Rockhill pharmacy

In Aug 2016, Patient received a prescription billed through her insurance. She admits she did not know her insurance had changed nor did she present a new insurance at that time. The old insurance still had them as active so the claim went through. There is no possible way for us to know about a new...

insurance if the claim was processed and paid. This is all submitted, in real time, at the time of dispensing. She was notified in November, at least 60 days later, by the insurance company about the error. We only have 30 days to process or reprocess claims online. This is a fraud protection feature of the insurance companies. I explained this and that she must work this out with the insurance companies. She did not like that answer and threatened to "turn me in" to NYS and that they would be calling. That was when I told her all correspondence from the any agency must be in writing, not that she must contact me in writing.As for the claim in September, we were very specific that if the prescription needed a prior authorization, and the patient chose to pay for the medication and pick it up at that time, we are not able to reprocess and bill to insurance after the meds are picked up. This is due to a regulation that all controlled substance medications that patients pick up must be reported to NYS at the end of that day. We report the day it was picked up and if the patient paid cash or used insurance. This is a state law and a registry that doctors and pharmacies must report to on a daily basis and we all use it as a reference for possible abuse or doctor shopping. It was explained at the time of the pick up and multiple times on her calls the reason why it has to be done this way. I am sorry she is having this issue but it really is between her and her insurance companies. I have tried to explain all this on multiple occasions. The insurance companies made the errors of not updating their records by both not discontinuing her first insurance in August and not having the patient active on the new insurance in September. I cannot control what they reimburse or if any deductibles are involved in the reimbursement. She needs to be talking to them.We pride ourselves on our service and we do whatever we can to help patients but regulations cannot and will not be broken by us. It would affect my professional license to work as a pharmacist and the license of my store to operate.