Roberto is a healthy individual covered by an Obamacare health insurance plan. However, one Wednesday, he experienced severe chest and back pain that seemed like a heart attack. Along with intense pain, his blood pressure was dangerously high. A friend, who is a nurse, advised him to go to the hospital immediately: “Better head to the ER because, if it’s a cardiovascular issue, you’ll get the right care there.”
Roberto drove himself to the nearest hospital. There, he underwent various tests: bloodwork, blood pressure monitoring, and an electrocardiogram. The ER doctor determined it wasn’t a cardiac issue and prescribed medication to relieve the acute pain: a muscle relaxant and a painkiller for the tightness in his back. “Take them for five days,” the doctor instructed.
When asked which pharmacy he preferred to pick up his medications, Roberto replied, “There’s a Walgreens near my house.” The doctor searched by ZIP code and sent the prescription to that pharmacy.
Roberto left the hospital around 3:00 p.m. and received a message from the pharmacy stating, “Your medications are ready.” He headed to Walgreens, but after waiting an hour in line, the pharmacist told him, “Sorry, we don’t work with your insurance.” Stunned and in pain, Roberto asked what he should do. The response was blunt: “Go to CVS and ask them to call us to transfer the prescription. Next,” they said, calling the next customer.
Despite the pain, Roberto drove to the nearest CVS. After waiting 20 minutes, he convinced the pharmacist to call Walgreens to transfer the prescription. However, he received more bad news: “This won’t be ready today; maybe tomorrow or the day after. Transfers take time.”
Desperate, Roberto explained that he urgently needed the medication. The pharmacist replied, “Sorry, the hospital made a mistake, and now it needs to be fixed. I’ll call, but I can’t guarantee it’ll be ready today. If you’re in a lot of pain, you can pay for the medication without using insurance. One costs $150, and the other $230.”
Roberto waited another hour and a half at CVS. Finally, the pharmacist informed him, “The other pharmacy hasn’t called to authorize the transfer. They know you’re here waiting.”
Frustrated, Roberto returned to Walgreens, where he found the staff chatting among themselves. After some insistence, they called CVS to authorize the transfer. The pharmacist defended himself, saying, “They didn’t tell me it was urgent. Head back there; I’ll call them.”
Roberto returned to CVS and, finally, around 7:30 p.m., was able to pick up his medications. He only had to pay $8.50 thanks to his insurance, but the exhausting process left a bitter taste and a valuable lesson.
This bad experience could have been avoided if Roberto had previously verified which pharmacies work with his insurance. That’s why it’s crucial to confirm not only whether your primary care physician is included in the plan but also whether nearby pharmacies are compatible with your insurance.
Overlooking this seemingly minor detail could expose you to the bureaucracy of transferring prescriptions between pharmacies, especially if you urgently need medication.
The enrollment period for Obamacare 2025 is open until January 15. Contact Univista Insurance for more information or to enroll in a health plan.
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