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NYS Med denial


28
FEB
2010
NY Prescription Denials - What to DoPrintE-mail

If you have been denied coverage/reimbursement for your doctors visits or prescriptions, please call the NY Attorney General’s toll free hotline.  

Hot Line (toll free) 1-800-428-9071  (Phone hours: 8:30-4:40 M-F) 

Be prepared to provide the intake person with your prescription information when you call.  The AG’s intake staff provises that information to AG advocates, who then call you back to try to personally help you.  

Please have your medication list, doses, etc and your pharmacies name/phone/fax # ready when you call.  Also have your insurance companies name and your policy # available.  

How this works:  The NY AG’s office can "over-ride" the insurance companies decision immediately so you can get your medications at your local pharmacy. Then the AG’s office deals directly with your insurer about the denial issues, saving you time, stress and money (free attorney, basically).  If the AG's office intervenes on your behalf when you call and approves the medications that the insurance company denied, you will not have to pay for those medications (normal co-pays may be an exception).  If the AG’s advocate can fix the problem, the insurance company may be made to cover your future medications. 

IMPORTANT-  If you are out of medications, or have not gotten something like Mepron that you just learned you need, tell them it is an “emergency” and they will try to get your meds for you in 24 hours or less.  If you have a refill being denied and/or have some medicine left that will last for a week or so, they said it will take about 7-10 business days to get you the medications.

Remember- the more calls made to this specific hotline with Lyme related problems, the more attention (and future funding) “Lyme” related problems will get in general.  I found these people to be very kind and helpful, and very familiar with Lyme issues.

Note- they do not handle disability claims, traditional Medicare or Medicaid, or workers compensation issues- just regular HMO issues.  Exception- they will assist you if you have a Medicaid/Medicare HMO policy- (example- Medicaid through MVP, BCBS or a supplemental policy that goes with Medicare and Medicaid).  Call them if you have questions. The same number can be used to report denials for reimbursement for your doctor's visits too.