Claim denial, Home Infusion Specialty Pharmacy Medication
Hi everyone, was hoping to get some thoughts about a situation. Recently changed employers and along with that came a change in insurance. I receive home deliveries of a high cost medication that I administer myself at home. The last delivery I received while covered was on 5/24, insurance coverage for that plan ended 5/31. A months supply of the medication was delivered on that date and the infusions are done by myself at home with no assistance. The EOB came and there were charges on there for 6/1, 6/8, and 6/15 for home infusion, injection that are not covered. What I'm struggling to understand is what these charges are for since I had already received the medication on 5/24 and no one but myself is administering it so what is the service they are providing at that point? Appealed once so far and it was denied stating that the request for payment was processed correctly. The associated code on the EOB for the "services" not covered is CAD 150 (Benefits for this service are denied. This service was received after your coverage was no longer in effect.) Any advice or background information would be much appreciated, thank you!
submitted by /u/BackgroundWay9247
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