cii rx and insurance limitation

[mona2004]

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If for a Cii rx in CA insurance doesn't pay the whole quantity can we split the rx to once under insurance and one cash. how about the medical insurance. should we send a TAR if insurance doesn't pay for the quantity on the rx. if pt agree can we call MD and change the quantity to the one that is covered? (under straight medical quantity written and dispense should be the same).

 

[Carboxide]

We never split. Either they can have the whole script for cash or the partial under insurance.

 

[mona2004]

We never split. Either they can have the whole script for cash or the partial under insurance.

According to the script 2011 p.15 it is
Legal but didn't specify about Cii.
" prescription is written for a quantity larger than the insurance will cover, can it be split into two prescriptions, with one being billed to the insurance company and the other being paid by cash?
A. Yes. There is no legal prohibition of this procedure."

 

[All4MyDaughter]

According to a memo we got from our BOP, this is permissible by our state and DEA regs ONLY if you can assign the same fill date and RX number to the insurance fill and cash fill. If you can't, it's not allowed. I will dig up the actual wording later. Currently in bed on pain meds. Not C2 though.

 

[owlegrad]

I have never known us to split and bill seperately.

 

[Carboxide]

According to the script 2011 p.15 it is
Legal but didn't specify about Cii.
" prescription is written for a quantity larger than the insurance will cover, can it be split into two prescriptions, with one being billed to the insurance company and the other being paid by cash?
A. Yes. There is no legal prohibition of this procedure."

Is that a state thing? I don't live in CA.

 

[Farmercyst]

Is that a state thing? I don't live in CA.

Yes. "The Script" is the CA BOPs newsletter. So that is CA specific.

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