Complaint Review: Medco

I am tired of insurance companies billing incorrectly and giving people the run around unitl they decide it is not worth it.

I had a perscription filled for Bupropion (smoking cessation) on 2/14/06. Medco is my Third party perscription administrator. This first time that I had this filled they charged me a copay of $19.64 and covered $52.34. The second time that I had the perscription filled they charged me $74.40 and only covered $4.18. The pharmacist told me that their system, which hooks directly into the Medco system said that I have reached "lifetime maximum" of $100 for prescriptions and that there is nothing I can do about it. When I called directly them they said that it was there mistake and told me that I should go back to the pharmacy. When I did the same thing happened again. Now I have spent 1.5 hours on this and I was started to get frustrated.

So I called Medco again and now they are telling me that their negotiated billing rate for this drug is $76.73 and yet they billed me $78.58. Medco had a $29 million judgement against them for this in the past. I am know sitting on the phone with Ralph who is a supervisor. THey have tried to pin this issue on the Pharmacist, (who I had conferenced in)and my benefit provider. None of these arguments made any sense to me as I had already gotten the prescription filled one month earlier without problem. They even tried to blame it on my doctor and said that he needs to give me a pre-approval for this prescription; the only problem is that this prescription had already be filled without any pre-approval and also the fact that this has nothing to do with what they billed me.

The worst part of this is that my smoking cessation program is going well (17 days now) but this stress is pushing my limits. I do not understand what the difficulty is unless this is an issue that is built in intentionally to their system to discourage clients from getting their money.

Oh, one more thing. They said that the prescription was reversed and everything was fine on one call.

I hope that someone nails these guys. They are supposed to be providing a service and since they have an oligopoly and such a strong market share they just don't care.

It is also my hope that other people add to this story and we can get a group together to put these people in their place.

Kurt
Dearborn, Michigan
U.S.A.