I am a career Firefighter/ Paramedic with a Metro Atlanta Fire Department. My son is a very High-Risk Infant who was born 11 week premature and was 2 pounds 6 ounces. With that came a whole bunch of medical issues of which a very Fragile respiratory system is the most dangerous. My insurance is with United Healthcare and I am so far pleased with them. ( it should be noted that until she had to quit work to care for my son- primary coverage through my wifes employer, was BC/BS and there was nevaer an issue with them or any of their providers) My son has to have Synegist vaccinations every month from October til March as prescribed by Doctors to protect him from RSV, which could be easily fatal to a High Risk Infant. Synegist must be administered every 28-30 days without fail to be 100% effective. nUHC unfortunately contracts with CVS/PROCARE/CAREMARK/PHARMACARE for these type medications and they have to be shipped to the Dr. office. nTo make a long story short. UHC and CVS are currently in a contract dispute(at least in my case) on proper payment amount. Everyone agrees to this fact. Against their contract with UHC, CVS has even attempted to bill me for the difference. It is also an agreed fact that this is a matter of contract negotiations and does not include my son. HOWEVER, according to several supervisory level CSR’s and account reps for CVS, they refuse to send my son’s medication until this med is paid for in full by someone. That’s correct, “we will not release the medication until this is paid in full””. This was on Wed. Feb 18 2009 at 7pm est and the med has to be at Dr. Office by 830AM 2-24-09. Basically

if it is not sent by noon on thursday it will not get there on time. When the CVS rep was presented with this fact she simply said She understood but “”sorry””- She would have a “”supervisor”” call me tomorrow (She never asked for my phone number until I asked what number he was going to call) nLet me be clear. UHC has a contract with CVS to provide certain medications for patients that are sent to the doctor’s office. They have a contract that specifically states the price agreed upon

and that they are clear that no matter how much they charge for the medication

thay will accept the assigned price agreed to by themselves and UHC. That is where the descrepancy is. While on a conference call with a Senoir UHC rep and a Senior CVS rep

they all agreed that this was obviously a miscommunication between the 2 companies and would be resolved at an Administrative level. I the asked for clarification… this was clearly an issue between a provider and an insurance company and either way there was absolutely NO PATIENT RESPONSIBILITY

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