Hug Your Pharmacist

Probably the most frustrating issue when it comes to insurance claims is the whole issue of prescription coverage. Your medication is on the insurer's preferred list, but you still have to go through the drudgery of taping all your tear strips together and sending in claims.

Hold it right there. If you have not done it the way I am going to outline right here, you will kick yourself for not thinking of it sooner. You will be so happy you will probably hug the pharmacist.

How to handle your insurance claim for prescription medications: Go to your pharmacy. Ask the very nice pharmacy tech to run out a statement of all your prescription orders for the month (or for the 90-day or 180-day period). You want whatever will fit ON ONE PAGE.

Make sure your name and address are somewhere on this sheet; if it does not appear, PRINT that information at the top along with your date of birth and policy number. Take out your Rx card. What is the address on the back? Address an envelope to that address. Insert the above printout from the pharmacy into the envelope and mail it.

Why have I told you to do it this way? Because you are sure to lose at least some of your tear strips from each prescription refill, and you will never be properly reimbursed for your out-of-pocket expenses. AND the printout has the advantage of listing all the important details that the insurer needs to key in your claim and process it correctly: things like the name of the drug, the NDC code, the date it was filled (NOT the date you picked it up), the dose and number of pills, and of course the price you paid.

Include your name/address/policy number because you will be amazed how common your name is, and often the insurer confirms the identification of a policyholder with a date of birth or at least an address. As a claims employee, I frequently had to send out policy letters asking for ID, not because we don't believe you are who you say you are. But because we have a dozen Cheryl Thompson's and we are trying to match up the right policy number for you.

THE NDC CODE
The WHAT code? The NDC code is standard in the US for identifying the name and dose of your Rx. You will find it on your prescription bottle, and if you look very hard you may find it on the tear strip. This is why the pharmacy printout is so important, because it gives the exact NDC code for that drug. If the insurer has to guess which one in the course of processing, the processor may guess wrong and it may be denied in another department or next month ... or whenever.

FOREIGN PRESCRIPTIONS
Foreign countries do not use the NDC, they use a DIN number. This is why processing your foreign Rx's will be slowed down. Also, please be aware that generally, only emergency prescriptions filled outside the US will be covered by insurance.

PRESCRIPTION ASSISTANCE PROGRAMS
There are literally hundreds of prescription assistance programs. The only way you can possibly learn if you qualify is to go online to https://www.pparx.org/Intro.php, and let the system sift thru them for you. As it explains on the site, "Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669)."