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I’ve been unable to receive reimbursement for my out-of-pocket medication expenses. My recent experience has proven to be deeply disappointing and has led me to question the efficacy of your services.
11/23/22 $ 171.93 (partial fill 30 of 90 pills) I had to cover the costs of my prescription medication out of pocket due to confusion with the pre-authorization on file
12/23/22 , 338.96 (remaining 60 pills) As the preauthorization issue still wasn’t settled.
I was told by express scripts that they didn’t have the preauthorization on file, I contacted my Dr and was told it was submitted 11/22/22 and they resent the preauthorization to express script multiple times yet I was continually told they hadn’t received it. After many phone calls to express script I was finally told that they had it however the Dr didn’t check a particular box needed to process the authorization. At that time I contacted the Dr and he immediately corrected his error. Had I been given the correct information from express scripts when I originally inquired the situation would have been taken care of immediately and I would not have had to pay out of pocket.
Additionally while trying to rectify the situation with the preauthorization I was told by express scripts to have it filled at the local pharmacy and I would be reimbursed.
I have repeatedly been refused reimbursement for both expenses.
When I was originally refused for the $171.93, They claimed the prescription was refilled too soon, which was incorrect. The prior fill was dated 10/12/22. I again contacted express script was told to resubmit and it would be paid. I again was denied and again called express script. At that time I was told to file an appeal which I filed on 8/04/2023 and this time I was denied because I used a coupon when filling the prescription. I was never told that if I used a coupon I would not be reimbursed
The reason for the originally refusal for the $338.96 was because the pre authorization wasn’t received when the script was filled. Yet the pre authorization was dated 11/22/23. After talking again to express script I was told it was an error and to resubmit, and then was refused because the rec’t submitted was not correct. However the rec’t was from the pharmacy and the only one I have. I was then told I was denied because I used a coupon when filling the prescription.
I then contacted customer relations via email since I the only phone number I could find was to member services.
Below is a list of those emails again with no resolution
Date Email From Information Requested from Express Script Date I replied
8/27/2023 Natalie Patient's name 8/28/2023
Date of birth
Telephone #
8/29/2023 Keira Name and strength of medication 8/29/2023
8/31/2023 Chunmei Thank you for your online inquiry.
I sincerely apologize. I will be happy to assist you.
I wanted to discuss this issue with you over the phone; however,
it is outside the timeframe that I am able to contact you.
Our team makes outbound calls between 8:00 am - 7:00 pm in your time zone.
9/7/2023 Jada Medication name and strength 9/7/2023
Full prescription number
Claim number and date
9/10/2023 teri Patient name 9/10/2023
Member ID number
Name of the medication
Strength of the medication
Patient address and phone number
Prescriber name, address, and phone number
Description of the reason for the review request
Desired outcome: reimbursement
