Ask The Insurance Decoder
By Lynne Lucio
Q. My employer provides me with group health insurance coverage. I pay a certain portion of the monthly premiums through payroll deductions. Recently, I recently tried to fill a prescription and the pharmacy tech told me I didn’t have medical coverage. What’s going on?—Wes D., San Diego, CA
A. This frustrating situation happens a lot and is often caused by a number of factors. Sometimes the person at the pharmacy is entering the wrong identification number because they have not updated their computer with your new identification or group number if you or your plan has experienced a change. Occasionally the pharmacy person adds a covered individual identifier, i.e. 01, 02, etc. at the end of the identification number when it may not be required for your plan. If your group number changes, be sure to remind the pharmacy to update their records. When you know you have coverage and the pharmacist is telling you that you don’t, have the pharmacy call the phone number on your card so they can get the problem fixed as quickly as possible and you can get your medications. Occasionally, there may be a delay in fixing the problem. If this occurs, you can purchase enough pills to get you through a few days, then be given credit for that purchase against your regular copayment when you pick up the balance of the prescription.
ASK The Insurance Decoder © Copyright 2012, Lynne Lucio. All rights reserved.
Lynne Lucio, the author of The Insurance Decoder: How to Maximize Your Health Insurance Benefits, Minimize Out-Of-Pocket Expenses and Stay One step Ahead of Your Insurance Company, has been a health insurance professional for over 20 years. As an insurance insider, Lynne learned how to decipher the medical claims labyrinth and developed the specific and practical knowledge of the claims process. Throughout her career, Lynne has shared her expertise with thousands of insured consumers, helping them resolve complicated health claims while showing them how to take full advantage of their health insurance benefits. The depth and breadth of Lynne’s knowledge of the topic encompasses not only the claims process but also the laws that influence and regulate health coverage, including ERISA, COBRA, FMLA, USERRA, HIPAA and others. Lynne provides consulting services to covered individuals and writes about health insurance issues on (www.ezine.com). For more information, or to submit your own health insurance related questions, contact Lynne at firstname.lastname@example.org.