I missed a payment, so my benefits have lapsed, but I haven’t met my Rx deductible yet. Does this matter?
Hi, I’m new to having insurance. I’ve watched the BDG video, so I’m somewhat familiar with the terminology. I recently got a new prescription, but the pharmacy is having trouble verifying my insurance. I have a payment scheduled, but I was told by an insurance representative that it won’t process until tomorrow. As a result, I won’t have any benefits until the payment clears. Since I’m far from meeting my Rx deductible, I understand that I’ll have to cover the full cost of my medication. If I need to pick up my prescription today and will be paying out of pocket anyway, does it matter if my benefits are inactive until tomorrow?
It sounds like you’re in a bit of a tricky situation! Since your benefits have lapsed due to the missed payment, you won’t be able to use your insurance coverage until that payment processes and your benefits are reinstated.
Regarding your prescription, you’re correct that if you haven’t met your Rx deductible, you would typically be responsible for paying the full cost of the medication out of pocket, regardless of your benefits status. If you need the prescription today and decide to pay for it out of pocket, it might make sense to proceed with that, especially if delaying could impact your health.
Just keep in mind that once your payment processes and your benefits are reinstated, you’ll be able to use your insurance for future prescriptions. You might want to check with the pharmacy to see if they can hold off on billing your insurance until your payment is processed, but if you need the medication now, it’s likely best to just pay for it outright.