CVS and/or Minute Clinic
DH took our son to CVS for his school immunizations. He approached the pharmacy counter and was told "Sign in over there, someone will be with you soon." and sent to a small waiting area just a few feet away. There were 3 chairs, a table with a computer for signing in, and a small room on either side of the table so that people can maintain privacy while receiving treatment. Cool. A man (turns out he was a nurse practitioner) came out and asked what they were there for, DH said two vaccinations for school, and the guy said he'd be right with them. He took DH's driver's license and insurance card and ran that while DH signed the consent forms. DH asked him if there was a copay and he said no, routine immunizations are covered in full. He gave DS the shots and they left.
I just received a bill for $200. Apparently we weren't at CVS, even though we were literally still within the waiting area of the pharmacy inside the building. Nope, our insurance was billed for "well child care" at "Minute Clinic", a medical clinic that is out of network. They refused the claim. We had no idea we'd "left" CVS and gone to some clinic. Nobody said a word about it. A customer service rep at my insurance provider told me to call them and ask them to resubmit the claim under my pharmacy benefit instead of medical, as that would cover the shots. The Minute Clinic rep said "I'm sorry but I'm unable to do that because we're strictly a medical clinic." I'm afraid I was very frustrated and replied "You're a kiosk
within a pharmacy
." She reiterated "No, we're a medical clinic, and that's how we bill."
I called the manager at the CVS who said "There are some types of shots we're unable to do at the counter and when that happens we do send people over to Minute Clinic. I'm sorry if you weren't informed that you were leaving CVS and going to the clinic. I'm afraid there's nothing I can do, they handle their own billing." Back to the customer service dept. at my insurance provider, they said all I can do is write a detailed letter and submit it to the "reconsideration" board and hope they'll agree that DH was misled and authorize the claim.
Oh, and what really fired me up, when I was speaking to the rep at Minute Clinic I asked her why did the nurse take our insurance card, run it, and tell DH there would be no copay? She said "We can take
whatever card you have but we can't guarantee your provider will pay it." I suppose she's got me on a technicality, but I feel deceived. We carry a huge nationally recognized plan. I find it very hard to believe that the nurse didn't know they wouldn't pay. And if he had no way of knowing, then why did he tell DH there was no copay and it would be covered? Every time I've received medical care the provider (well, the front desk) has always ran my card and told me how much the copay was. I assumed it was because their computer was communicating with some computer somewhere at my insurance company and that one was saying "Yep, they're covered, here's how much to charge them..." Obviously that didn't happen here so I don't understand why he told DH it was covered in full. The least he could have done is said "I'm not able to check your benefits from here but it should be covered, you'll need to check with your insurance plan to be sure." DH would have checked, he would have found out it wasn't going to be covered, and he would have walked!
*edited to add - We always check the "provider directory" via our insurance plan's website before we go anywhere. We've literally never had a claim denied before, for anything, in the 8+ years we've carried this insurance plan. The whole reason why we went to CVS was because that's where we get everyone's prescriptions filled so we already knew for sure they were a preferred provider and everything would be covered. In case I made it sound like DH just walked in, handed someone his insurance card, and assumed he'd be told if there was a problem.