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.


  • 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

Money Saved:  $4,800/year