thank you gift ideas?

ToastieSimons · March 2014

Totally random situation. Our pharmacist got audited by our prescription coverage. They denied all of one prescription he made for both my boys. He compounds Prevacid into a liquid for us. He also does this with a muscle relaxer for the boys. They have no issue with the muscle relaxers. But, they have decided they don't want to cover any of the Prevacid, FROM LAST YEAR!. They want him to pay back over $4000 by April 3. Obviously he is going to appeal and both he and I are fighting it.

He is very upset over this. He is an older gentleman and runs a small pharmacy. Very few places compound medication because of the materials needed and he is so accommodating to us. I know this isn't my fault but he's called me every day about how he's just trying to help my kids and this is the thanks he gets from the insurance companies. And if this is what America is, he's scared of where it's going. $4000 would be a lot for him to pay, again a small local pharmacy not a chain.

I think he's a little over the top dramatic but hey, he's such a pleasure to deal with when it comes to the medication that I'm willing to indulge him a bit and I'm happy to call the insurance company or DH's HR if he needs me to. I'd like to give him some sort of thank you when this is all over just to keep everything good between us and so he'll continue compounding our medications.

Any suggestions?

ToastieSimons · March 2014

I Heart The 80s said:

I find this whole thing strange.
Also, have you tried Prevacid solo tabs? Much for effective for reflux. The compounded liquid loses potency. I had to beg our pedi gastro for the solutabs for my son when he was 7 weeks. It was life changing, however.

My boys have special needs and the solutabs don't really dissolve well enough for us. The compounding is easiest. My boys reflux is secondary to their neurological issues and the compounding is effective enough for them.

dmartin726 · March 2014

Just out of curiousity...how did it take a year for them to decide not to cover the compounding of it? Was it ever covered? Or did he just keep submitting the claim, and never get any coverage.?

I think it would be nice to get him a restaurant gift card and maybe a movie gift card. Like a night out or something.

Something sounds fishy with the paperwork/claims. Maybe he didn't submit them correctly or something, just seems strange that the process took a year.

Either way that really sucks, sorry.

ToastieSimons · March 2014

dmartin726 said:

Just out of curiousity...how did it take a year for them to decide not to cover the compounding of it? Was it ever covered? Or did he just keep submitting the claim, and never get any coverage.?

I think it would be nice to get him a restaurant gift card and maybe a movie gift card. Like a night out or something.

Something sounds fishy with the paperwork/claims. Maybe he didn't submit them correctly or something, just seems strange that the process took a year.

Either way that really sucks, sorry.

Nope, we have compounding coverage and I got all the print outs of every claim they accepted. When they audited it, they're claiming he dispensed the wrong medication and the wrong amount. They're claiming they'll only cover $50 of the retail cost and he has to cover the additional $400. Which if he dispensed the wrong medication and the wrong amount why would they cover it at all? I'm guessing they're crabby because this company normally doesn't offer compounding coverage. And he's a small pharmacy. It's $4000. It would cost him more to hire a lawyer to fight it than to just pay it in the end. If it was walgreens they would never get away with it. But this is Towne Pharmacy and there is one old pharmacist and his wife as the cashier.

ToastieSimons · March 2014

I Heart The 80s said:

Oh, Ok. I promise I wasn't trying to be a bitch. We just found the solutabs to work so much better, and I honestly didn't know it was an option until I read about it on TB (LOL).
I apologize for sounding like I was questioning your choice.
But I still think it's odd your pharmacist is putting you in a position you need to send a gift!

sorry, is okay. I wasn't insulted. It is odd, but the poor guy. He's gone out of his way to get us our meds for the boys and he always calls and tells us exactly when they're ready. so it's more that I just to make sure he knows how much I appreciate his commitment to my boys and that I'm sorry this happened.

dmartin726 · March 2014

ToastieSimons said:

dmartin726 said:

Just out of curiousity...how did it take a year for them to decide not to cover the compounding of it? Was it ever covered? Or did he just keep submitting the claim, and never get any coverage.?

I think it would be nice to get him a restaurant gift card and maybe a movie gift card. Like a night out or something.

Something sounds fishy with the paperwork/claims. Maybe he didn't submit them correctly or something, just seems strange that the process took a year.

Either way that really sucks, sorry.

Nope, we have compounding coverage and I got all the print outs of every claim they accepted. When they audited it, they're claiming he dispensed the wrong medication and the wrong amount. They're claiming they'll only cover $50 of the retail cost and he has to cover the additional $400. Which if he dispensed the wrong medication and the wrong amount why would they cover it at all? I'm guessing they're crabby because this company normally doesn't offer compounding coverage. And he's a small pharmacy. It's $4000. It would cost him more to hire a lawyer to fight it than to just pay it in the end. If it was walgreens they would never get away with it. But this is Towne Pharmacy and there is one old pharmacist and his wife as the cashier.

That's crazy. I hope it all works out and isn't too much of a headache.

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