• Omeed

No Longer Billing Compounds & Here's Why

Due to the unethical practices of health insurance companies, we can no longer bill compounded prescription claims to your insurance.

This is because health insurers conduct abusive prescription audits in order to find obscure clerical errors, such as a typo, or something as inane as your address missing from the prescription, in order to claw back (i.e. take back) reimbursements paid to us on your behalf.

Health insurance companies or their "pharmacy benefits managers" (PBM) will charge the pharmacy an "audit fee" - in essence they charge us for conducting the audit they initiated. What's worse is they force us to sign banking agreements that give them bidirectional access to our bank accounts so that they can withdraw funds at any time. If we don't agree to their terms then they won't allow us to bill for any of their patients; essentially they're using you, the patient, as a hostage.

As a result, we have lost thousands of dollars, and can no longer take the risk associated with billing your insurance for your compounded medication. Unfortunately, insurers are notorious for auditing compounded claims. A primary reason for this is that insurers have contracts with the drug manufacturers, incentivizing the insurer to cover a specific manufacturer's drug, while pushing the same drug from other manufacturers, or even similar drugs, on to the insurer's "non formulary" list, i.e. their list of not covered medications. All of that thanks to their contracts with a Big Pharma companies.

Since it is an election year, we have a prime opportunity to call our elected officials, or 2018 candidate of your choice, and tell them if they want your vote, they’ll need to show you legislation presenting checks and balances on the insurance industry before they get your vote. Tell them you have no way of telling where your premium dollars go. Insurers pay pennies to the people responsible for your care, and pocket the majority of the premium as bonuses and profits.

One of the only industries to profit in the billions of dollars during the 2008 financial crisis was the health insurance industry. Act now and call your representatives, or 2018 candidate of choice, and demand that health insurers be regulated to spend your money on health care, not their executives’ homes, cars, boats, and off shore accounts.

Finally, demand a cap on health insurer executives salaries; there is no good reason why the CEO of ExpressScripts (CEO: $14.8 million), CVS/Caremark ($12.3 million), and OptumRx (CEO: $66.13 Million) should be making tens of millions of dollars off the backs of sick Americans. That's money that could reduce the cost of health care for every American, but instead it finds itself in a few men's pockets.


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