Case Study 3
Claim Summary:
An HSA Member with a chronic condition had an issue with prescription refill authorization. Recent insurance changes through Employer, resulted in denial of medication. Member had a week of medication and, neither his HR dept. nor his physician were able to solve issue.
Remediation:
- Obtained copy of member’s records and submitted documentation to member’s IPA for urgent review on terms of medi- cal necessity
- Received approval from Medical Board and Medical Director in 3 days
- Located a pharmacy in area to fill prescription
- Member had refill 5 days after contacting us