What should I do if my insurance company has made a clerical error but is not fixing it?
Question Details: I got health insurance through my work back 4 months ago. Every month since then I have had issues getting my prescription medications. Since last month, my pharmacy reports that my coverage ended in January and can't bill my insurance. Every time this has happened, I called the insurance company and was told thatthere is a clerical error that "should be fixed tomorrow". When I follow up with my pharmacy the next day, the same error persists and I have never gotten a follow-up e-mail about the issues. Since the medication that I need for my wife is critical for her daily functioning, I have had to resort to using a discount card program to get the medications each month. This process keeps repeating. What should I do if my insurance company has confirmed that there is a clerical error but continues to do nothing about it? I'm paying my expensive premium, however I'm not being covered for what I need and there seems to be nothing I can do about it.
You can sue your insurer for any costs you incur by buying the medicines elsewhere or in some other way, if the insurer should have covered them for you. You would sue based on breach of contract, or them violating their contractual (the policy is a contract) obligations. You would sue for the difference between what you paid elsewhere/otherwise for the medicine vs. what you would have paid had it been properly covered (e.g. an copay). Unfortunately, if they will not voluntarily reimburse you for any cost you incur, suing them is the only effective way to seek compensation.