Insurance lapsed on the day my prescription was refilled. Now I have to pay $1.2k

I am in pretty unlucky position with regards to a prescription of PreP (Descovy) that was filled on a very narrow window in which I was not covered under my primary insurance Blue Cross Blue Shield (Blue Focus). I received a bill last week for an overpayment request of $1,200 from BCBS that I must pay. BCBS had paid for the prescription at the time and is now retroactively requesting money back because that bottle was filled when I wasn’t technically covered. They claim their system is not always up to date so they showed me as covered at the time. I missed coverage by 2 days…

I go through Mistr to receive free Prep medication whom uses Gilead Co-pay to cover the copay ($350) and Broadway Pharmacy to fill the prescription. BCBS covers the rest ($1.2k) I’m a new user of Prep and had no idea Descovy is the name brand. I was not given a choice between Descovy or generic, and because cost would always be $0 to me, I did not care that I was receiving name brand. But holy cow is Descovy expensive. I had no idea my insurance was paying so much for it!

How can I fight this insanely high bill for a prescription medication that is supposed to be free? How can this kind of systematic failure be allowed to happen and absolutely screw a patient like this? My last resort is to beg Mistr to negotiate with BCBS. Barring that I am wondering if filing an official complaint with my states Department of Insurance would make BCBS budge.

I am curious if others have had this experience as well because it’s not like it’s a $100-$200 bill. The cost of medication in the U.S is out of control.

submitted by /u/quillsterz
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