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2016.10.10Negligence? Or Am I Just Getting Fleeced?

I called in a refill for my prescription from the bariatric clinic yesterday afternoon. This morning I was contacted by the clinic.

The nurse explained that she can only approve enough additional medicine to take me up to the date of our next appointment. She added that I’d have to pay full price for the medication, even though I’m receiving only a fraction of the 30-day prescription.

After some discussion, I learned that the reason I’m now in this position is because the clinic scheduled my upcoming appointment more than 30 days after my last one. In other words, the clinic just jacked the price of my medication up 300% because they pushed my appointment out.

It’s important to note that the clinic had just prescribed me a scheduled substance which cannot be prescribed for more than 30 days at a time, and knew that my insurance plan refuses to pay for the medication. The medicine was described by the clinician as the medicine they prescribe most. I feel like there’s no way they couldn’t have known that scheduling my follow-up appointment so far out wouldn’t have these ramifications.

The clinic should have anticipated the impact of scheduling my follow-up greater than 30 days out and made some arrangement to account for the gap without impact to me. Instead, they have forced me to decide between paying an exorbitant amount for the medication to cover the gap, or going without the medication.

I’ve contacted the patient advocate and explained my view. The advocate was going to discuss things with the clinic. What I really want is some arrangement by which I will not be financially accountable for the additional medicine required to get me to the next appointment. There’s probably not much chance of that happening. But at least I’ve made the advocate aware that I’m also likely not the only one this will happen to.

A few hours later, I heard back from the patient advocate. In short, I was told there was nothing they could do for me. I suggested the advocate consider talking with the clinic and ascertaining how many people were scheduled for follow-ups in excess of 30 days to determine how big of a problem this really is. Meanwhile, the advocate weakly suggested the my pharmacist may not charge me the full sum, given the quantity of medication I'm due to receive. We'll see.

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