My wife suffered a major stoke in Sept. 2010. It caused significant mental damage and physical impairment. I was forced to take over her care; and her previous job of managing our household and finances. At her recommendation, I continued to use Tuminaro Pharmacy. She had been using them for years. They were very familiar with the procedures to be followed to obtain payment for prescriptions from our insurance company. On January 17, I had a new medication prescription filled for my wife. It was a 30 day supply. When I picked up the medication, I was told by one of the Tuminaro Pharmacist, it wasn't covered by insurance. I was told I would have to pay the full price of $190.50. I couldn’t understand why it wasn’t covered; but I didn’t have time to call the insurance company. I needed the medication and paid. The Pharmacist told me they would reapply for payment, if at a later date, I got a commitment to pay from our insurance company. Providing 24/7 care for my wife, I didn't get a chance to call the insurance company until after I had her prescription refilled for a second time on 2/17. I was again told by Tuminaro it would cost $190.50. I paid the bill; but still wondered why this particular drug was being signaled out for nonpayment.
Monday, February 21, was a holiday. We had no appointments. Now I had some free time and called our insurance company. Their representative told me the drug in question was covered. It should have cost us $102.71 instead of $190.50 we were charged; and they had no record of Tuminaro Pharmacy filing for payment. I then called Jeff Tuminaro and asked why the Insurance Company was telling me they hadn’t applied for payment.instead of working toward a solution, he became very abusive and told me I was too much trouble to deal with. He said he wasn’t going to help me resolve this; and he didn’t want us for a customer any more. I was furious. They were not getting away with this. We have given the Tuminaro Pharmacy thousands of dollars in business over the years. We spent over $1700 in their store in the past 14 months. As soon as I got off the phone, I went to their store to get what I needed for our Insurance Company to reopen our case for payment. Jeff refused to be cooperative; so I requested a response from the East Fishkill Town Police. It was only after the police arrived and got involved, that Jeff Tuminaro gave me the papers I needed to file claims for payment. This was the third time in the past year, Tuminaro’s Pharmacy told me a medication was not covered by insurance, when it was. The first time, it took me 3 months to resolve the issue with our insurance company and get reimbursed for over payment. If Tuminaro Pharmacy had fulfilled their responsibility, a drug copayment would have been the only charge at time of purchase. Jeff Tuminaro’s actions were a direct violation of the Licensing Rules of the New York State Board of Regents. His professional misconduct includes the following:
• “Engaging in acts of gross negligence or incompetence on more than one occasion”, by failing to properly file insurance claims for the benefit of their client on three separate occasions; claim procedures they were well versed in, and had properly filed on numerous other occasions• “Failing to return or provide copies of records on request”; until the police forced him to cooperate. These were “copies of documents in the possession or under the control of the licensee which have been prepared for and paid for by the patient or client;” papers needed by the client to file his own claim for insurance coverage.
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