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Old 03-25-2010, 10:34 AM
 
Location: Durham, NC
3,576 posts, read 10,607,726 times
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Can a pharmacy legally withhold and refuse to refill prescriptions?

Scenario: I placed my spouse into an Assisted Living facility in January of last year. She is not eligible for Medicare and is covered under my healthcare insurance policy. I made the unfortunate decision when she was placed to sign the admission form as the "Responsible Party".

As the past year has progressed, I've reached the point where I'm paying all (100%) of our combined net income for her living expenses. I keep nothing for mine. I have a balance owed to the Federal for our 2009 taxes.

The pharmacy that the facility uses just called me to say that they're going to cut off all of her prescriptions. On top of everything else, for some reason there's a monthly co-pay charge of over $200, and the current balance is in excess of $1200. I asked them not-so-politely where they think I'd find $1200 to bring the bill up-to-date, not to mention the monthly amounts just to keep things going.
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Old 03-25-2010, 10:40 AM
 
5,644 posts, read 13,173,920 times
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Sorry to hear about your financial difficulties has to be incredibly hard with your spouse needing the care.

No pharmacy is required to fill any prescription without payment...you are buying a product. There is no law requiring them to provide the product without compensation.
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Old 03-25-2010, 10:58 AM
 
Location: Durham, NC
3,576 posts, read 10,607,726 times
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They are getting paid. They only thing they're not getting from me is the co-pays. Surely they must be able to bill those back to the insurance, or to some other state or federal agency?
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Old 03-25-2010, 02:06 PM
 
Location: S. Charlotte
1,513 posts, read 3,341,303 times
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Quote:
Originally Posted by superk View Post
They are getting paid. They only thing they're not getting from me is the co-pays. Surely they must be able to bill those back to the insurance, or to some other state or federal agency?
If they submit the co-pays to the insurance, the insurance will kick them back, assuming your policy is clearly stating what is your responsibility for medication co-pays and what is theirs. So it will come back to you.

Maybe with the new law signed in for health care there is something that can be done?

This is a crappy situation to be in.
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Old 03-25-2010, 02:20 PM
 
8,411 posts, read 39,165,779 times
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I would call your insurance company first to make sure its not just some odd clerical error. Then I would talk to your doctor about assistance programs that cover medications. Some companies will send it out free or low charge without insurance coverage. If that charge is legit you have to start making payments because of the amount. You don't want to be sued or to have your income garnished.
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Old 03-25-2010, 04:34 PM
 
Location: State of Being
35,879 posts, read 77,093,118 times
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Quote:
Originally Posted by chicagomichauds View Post
If they submit the co-pays to the insurance, the insurance will kick them back, assuming your policy is clearly stating what is your responsibility for medication co-pays and what is theirs. So it will come back to you.

Maybe with the new law signed in for health care there is something that can be done?

This is a crappy situation to be in.
The legislation being passed doesn't go into effect until 2014.

The pharmacy doesn't have to provide anything without being paid; however, if insurance is not being filed, you can work something out about that. And . . . if medicaid is supposed to be picking up the charges and the rehab center is not filing that, then you need to work that out with them (but I don't think she is getting Medicaid, is she?)
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Old 03-25-2010, 05:13 PM
 
Location: Mayberry
36,333 posts, read 15,932,517 times
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Sounds like she is under 65, not on Medicaid, Superk is paying all bills. Whatever your copay is on your insurance for dependents is what you should be paying the pharmacy and they should be billing the ins. co for anything else. When the AL orders prescriptions there may be a charge to them, they pass on to the residents. The only way to avoid any extra fees is to get the prescriptions yourself and deliver them to the AL, they don't like that though. If you were to go get them, whatever your copay is, is all you should be billed from the pharmacy. The AL I worked at was not good at sending said bills to the residents families, I found out.
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Old 03-25-2010, 09:35 PM
 
Location: east of my daughter-north of my son
1,928 posts, read 3,630,355 times
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I don't know if this will help but some pharm companies have programs to help you pay for meds if you have no insurance. Some also have coupons. Our prescription insurance always runs out by September and last year we used a few of the programs offered by the company where I get my inhalers.

I am sure she is on some pretty heavy meds, but maybe it wouldn't hurt to check it out.

As always, good luck.
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Old 03-25-2010, 10:05 PM
 
Location: North Adams, MA
746 posts, read 3,490,122 times
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Quote:
Originally Posted by superk View Post
Can a pharmacy legally withhold and refuse to refill prescriptions?

Scenario: I placed my spouse into an Assisted Living facility in January of last year. She is not eligible for Medicare and is covered under my healthcare insurance policy. I made the unfortunate decision when she was placed to sign the admission form as the "Responsible Party".

As the past year has progressed, I've reached the point where I'm paying all (100%) of our combined net income for her living expenses. I keep nothing for mine. I have a balance owed to the Federal for our 2009 taxes.

The pharmacy that the facility uses just called me to say that they're going to cut off all of her prescriptions. On top of everything else, for some reason there's a monthly co-pay charge of over $200, and the current balance is in excess of $1200. I asked them not-so-politely where they think I'd find $1200 to bring the bill up-to-date, not to mention the monthly amounts just to keep things going.
If you were in Massachusetts there are several agencies I could refer you to in order to make things easier.

If your income is not enough to cover her expenses, then what about other assets? The needs test is the first one on the way to getting help. If you have savings, stocks, bonds or other assets, that needs to be depleted before you can apply for something like Medicaid.

And yes, many of the pharmaceutical companies have assistance programs, but they are needs based. If you are broke and spending every cent on her care, you will qualify.

Whether or not you signed an admissions form as the responsible party, I believe that in marriage the assets (and liabilities) belong to both of you.

I wish I could be more specific. That's tough without getting into the complicated details of your current insurance plan, finances, and the North Carolina Medicaid specifics (each state has different rules and pays part, as does the Federal government.)

Good luck.
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Old 03-25-2010, 10:26 PM
 
Location: Hawaii
1,689 posts, read 4,285,185 times
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Who provides the coverage for the Rx? Many health insurance company's don't provide for Rx's but have contracts with pharmacy insurance.

These are usually communication errors.

Hat off to you sir for looking out for your wife. She is lucky as some spouses turn and run.

If there has been a mistake with the payments you are the one responsible; it's your insurance. This place you put her; does it have a nurse or social worker to help you with these types of concerns?

Find out from your insurance company what's going on. Pharmacies are usually very good at letting you know what's this and that per insurance.

Legally they can; morally...

If you aren't the responsible party; who is?
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