Insurance made me pay OOP for meds, PBM refusing to reimburse

Hi,

I am with Molina medicaid of WA. Earlier this year I had to be out of state long enough that I would need to pick up more meds. I requested a vacation override so I could have them all at the beginning of the trip. Molina denied this, saying that they cover everything within the country, even if it’s in a different state, and that I would be fine. Believe me, I grilled them on this, and they swore up and down that It Would Be Fine. (I did not believe them, and every pharmacist I talked to had a laughing fit at the very idea, but there was nothing I could do.)

I made sure to have my prescriptions sent to big pharmacies, e.g. Kroger-owned stores or Safeway. As expected, my insurance did not work at any of them because they were not registered with WA medicaid, so I had to pay OOP.

Molina doesn’t make it clear how to get reimbursed, but after a long time I was told that CVS is Molina’s PBM and I had to submit my reimbursement claims to them, which I did. Today I received a reply stating that I am not being reimbursed because the pharmacies were not registered with WA medicaid. (What a revelation. /s) It wasn’t explicitly labeled as a EOB, but I think it is? The reason-code was “890: Pharm not Enrl St Mcaid”.

Does anyone have an idea of who I should be focusing on calling to get reimbursed here? Molina is the one that refused to do an override and caused me to have to pay OOP, but CVS apparently handles the cost of medications for Molina…

If you know anything, please let me know, I’m a bit desperate.

Age: 31

State: WA

GRI: unemployed/$0