Posted by: Liza | 2009-03-12

Med-Aid and medical-legal question

My med-aid took 2 weeks to approve new chronic medication. I had to re-fax the prescription 3 times during this time. I also went and bought a couple of the VERY expensive tablets on 01/03 to tide me over until the approval. On Friday the 6th, the pharmacist conditionally gave me some more tablets until the approval. With approval, the pharmacist subtracted the amount of tablets he gave me on the 6th, and put a claim through to the medical aid for a whole months'  supply, giving me the balance of the tablets. Now even though the chronic approval has been back-dated to the 23rd of February, the med-aid will not reimburse me for the tablets I paid cash.

To get to the point - the consultant at the call centre now told me that the pharmacy has to reimburse me for those tablets and subtract it from the tablets I get. Only problem - I' ve already received the tablets. AFAIK it is also illegal for me to take the tablets back to the pharmacy and be reimbursed. Does anyone know for sure whether it is illegal?

This whole saga has me so tense. I am absolutely and truly sick with trying to sort this out!

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Our expert says:
Expert ImageCyberShrink

Years ago I realized that about the only thing you can't insure yourself against, is damage caused by insurance companies.
Sounds like your medical aid is being thick-headed and plain stupid, and one should appeal this decision --- they are not entitled to damage your health by delaying approval, or to expect you to cary the cost of THEIR delays. By reimburse, don't they mean the pharmacy should refund you the cost of those earlier tablets, rather than to take them back ?

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Our users say:
Posted by: **** | 2009-03-13

A pharmacy is by law not allowed to take medicine back that has already been dispensed for obvious health reasons.

You' re medical aid, if you have a receipt as proof of payment is obliged to pay you back , read thru the benefit schedule that you received from them, If they refuse to re imburse you speak to a manager and if that does not work report them to the medical aid council

Reply to ****
Posted by: Kelly | 2009-03-12

I really dont get this...
Why are they making such a big fuss about this.
If it is that you paid the pharmacist for some of the pills and the medical aid has paid the pharmacy then the pharmicist should reimburse you what you have paid as they will receive payment from the medical aid.

If you have paid for all the pills your should be reimbursed fully by the medical aid.

Which medical aid are you on?
It is not illegal to return it though

Reply to Kelly

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