Posted in Insurance

Exchange plan buyers beware…

Recently, I had the pleasure of meeting and with a Merk rep, Gina. I always get plenty of reps during my time @ Dr. Celina John’s Office. The visit is usually involves the doctor and the rep. However this time both her and I struck a coversation about medication coverage and pharmacies.

Although, I personally do not have this problem with pharmacies I found out from Gina that she was a victim of a pharmacy charging her a $120 copay for a medication (generic)?!

She, just like many other thousands of people has an exchange medical plan and until recently she thought that she would have no problem of using her local pharmacy for her medications. But to her suprise, she paid a whoping $120 copay for a medication that she thought had no copay at all. Why this happened? Well, it’s because that particular pharmacy was OON (out of network) with the particular exhange medical plan that she acquiered. What?! I personally do not know any doctor office that takes a copy of your pharmacy card. I always ask the patient for their pharmacy information-for escripts purposes.

In the end the moral of the story is that anyone that has an exchange medical plan please call the pharmacy number on your card and find out if a particular pharmacy you are going to use is INN (in network/ participates) with your plan. This way you will avoid those costly $120 copays, like Gina had to pay, and obtain your medication for low or no copay.



My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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