Regel Pharmalab

This pharmacy stated they would run my insurance information, but then refused to take payment from my insurance and stated that I had to pay in full.On 12/1/2014 I went to Regel Pharmalab to get a prescription filled. I gave them my insurance information, and I was told they were unable to get in touch with my insurance. The pharmacist stated that if I needed the medication that day, then I would have to pay in full. I needed the medication that day, so I had to pay in full. The pharmacist stated that if they heard anything from my insurance company they would call me. Several days went by and I hadn't heard anything. I called the pharmacy several times over the next couple of weeks and felt like I was getting the run around. At one point I was told by a worker that they had gotten ahold of my insurance company, and that they weren't willing to pay enough to the pharmacy. When that was stated I asked what that had to do with me. I had gotten the medication the month before at another pharmacy and paid a $10 co-pay. At this point I called my insurance company who stated that a claim had been filed on 12/1/2014 and I should have paid my $10 co-pay. She asked how much I had paid and I stated I had been charged the full amount of $251. My insurance company then stated that it looked like the pharmacy had re-called the claim, which in turn was when they charged me in full. Desired SettlementI want a refund for the difference minus my $10 co-pay. I also want to know if this is legal to do, and how often they are doing this to people. If is legal, then I think they need to make patrons aware of their ability to choose whether to get reimbursement from insurance or charge someone in full for medication. I also want to know how they can choose when they state up front that they take insurance.Business Response Ms. [redacted] came to our pharmacy on 12/1/14 to fill a prescription. We ran her insurance information and the insurance company only offered us a portion of the amount we filed for. The amount the insurance company offered was less than the actual cost of the drug alone, not including my expenses in preparing, packaging, and dispensing the medication. Any pharmacy has the right to deny accepting an insurance company's payment for medication. We cannot accept the insurance company's payment and then add the difference to her copay to cover our costs. As a result, we either accept the insurance company's payment or the customer must pay cash. As a small business, our policy is to never accept underpayment from any insurance company. We simply cannot cover loses from every insurance company we work with and still remain in business. We explained this to Ms. [redacted] and offered her to fill the prescription at another pharmacy that can take that loss. She chose to fill the prescription and pay cash. We were true to our word and called her insurance company several times trying to get the prescription covered. We ran the claim seven times trying to get adequate payment for the prescription. We continued to be unsuccessful in getting the claim adequately covered. We regret the conflict and any feelings she may have that we did not convey this information adequately to her. In short, Ms. [redacted]'s conflict lies with the insurance company since they are unwilling to cover the actual cost of her prescription. She still has the right to file this prescription with her insurance company directly to be reimbursed for her money spent. Consumer Response (The consumer indicated he/she DID NOT accept the response from the business.)First of all, the pharmacist recollection of this situation seems to be self serving. When I was at the pharmacy on 12/1/14 I was told by the pharmacist that he would run my insurance, but it would take time. 30 minutes later he came back, and stated he had been unable to get in touch with my insurance company. Since he had been unable to get in touch with my insurance company if I needed the medication right then I would have to pay out of pocket. He never stated I could or should get it at a different pharmacy that would be able to take the loss of an underpayment from insurance. I left the pharmacy paying out of pocket, and he explained to me he would let me know as soon as he got in touch with my insurance..... he never contacted me, and I felt like I was getting the run around which is when I filed the complaint with the Revdex.com.[redacted]UPDATE!!! The pharmacist states at the end of his response that my conflict now lies with my insurance company, and that I can file this with my insurance to get directly reimbursed. However, he did not know that I had spoken with my insurance company several times since I submitted the claim with the Revdex.com... I did speak with my insurance company to find out how to file the prescription with them, and did that. However, I received a denial from them. I contacted my insurance to inquire about the denial. At that time I was informed that not only had my claim been approved on 12/1/14, but they had actually spoken to the pharmacist. So essentially he lied when I had sat there for 30 minutes, and he came back saying the claim wouldn't go through and he couldn't get in contact with my insurance company. **The main issue with the denial according to my insurance company has to do with the fact that the pharmacist filed the claim 7 times (as the pharmacist states in his response), but with 7 different diagnoses. Subsequently my insurance company does not know which diagnosis is correct, and my claims have been continually denied. I have time out of my work day to speak with my insurance company on multiple occasions to get this figured out, and have been unsuccessful because he filed it so many times with different diagnoses in as he stated to be compensated adequately. I am sympathetic with small business owners, and their financial needs. However, this is more concerning customer service, and his actions resulting in my denials.Final Business Response We really do understand the frustration with this situation. We desire to resolve this conflict and have reached out to Ms. [redacted] in order to resolve this. I left her a message and wait to hear back from her. To address some of the issues in the previous comments, while I am unable to remember the exact comments from December 1, it was never my intent to mislead or be devious towards the patient. I tried to resolve the issue to the best of my abilities at that time. It is common to be unable to resolve insurance issues in a timely manner. Secondly, I was able to get the prescription covered as previously explained but was unable to get the insurance company to cover my costs. That requires approval from someone in the insurance company and after speaking with them, I was unable to get that approved on that day. As the patient and I both stated, it was submitted 7 times that day so we were diligently working on this patient's claim for that 30 minute period. Again, it is never my intent to lie or mislead a patient. Lastly, pharmacies do not even have the opportunity to submit diagnosis with a prescription. Only physicians are allowed to diagnose so insurance companies cannot allow pharmacists to do so in a prescription claim. We do not have a computer field in which to submit a diagnosis code. I have no idea how the diagnosis was changed each of the 7 times. I am unable to do that. I believe much of this issue still lies with the insurance company.