health insurance keeps thinking I have dual coverage when I don’t anymore (CA)
I'm not sure what flair to use. I choose Prescription drug benefits because the current problem is a prescription getting cancelled due to supposed dual health insurance coverage…
I previously had dual coverage with Blue Shield of CA under one or both of my parents until I turned 26 in mid-2023. Once I turned 26, San Francisco Health Plan (SFHP) – medi-cal became the primary and only health insurance. The health coverage never lapsed since SFHP was the secondary insurance at the time.
In October, I had to pay out-of-pocket for a doctor's visit. SFHP said I had dual coverage (I didn't) and my medical group (AAMG) was not helpful in resubmitting the claim to get it covered by insurance. The medical group stated that the system showed only SFHP-medi-cal and that insurance covered the visit, but the doctor's office said it didn't so I just paid the bill.
Now, I am running into a similar problem again. I usually get the same prescription in 2 different dosages each month. One dosage was filled, but the other wasn't?! The pharmacy started filling the prescription twice, then cancelled it both times. I called and the pharmacist said insurance thinks I have dual coverage. Today, I called SFHP and they also said I only have one active insurance showing (SFHP) and that my medi-cal was also active. It also showed the Blue Shield has been inactive since the month I turned 26. My Walgreens account shows that the primary insurance is SFHP-Medi-cal, but I also see the 2 blue shield of CA insurance info and something labelled "CHIPPO" on file.
Is this a health insurance problem or a pharmacy problem? Every time I call, each person says I don't have dual coverage. However, I keep getting mail or something declined due to supposedly having dual coverage. Should I reprint and mail the Coordination of Benefits form stating that I don't? Do I call the pharmacy? What steps am I supposed to take when this keeps happening?
submitted by /u/underweather813
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