Copay AND Coinsurance Charged for Prescription?

melissajm

New Member
1
I recently went to the dermatologist, and she prescribed me a medication. Their office doesn't use your typical CVS or other standard pharmacy, they use an express online pharmacy where they FedEx your prescription to you next-day.

I called their pharmacy and verified all of my information, and was told it'd be a $35 copay for the prescription. No problem, and I paid over the phone with my credit card. Got my prescription next day, as promised, including the receipt saying I paid a $35 copay.

About a week later, I got an explanation of benefits in the mail from my health insurance company saying that I owed an additional $575 for that prescription. They covered $0. Has anyone ever heard of such a thing?

I never in my life would have filled the prescription if I knew it was going to cost me $610 for a single bottle (I'm supposed to use 8 bottles!). Besides, how can my insurance charge me coinsurance (I've already met my deductible) AFTER I paid a copay for a prescription?

I'm going to contact my health insurance company tomorrow, but I was wondering if anyone here has heard of such a thing before?
 
I recently went to the dermatologist, and she prescribed me a medication. Their office doesn't use your typical CVS or other standard pharmacy, they use an express online pharmacy where they FedEx your prescription to you next-day.

I called their pharmacy and verified all of my information, and was told it'd be a $35 copay for the prescription. No problem, and I paid over the phone with my credit card. Got my prescription next day, as promised, including the receipt saying I paid a $35 copay.

About a week later, I got an explanation of benefits in the mail from my health insurance company saying that I owed an additional $575 for that prescription. They covered $0. Has anyone ever heard of such a thing?

I never in my life would have filled the prescription if I knew it was going to cost me $610 for a single bottle (I'm supposed to use 8 bottles!). Besides, how can my insurance charge me coinsurance (I've already met my deductible) AFTER I paid a copay for a prescription?

I'm going to contact my health insurance company tomorrow, but I was wondering if anyone here has heard of such a thing before?

The important piece of information is in your plan documents. Can you provide a copy of the wording in your plan as it relates to your RX benefit.
 
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