1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
    Check out the website, Facebook and Twitter. Join in donate and spread the word!
Nitric oxide and its possible implication in ME/CFS (Part 2 of 2)
Andrew Gladman explores the current and historic hypotheses relating to nitric oxide problems in ME/CFS. This second article in a 2-Part series puts nitric oxide under the microscope and explores what it is, what it does and why it is so frequently discussed in the world of ME/CFS....
Discuss the article on the Forums.

Express Scripts Problems? Help?

Discussion in 'General ME/CFS Discussion' started by acer2000, Apr 17, 2014.

  1. acer2000

    acer2000 Senior Member

    Messages:
    594
    Likes:
    247
    Hey guys,

    I chose to fill two prescriptions using the Express Scripts Mail order pharmacy in January. Ever since then, it has been nothing but problems. They overcharged me for both prescriptions, in one case by more than $100. They also sent me a prescription that I didn't even authorize and billed me for it. I have spoken to them more than 20 times, spoke to supervisors, was assured they will fix the issues, but they haven't. I filed a greivance with my medicare drug plan and they said they'd fix it within 30 days (according to their contract), but they haven't. I even disputed the charge with my credit card, and despite them finding in my favor, Express Scripts is still trying to bill me. Has anyone else had this experience with them? Who do I have to talk to there to actually accomplish them resolving their billing errors? What are my options at this point if filing a complaint with Medicare can't even get them to comply? Help?
     
  2. minkeygirl

    minkeygirl Narcissism = lack of self awareness

    Messages:
    2,295
    Likes:
    1,483
    Left Coast
    I dealt with them once and found them to be idiots. Took me forever to get them to stop calling me.

    I'd cancel that credit card to start. Them when you are calm call and ask for a supervisor. Document it all.

    It seems like you've done all your can.

    Have you called HICAP? They can intercede on your behalf. Give them a call. When I get on my computer I'll look for the email and the name of the person who helped me.
     
    NK17 likes this.
  3. Desdinova

    Desdinova Senior Member

    Messages:
    275
    Likes:
    132
    USA
    Express Scripts that's who my employer uses. We had Care-mark for years and they were great. Express scripts had me paying twice the price for PROVIGIL (modafinil) $410 for a thirty day supply.:mad: There advice was for me to go to another pharmacy (chain) and pay out of pocket.

    When I pointed out the my insurance was a High Deductible plan tied to a HSA account. Their reply was "well what's the problem you'll pay the deductible off quickly and get everything for free from that point on". :rolleyes:

    When I tried there mail order service they would lose the prescriptions I sent them. They even insisted that my primary care Dr. and his office were lying when they insisted they sent the prescription to them on multiple attempts.

    I haven't been billed for prescriptions I didn't order though. I gave up on mail order from them. Luckily three pharmacies are almost right out my door.
     
  4. PNR2008

    PNR2008 Senior Member

    Messages:
    442
    Likes:
    692
    OH USA
    Horrible service and yet they call and call and call. They gave me phone PTSD.
     
    NK17 likes this.
  5. minkeygirl

    minkeygirl Narcissism = lack of self awareness

    Messages:
    2,295
    Likes:
    1,483
    Left Coast
    Provigil should be $10 for generic. They wanted to charge me $125 for flexiril I could get at target for $4.

    Don't waste your time lowlings. And call HICAP. There has to be an advocacy group.
     
  6. Desdinova

    Desdinova Senior Member

    Messages:
    275
    Likes:
    132
    USA
    Unfortunately at that time back in 2009-2010? There wasn't a generic in the US yet.
     
  7. SOC

    SOC Senior Member

    Messages:
    5,362
    Likes:
    6,424
    USA
    My insurance company used Medco, which gave me no problems until it was purchased by Express Scripts. Express Scripts has given me nothing but trouble.

    They repeatedly lost prescriptions for expensive medications requiring my doctor to resubmit them multiple times. They refused me meds that my insurance had been paying for and Medco had been supplying. I finally had to get my insurance company to call them and complain, which quickly resolved the problem, although I had to go 6 weeks without my meds while they screwed around. Express Scripts continually delays my prescriptions through some bureaucratic snafu or other, making trouble for both me and my doctor.

    There is no talking to them as the patient. They simply make excuses, refuse to listen, deny legitimate services, and as far as I can tell, flat-out lie. There is no such thing as customer service. It's more like customer denial. As far as I can tell, patients are non-entities to them. The only way we've found to get them to straighten up and fly right is to get the doctor or the insurance company to intervene.

    I hate Express Scripts. :mad:
     
    NK17 likes this.
  8. acer2000

    acer2000 Senior Member

    Messages:
    594
    Likes:
    247
    Heh OK now they doubled their bill for the chargeback they agreed to resolve. Somehow they now think I should pay twice for their mistake. These people are either truly incompetent or they are running a scheme to defraud people. I am not sure what to do at this point... I guess call my state AG and hope they help? Medicare says that if they don't respond to their complaint there isn't anything more they can do. This is nuts...
     
  9. SOC

    SOC Senior Member

    Messages:
    5,362
    Likes:
    6,424
    USA
    I usually attribute these kinds of things to general incompetence, but my experience with Express Scripts makes me suspect fraudulence as well.

    I'd try pushing Medicare (I know, like that works. :rolleyes: But ya gotta try.) After all, they're the ones ultimately responsible for appropriate payment of your healthcare costs, not Express Scripts. Express Scripts, Medicare's contractor, is cheating you. Medicare is responsible for the behavior of their contractors, so they need to deal with this problem. Try threatening to report the Medicare person (the one who claims they can't do more) to their boss for lying to you. Get a name. File an official complaint. Medicare can correct their contractor, someone just doesn't want to be bothered.

    Then, of course, go to your state AG, but make sure you have documentation of all of this nonsense.
     
    NK17 likes this.
  10. acer2000

    acer2000 Senior Member

    Messages:
    594
    Likes:
    247
    Hmm Medicare says I need to file a dispute against the drug plan, the drug plan just makes excuses for Express Scripts says I need to file a dispute against Express Scripts, and Express Scripts thinks I need to file a dispute against Medicare (instead of fixing their own simple billing error). Seems a bit circular.

    Their explanation at this point seems to be that their web site prices are only an "estimate" and that they can charge me whatever they want. In this case they charged 5x what they web site quoted and 2x on another occasion. I was originally told that a supervisor would adjust my bill to reflect the web site price, but apparently their supervisors represent themselves as having the authority to adjust bills, but in reality they can't. As for the prescription that was sent to me in error (and billed), they originally told me I would be given an credit and would be able to send it back. They are now claiming my doctor wrote it for me, then canceled it as an error before it was filled. But they filled it/shipped it anyways and now I have to pay for their mistake. So basically I have some random medication delivered to me because they are stupid.

    On top of that they appear to have applied my copay correctly sometimes, but not others.

    These people are beyond incompetent.
     
  11. acer2000

    acer2000 Senior Member

    Messages:
    594
    Likes:
    247
    Well I filed an official complaint with Medicare. I have now received a credit for the medication they sent me in error. I don't think it had anything to do with the medicare complaint, I had to have a friend in the industry intervene on my behalf.

    However they have now reset my copays so that essentially my medication is at such a high tier that its not covered by my plan. This, despite my plan contract explicitly stating what tier my medication should be and what the corresponding copay should be.

    Also, they are refusing to deal with a bill they sent me to charge me for a chargeback my credit card company issued them in effort to resolve this issue. I wasn't even aware they could go around the credit card company.

    I'm not sure Medicare complaints are even worthwhile. The people who take them have no idea how the system works. And the companies (insurance, benefits managers, pharmacies) also have no idea about them and thus they have no teeth.

    Part D is such a screwed up program. All of this inefficiency and nonsense is being taken advantage of by all these middlemen and its costing taxpayers a fortune and at the same time we patients aren't getting our meds. Its nuts.

    So yeah, I managed to get their attention. But all it did was get me back into their mess of uncoordinated incompetence.

    Anyone who is reading this - DO NOT use this company. I don't care how much they claim to be able to save you on your meds. Its not worth the headache.
     
    Last edited: May 18, 2014
    NK17 likes this.
  12. perchance dreamer

    perchance dreamer Senior Member

    Messages:
    316
    Likes:
    157
    I have a general suggestion: Write a letter of complaint to your state board of insurance and copy all the relevant names you've already dealt with. From what I can gather, insurance companies do not want to get in trouble with the state board.

    I'd also call your state board of insurance first and describe the problem and ask for suggestions. I did this, and the person was very helpful with points to stress in the letter. I got satisfaction when my insurance was at first refusing to pay for physical therapy they had already committed to.

    I got this idea from a great book: http://www.amazon.com/Shocked-Appal...sr=1-1&keywords=shocked appalled and dismayed
     
    NK17 likes this.
  13. Iquitos

    Iquitos Senior Member

    Messages:
    376
    Likes:
    562
    Colorado
    Consider calling your representative(s) in Congress. I've had pretty good response from mine. (But it was about other issues. If you emphasize the idea it may be fraud involved, that might help.)
     
  14. NK17

    NK17 Senior Member

    Messages:
    457
    Likes:
    1,029
    So sorry to read this awful mess you got into because of Express Script @acer2000
    This past winter I too was involuntarily entangled in a big messy prescription order situation with them.
    Both my husband and my ME/CFS specialist (his nurses) had to make tens of calls because of Express Script screw ups.
    Now that we had to switch insurance plan and the very expensive drug is not covered I still get weekly calls from ES!
    I was very happy and it was much more convenient for me to get my RX filled by the pharmacy close to where I live, but Anthem forced us to go through ES.
    This company already smelled fishy back last october, now after reading all yours bad experiences it's evident that there is something really wrong.
     

See more popular forum discussions.

Share This Page