescription. This CVS can be fined by the CA State Department of insurance a fine for up to 3 times the amount of your prescriptions! I would contact the CA department of insurance and file a complaint.

 I would also switch your pharmacy (and everything else 1171 suggested). I go to CVS and they automatically fill my prescription using my private insurance card when there is a delay with work comp, even when I do not want them to.

I also recommend having your pharmacist run the prescriptions through a few times a few days apart as it can take a few days to get approval from the claims adjuster. A denial does not always mean it is denied, just not approved yet. Some of the CVS pharmacies are not very educated in work comp, and it sounds like you have one of those.


Thanks for your help .. It's actually Walgreens and I am at my wits end with this BS. One of the scripts was for 90 tablets .. they took it upon themselves to modify it to 30 . I said let me get this straight .. The IC won't pay for this but yet it gets modified .. who made that decision ?  He filled it for the prescribed amount and I paid for it .
 
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#5
Something does not sound right about him lowering the amount. I do not think this is legal. I would contact corporate. Try CVS pharmacy for your next prescription.

Have you contacted your private insurance to make sure they will cover a denied work comp medication? I just wanted to make sure you have, to avoid any problems later. Most of them do, but it is better to be safe than sorry. They may want the option to place a lien on your carrier.
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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#6
(10-20-2015, 10:40 AM)California_Help Wrote: Something does not sound right about him lowering the amount. I do not think this is legal. I would contact corporate. Try CVS pharmacy for your next prescription.

Have you contacted your private insurance to make sure they will cover a denied work comp medication? I just wanted to make sure you have, to avoid any problems later. Most of them do, but it is better to be safe than sorry. They may want the option to place a lien on your carrier.

They have been modifying my scripts for a long time .. Lets say 120 NSAIDS x 1 daily .. I would get approved for 30 days and then have refill every 30 days .. pain in the butt. They did pay for it .

Recently they modified a denied Med .. I called him on it .
 
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#7
I think going to a different pharmacy who has more knowledge with work comp would ease some of these headaches.
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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#8
(10-19-2015, 09:58 PM)1171 Wrote: request the carrier provide you alternative pharmacy services.
have the physician provide you the script so you can control the provider.
report the pharmacy to the licensing board. do it in writing with a copy to the pharmacist.

I agree with the above information. Although I live in Florida I had a very similar issue. I had an attorney because of other complications with my workers comp but he referred me to an actual workers comp pharmacy that got my medications approved when the pharmacy recommended by the IC denied them. You shouldn't have to get an attorney to do this though I would call the IC.
 
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