Case Histories

Appealing Prescription Limits A Case History of an Employee at a New York Textile Importer

Issue: After an insurance carrier change, an employee of one of Schulman Insurance Brokerage’s clients was denied coverage for the quantity of medication prescribed for her condition. Her condition required daily medication, while the new coverage only covered up to eight doses per month. Her doctors submitted an appeal, which was denied.

Measures/Methods: The employee contacted Schulman Insurance Brokerage, and our advisors began discussions with the insurance carrier as well as the prescription vendor.

Solution: Through Schulman advisors’ relationships and knowledge of the health insurance industry, they were able to come to a viable solution. The advisors determined that the employee’s health care plan would allow eight doses per prescription but as many as four prescriptions per month.

Outcome: The employee can now utilize her healthcare benefits to fill as many as four prescriptions per month using her co-pay. This saves her about $355 per month.