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U.S. Doctors, Pharmacies, and Referral Services >> Open discussion (USA)

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mac61
Newbie


Reged: 10/14/03
Posts: 28
Health Plan Pharmacy Services
      #139947 - 02/20/04 05:29 PM

I'm sure I'm not the only one who received a large packet of information and forms from this pharmacy today. Their consult is $50.00, and shipping as low as $5.00 ground and $10.00 two day air. They didn't give a price list for meds, but I hope they will be as reasonable. Remember, this is Ephy's old pharmacy.

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omega55
Enthusiast


Reged: 12/03/02
Posts: 254
Re: Health Plan Pharmacy Services [Re: mac61]
      #140042 - 02/20/04 09:08 PM

Yep!! I got that same packet mac61 and am considering using them once my refills are done at EPhy. I guess there was a little stepping on the toes here by Health Plan Pharmacy. They cut out the middle guy and decided to set up their own consult shop. I also am getting the impression that you may be able to use your own health insurance prescription plan to pay for the scripts their docs write. There's a section on one of the forms that asks for your health insurance info. If this is true, OMG!! I'd only have to pay $2 per script. It'll be 2 months before I have to do another consult so if someone can find out in the meantime if this is true that would be greatly appreciated.

Funny, after this happened EPhy dropped their consult fee from $60 back down to their old $45 fee. Either way I go it's a win win situation, as far as consult fees go.


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NJ_Hoss
Enthusiast


Reged: 10/29/03
Posts: 263
Loc: USA
Re: Health Plan Pharmacy Services [Re: omega55]
      #140094 - 02/21/04 12:00 AM

A word of caution regaring submitting OP prescriptions for insurance reimbursement.

Insurance companies, for several reasons, provide DUR (drug utilization review) as part of their benefits services, both to ensure that they are not reimbursing for duplicate or inappropriate therapies and as a means of intervening to perhaps recommend treatment changes if it notices a statistically more sucessful, or less expensive alternative. As hedging their bets to pay the very least overall is at the heart of their business, rest assured that they invest a significant amount in some very sophisticated tools designed to accomplish this task.

Should patients be supplementing their care from primary physicians with OP's, be aware that the insurer may not only deny your claim for the OP prescription, but this could have ramifications for other locally-prescribed prescriptions as well. While this is not likely to be a cause of major concern if an individual is obtaining care through a single practitioner through a single fulfillment source, it may become relevant to those whose needs, and means of meeting them, are more complex.


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omega55
Enthusiast


Reged: 12/03/02
Posts: 254
Re: Health Plan Pharmacy Services [Re: NJ_Hoss]
      #140124 - 02/21/04 05:29 AM

Those are very valid issues NJ_Hoss. Thanks for pointing them out.

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Boobetty
Veteran


Reged: 12/30/01
Posts: 637
Loc: The windy City...Boo:)
Re: Health Plan Pharmacy Services [Re: omega55]
      #140206 - 02/21/04 10:58 AM

I also got this big package today, but hum...you do bring up valid points on the insurance issue and if we say we don't have insurance and they are requiring you to sign the page to let your doc give up your records then they will see what kind of insurance you have. Our family insurance is terrible at this point and we are paying up the yinyang and have to get tripple orders all at one time and so my doc will not prescribe me my pain meds much anymore. It seems that they are trying to stay in the guiedlines of law's but I dont think that many will jump on the band wagon with these folks. You can just go to your doc and get all of this...oh and if anyone uses them please let us know how it goese. One more thing. Funny how they say they are a pharmacy with a doc on board...isn't it suposed to be the other way oh well...have a great pain free day all of you that are suffering the affects of chronic pain disease like me... Boobetty

By the way, I would wonder how they got my addy. I never orderd from them I just inquired to them about there pricing and shipping and started to fill there form out after AAA went bust...hummmmmmm somone is watching me (song)

--------------------
living with pain is not living at all. Boo


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