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Old 08.09.2012, 11:45
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Pharmacist was not sure if medication would be reimbursed by insurance... what to do?

My psychiatrist sent me away yesterday with two new prescriptions. One of them she knew wasn't covered, the other she thought was. However when I got to the pharmacy, the pharmacist seemed unsure if this second prescription was covered. It was a little confusing, she didn't say definitely 'this is not covered', and said something about if my doctor thought I needed it... I thought that either items were on the 'list' or they were not (for basic insurance).

I'm especially confused as it wasn't my usual pharmacy (where I have a very good relationship with the staff), I don't normally pay upfront for my medications so I hardly ever send prescriptions to Assura (I have a cession de créance at my usual pharmacy) and as I was feeling a little hazy... so I didn't really understand what pharmacist was saying.

As said medication was not exactly cheap... can anyone advise me what the best course of action is to get my insurance to cover it? It's supposed to build up my strength and energy as I'm dangerously underweight and run down, and have shingles...

Should I phone my insurance company and ask if they cover it?

Might they require some kind of statement from my psychiatrist to the effect that I 'need' it?

Or do I just send it off and hope for the best?

Oh, the stuff is called Bio-Logos. And it tastes lovely... for a change!

Last edited by Vlh22; 08.09.2012 at 11:45. Reason: English error
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Old 08.09.2012, 11:59
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Re: Pharmacist was not sure if medication would be reimbursed by insurance... what to

Just send the receipt off and claim, if you are already over your franchise amount then it will most likely be covered otherwise you will need to reach the limit first. Remember the insurance is designed to cover the big expenses not to turn every medicine into being free

Trust this helps but I would just send it off since you have already opened the bottle so even if it is not covered it will make no difference as you have already paid.
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Old 08.09.2012, 13:05
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Re: Pharmacist was not sure if medication would be reimbursed by insurance... what to

Thanks,

I've passed everything this year (300 chf franchise and I've paid 700 chf in the 10% contributions) so my medical costs are generally fully reimbursed. (My insurance company must LOVE me... this is the second year in a row I've gone over all the limits).

But I was unsure because the pharmacist seemed to be saying this particular medication was not always reimbursed. I've never come across that before - normally either the medication is reimbursed, no questions asked (if it's on the liste de specialities) or it's not reimbursed, full stop (like the pill). I've never had a pharmacist be unsure if a medication will or not be reimbursed.

I don't have a problem paying if it isn't covered, money may be tight but my health is important. I was just wondering if there was any special procedure to follow if there is a question mark over the medication.
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Old 08.09.2012, 13:29
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I have a twice yearly infusion of something to improve bone strength. my oncologist wasn't sure if it would be covered, so he wrote a letter to my insurance, detailing why I needed the infusion and asking about coverage. They wrote back saying that if it was billed correctly they'd pay it, or something like that (the letter was in German and that was the gist of it) And they did pay it, no problem. So anyway, you might ask your physician to write some justification for the prescription. Now, one caveat - my insurance did not pay for the vit b6 (to limit neuropathy from chemo) that my oncologist prescribed (it worked!) and they don't pay for a flu vaccine - I have just basic also, but they have been fab with the other stuff.

in the end, I suppose it depends on how they classify the med, but a letter from your doc can't hurt.

hope it helps and hope you feel better soon!
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Old 08.09.2012, 13:34
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Re: Pharmacist was not sure if medication would be reimbursed by insurance... what to

Send it off and wait to see.

A pharmacist told me that my son's vitamin D drops were most definitely not covered. Normally the prescription goes straight to the health insurance company and this one he said wouldn't be covered and I had to pay right away.

He was wrong. I sent it in and it was covered. Try it and see what happens. G'luck!
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