American health insurance reimbursement clusterfuck.
August 18, 2009 12:32 PM   Subscribe

American health insurance reimbursement clusterfuck.

I spent the summer traveling. I also spent it between jobs, so I had to get COBRA insurance. What with all the paperwork, and the fact that my address changed partway through, I just finally got my insurance card — but it's okay, they tell me I've got retroactive coverage going back until the start of the summer.

Problem is, I've got a rather expensive prescription that I need to fill every month. So for June and July, not having an insurance card yet, I paid for it out of pocket — a total of almost $700. Still, no problem, I can just submit that to my insurance company for reimbursement when I get home, right?

Well, here's the bigger problem: I can't find the receipts. Swore I set them aside someplace safe, but they're not there.

Assuming the receipts don't surface, did I just throw $700 out the window? Is there anything I can do? I'd rather not take this up with my insurance company until I've got a plan of attack — if there's even the slightest chance I'll be able to get reimbursed for this, I don't want to blow it by giving them any indication I've made a mistake, since obviously it's in their best interest to prevent me from being able to file a claim any way they can.

In case it matters: my insurance is Blue Cross Blue Shield of Texas, and I filled the prescriptions at a Duane Reade in NY.
posted by nebulawindphone to Health & Fitness (6 answers total)
Call Duane Reade, see if they'll send you copies.

Did you pay with a CC? Check your statements.
posted by unixrat at 12:33 PM on August 18, 2009

The plan documents may also have a provision for lost receipts.
posted by Pax at 12:42 PM on August 18, 2009

Call Duane Reed and ask if they can re-print you the little pamphlet that has the date and the amount you paid. They should be able to. Also call your insurance and ask if this would be sufficient documentation.
posted by amethysts at 12:48 PM on August 18, 2009

A few years ago, when I itemized health-related expenses for tax purposes (bad year, car accident, lots of bills, long story) I was able to get full documentation from Duane Reade of all of my prescriptions for that year, including dates and out-of-pocket charges. If you paid with a credit card, that can serve as additional documentation.

Assuming you can get a printout from Duane Read, which shouldn't be a problem, I wouldn't even flag it with an explanation, since this seems like an invitation for the insurance company to contest the charge. It should be sufficient documentation, particularly since this wasn't a new medication. Just submit it to the insurance company and follow up on the claim. If they deny it, don't get discouraged -- many of their denials are just to see what they can get away with.

Good luck!
posted by foxy_hedgehog at 1:40 PM on August 18, 2009 [1 favorite]

Best answer: I've been able to get replacement receipts from the pharmacy before, or at least a statement showing my payments made, with no problem.

You can also probably get some kind of document based on your payment method: a credit card duplicate receipt or statement, cancelled checks, etc.

Finally, get a copy of the claim form and read the instructions. Usually it will tell you what documents are needed/accepted, and that may help you figure out how what avenue to pursue.
posted by not that girl at 5:29 PM on August 18, 2009

Pharmacies are pretty amazing in terms of how much documentation they keep of who got what filled – most likely at least partially to prevent gaming the system. I daresay it's about 95% likely you're not going to have a problem getting documentation from them on this.
posted by WCityMike at 7:57 PM on August 19, 2009

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