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Medical Forum / Diseases and Disorders / Asthma / February 2007Caremark / BCBS Allery Shot Coverage
Hello, My wife just started allergy shots. We got a bill for $585 for the allergy serum, and now we're battling with the insurance companies to get reimbursed. We've got Blue Cross Blue Shield for medical, and Caremark for prescription. BCBS denied our claim, stating they will not cover pharmacy drugs. Caremark denied our claim stating they will only pay if the serum is produced in an outside pharmacy. If the serum is produced in the doctor's office, then BCBS should cover it. This particular allergist produces his own serum, a few doors down from where the shot is given. So Caremark denied us. So now I am appealing both. Anybody have a similar experience and can offer any advice? Thanks, Chris Your contract with BCBS should state what you've stated here -that if it's formulated outside a pharmacy, BC will pick it up. Call them back and ask for a manager (you may have to insist on speaking to a manager) and tell them you've got the contract in front of you and want to know why you're being told BC won't reimburse you. If that's what your contract states, there's no sense in appealing it with Caremark, because they're not the ones responsible for it. If you can't find this in your contract, it's possible you were confused about coverage. > If you can't find this in your contract, it's possible you were confused > about coverage. I can't find my darn contract. I have tried to find it with the insurance company, and with the employer. I keep getting told by the reps what my contract says, but I can't find it myself, so I don't have a leg to stand on. How does one get a hold of their contract? Thanks Contact your human resources department or the benefits administrator at your company and tell them you need a copy. They should be able to tell you what the correct procedure is for filing claims for prescriptions made outside the pharmacy, so I would ask them that question, too. |
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