Options for filling a prescription amid switching health insurances?
July 2, 2017 6:12 PM Subscribe
I recently changed jobs and I'm switching my family's health insurance over to the coverage I receive through my new job. We're presently covered through my husband's employer, although the new coverage will be backdated to the first day of my new job and the old coverage will backdate to end when the new coverage begins. What will happen if a prescription medication is filled under the old coverage before I call and cancel it?
I started a new job on 6/26. I signed up for health insurance coverage right away, although it will take a few weeks before processing is complete and for the new insurance company to have us on file, start deducting premiums, and send me the new insurance cards. The coverage will be backdated to 6/26. Once I have the new coverage in place, I will cancel the coverage we presently have through my husband's employer. Since gaining new coverage is considered a "life event" and will require documentation of the new coverage before I can drop the old coverage mid-year, I have to wait until I have the new insurance cards in hand anyway before I can cancel the old coverage and backdate the cancellation to 6/26.
I have a rather expensive medication sitting at the pharmacy right now, waiting for me to pick it up and pay my hefty co-pay. This would be run through our present coverage, which will be cancelled effective 6/26, but at this moment is still active. My question is, if I pick up the medication now and it gets run through my old insurance, what will happen once the old insurance is cancelled, backdated to 6/26? Will the old insurance company contact the pharmacy to reverse out their payment, and will the pharmacy then contact me in an effort to rebill either to new insurance or to balance-bill the full cost to me?
I went through hell convincing the old insurance to approve this particular medication, and it required medical documentation from my doctor and preauthorization. With the new insurance coverage, I'm not yet sure if the doctor that wrote the script is in their network and whether they will require preauthorization of this particular medication as well. Am I better off filling the script now under the old insurance or waiting until I have the new coverage available?
I started a new job on 6/26. I signed up for health insurance coverage right away, although it will take a few weeks before processing is complete and for the new insurance company to have us on file, start deducting premiums, and send me the new insurance cards. The coverage will be backdated to 6/26. Once I have the new coverage in place, I will cancel the coverage we presently have through my husband's employer. Since gaining new coverage is considered a "life event" and will require documentation of the new coverage before I can drop the old coverage mid-year, I have to wait until I have the new insurance cards in hand anyway before I can cancel the old coverage and backdate the cancellation to 6/26.
I have a rather expensive medication sitting at the pharmacy right now, waiting for me to pick it up and pay my hefty co-pay. This would be run through our present coverage, which will be cancelled effective 6/26, but at this moment is still active. My question is, if I pick up the medication now and it gets run through my old insurance, what will happen once the old insurance is cancelled, backdated to 6/26? Will the old insurance company contact the pharmacy to reverse out their payment, and will the pharmacy then contact me in an effort to rebill either to new insurance or to balance-bill the full cost to me?
I went through hell convincing the old insurance to approve this particular medication, and it required medical documentation from my doctor and preauthorization. With the new insurance coverage, I'm not yet sure if the doctor that wrote the script is in their network and whether they will require preauthorization of this particular medication as well. Am I better off filling the script now under the old insurance or waiting until I have the new coverage available?
Are you absolutely sure that insurance cover begins at your new company on the day you start, and that coverage on your old plan ends that day too? Usually they like to start/end cleanly. I started a new job on June 5 and my new coverage started July 1. I ended my old insurance June 30.
posted by radioamy at 10:56 PM on July 2, 2017 [1 favorite]
posted by radioamy at 10:56 PM on July 2, 2017 [1 favorite]
Yes, do check and make sure that your new insurance starts on your actual first day. A lot of insurances that "start immediately" actually start on the first of the next month (ie., you start 6/26 and your insurance becomes active 7/1). Similarly, most health insurance will run through the end of the month that you leave your job. (You start on 6/26 but your old insurance is active till 6/30).
posted by The Elusive Architeuthis at 12:06 PM on July 3, 2017
posted by The Elusive Architeuthis at 12:06 PM on July 3, 2017
« Older How is important is a medium-range headset? | Name that Tune - Belle & Sebastian edition Newer »
This thread is closed to new comments.
Your insurance carrier might reject the pharmacy's claim once they realize your policy is cancelled (leading to your pharmacy billing you for the full cost), OR they might say, Hey, we paid this claim for you, so you've got to pay for your insurance for this period (leading to you paying for two insurance policies during the overlapping period).
More likely, though, the first thing will happen and you'll just be in a weird claim payment limbo for a few weeks while the pharmacy and two insurance carriers get their stuff settled amongst themselves. I recommend checking in with all parties regularly once the claims re-processing is in motion.
Messy, but obv don't delay getting a health-critical prescription filled.
You may want to reach out to your doctor asap to ask about pre-authorizing the medication with your new insurance.
posted by rhiannonstone at 6:39 PM on July 2, 2017 [1 favorite]