My husband's company uses Caremark as its Pharmacy Benefits Provider. There was a glitch with the employee "on boarding" process that delayed receipt of our new Caremark member ID cards for weeks. The coverage was effective as of my husband's start date but we couldn't access the benefits without the member ID.
Meanwhile, we were both running low on some maintenance meds. I told the CSR that we were running low on some maintenance meds and asked what to do.
She said I should go ahead and buy the meds and that I could submit a paper claim to be reimbursed. She did not tell me that to be eligible for reimbursement, I would have to get brand new prescriptions from the prescribing doctors, take them to a Caremark network pharmacy, avoid using any other insurance for the transaciton (yes, we briefly had dual coverage), pay 100% of the tab out-of-pocket and present original pharmacy receipts that include this dаta: day's supply, NDC number; NPI, NDPDP, or NABP number; member ID number, RX number, date of fill, quantity. How is a person supposed to know any of this unless they are told??? If this information is on the Carmerk web site, it is well hidden.
My first attempt to get reimbursed was rejected with a form letter which cited "insufficient documentation" as the reason and included a Frequently Asked Questions sheet. I made several attempts to get the correct supporting documentation. Months later, I resubmitted the claim which was again rejected, but for a different reason. Long story short, per their CSR organization Caremark is sorry but they cannot reimburse me for over $500 in RX costs. Nevermind that all of this could have been avoided had our membership card been issued on time and had the original Caremark CSR I spoke with provided more detailed information about requirements for getting reimbursed.
I am one unhappy Caremark customer.
0 comments