Getting a doctor to reimburse for an incorrect prescription

[grizmonkey]

This past weekend, my son got pink eye which caused his eye to be glued shut when he woke up.  My wife searched the net for information and found that it can be caused by many things - bacterial or viral infection passed on from another person, allergies, or irritants in the eye.  

Being Sunday, we took him to Pediatric After Hours in Waldorf to get it looked at.  The Physicians Assistant there determined that, since he had been outside the day before in all the pollen, it must be caused by allergies, though he's never had them before.  And from what my wife read, the oozing discharge is only evident in viral and bacterial infections, not from an allergic reaction.  

The PA prescribed some eye drops that were supposed to do little more than soothe the irritated eye.  Upon picking up the filled prescription at Eckerd Drug in Waldorf, I was told I had to pay $35 for a 1/2 ounce bottle of drops.  When I asked if my insurance declined to pay for it, the pharmacists assistant showed me that the insurance company paid about $45 - a total of $80 for 1/2 ounce of eye drops.

We were skeptical about the PA's assessment, took him to our regular pediatrician on Monday, who determined that it was a bacterial infection, not from allergies.  He prescribed antibiotic drops that only cost us $10.  

(Sorry this is so long) So now I'm fuming that I had to pay $35 for something my son didn't need, which was based on a doctor's incorrect diagnosis.  Has anyone else had this happen?  I'm thinking of calling my insurance company.  I'm sure they would like to get their $45 back.

[missi1013]

I would be mad too! You should call the insurance company and see if they will help you.

[sunny]

If the bottle is still sealed try to return it to the pharmacy. Usually they will take meds back 1) If they were not a special order item 2) If they are still sealed as most eye drops are pre-packaged and pre-sealed. If Superfresh was still in business in Leonardtown, George the Pharmacist that use to work there would take them back in a heartbeat and would even make the calls to your insurance company for you, but alas, Superfresh closed and took So.Md.'s only caring Pharmacist with it. Good Luck.

[grizmonkey]

Unfortunately we decided to give the PA the benefit of the doubt and try the drops, so they aren't sealed.  I called my insurance company who told me I can send a letter to their appeals department.  I'll give that a shot, and if it doesn't work I'll just send a bill to the doctor for my share of the prescription along with an explanation of why I think they should pay for it.

[GreenHornet]

Yes.