WC AND PRESCRIPTION MEDS.

szemcumo

When we can we pay the first $500.00 on WC claims so they are reported for report purposes only. Of course if it is a major injury it is reported from the start. However when possible we don't. My question is is it out of line for us to ask the ee when filling prescriptions to use their medical card so that the script is filled at the co-pay rate? We then reimburse the ee for the co-pay out of pocket to them. EE since she is on her husbands insurance doesn't want to use the insurance card for scripts filled because as she puts it, it is WC so why should it matter. Her way of thinking not ours.
Any help is greatly appreciated.

LivindonSouth

In my opinion if you are a party to this, you are complicit in defrauding the insurance company who sponsors your group insurance plan. It's all smoke and mirrors and a shell game of shifting or manipulating the money. But, it's never a good business idea to hide money trails or anything regarding insurance policies or employee health. There is much more negative potential in this than there is positive.




Disclaimer: This message is not intended to offend or attack. It is posted as personal opinion. If you find yourself offended or uncomfortable, email me and let me know why.

szemcumo

Just spoke to our carrier and they also said not to use the insurance card. It was not our intention to defraud anyone, just thought of the prescription like any other (wrongly evidently) and thought you would use insurance. We have paid the ee for the full amount and not using the co-pay. Thanks for your quick response.

LivindonSouth

[font size="1" color="#FF0000"]LAST EDITED ON 07-13-05 AT 05:23AM (CST)[/font][br][br]I worked for an employer once who had a similar practice but I think it was the first several hundred dollars. We would call the clinic or hospital and tell them to bill us (the employer) directly and not charge the employee/patient. If a scrip was involved, we also made that call to the pharmacy the company regularly used so that the employee paid nothing and accounts payable handled the bills.




Disclaimer: This message is not intended to offend or attack. It is posted as personal opinion. If you find yourself offended or uncomfortable, email me and let me know why.

szemcumo

Thanks. That sounds good with pharmacy. Wonder with HIPAA if they would do that now? Will check into it.

lorrie

HIPAA should not be a problem for w/c claims. There should be no problem with the pharmacy sending you a bill for the ee for a w/c claim.

LivindonSouth

Incidents of industrial accident or injury (work comp) are not covered by HIPAA as relates to clinics and pharmacies sharing information. Even if the pharmacist is concerned, just tell him to bill the company without providing any information about the patient. Explain to him/her that your company pays doctor and drug bills in cases of comp injuries that are at a minimum dollar amount rather than involve the comp paperwork and payment system.




Disclaimer: This message is not intended to offend or attack. It is posted as personal opinion. If you find yourself offended or uncomfortable, email me and let me know why.

szemcumo

Thank you both!