Please note our 2023 holiday schedule will be as follows. Our office will be closed Monday, December 25, 2023 through Monday, January 1, 2024 and will reopen on Tuesday, January 2, 2024, at 8:30 am EST.✕
Patient Advocate Foundation (PAF) is a national 501 (c)(3) non-profit organization which provides case management services and financial aid to Americans with chronic, life threatening and debilitating illnesses.
Since medications must be paid in full before you get them in your hands, you may first become aware of an insurance issue at the pharmacy counter. Whether
you are prescribed the newest medication on the market for your condition or a generic that has been around for a long while, you count on your insurance coverage to offset a significant portion of your medication expenses. If you find yourself in a situation where your insurer is not covering your medication, or if your portion of the cost is higher than you expected, these recommendations can help you identify and hopefully resolve the source of the problem.
Identify the Exact Reason it is Being Denied
Your insurer may provide the pharmacist with a specific reason why your medication claim is not being covered. Having this information will help you decided on your next step – for example, it will tell you if you are missing information from your doctor, or if the prescribed drug is not on your formulary. Your findings may mean that your next step is to submit an appeal to your insurer to ask for reconsideration. Once you have the reason call your insurer to ask what options are available to fix the root issue. If your pharmacist is not able to provide the reason, call your insurance company directly.