Guest guest Posted December 30, 2006 Report Share Posted December 30, 2006 Hi, I am trying to fill out my insurance company's paperwork for reimbursement for Falls Pharmacy compounded DMPS. Falls refused to submit it or the nystatin they compounded for my daughter (despite saying they'd do the latter) because " insurance companies never pay for DMPS and almost never for anything compounded " . I have Medco coverage and the form has explicit instructions for what to do with compounded presriptions, which implies there must be coverage for them in at least some cases. Falls is being less than helpful in supplying all the info I need to submit the claim. (The insurance company wants all ingredients listed on the receipt. Falls has given me just a handwritten note with no signature listing active ingredients only. I'd like to know what the fillers are for my own sake, but I haven't gotten that yet.) The total bill is $455, so I'd at least like to try. Is this just a waste of my time and theirs? says some people have been able to get coverage, but not many. Thanks, W. P.S. I suspect the DMPS filler is FOS. Does anyone know if that is a bad idea with a Citrobacter infection? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2006 Report Share Posted December 31, 2006 , I also have Medco coverage and started with Falls as my supplier of compounded DMPS. I found them helpful in the sense that my script specified exactly what to fill it with as pecified by Andy and they complied. Medco DID pay for DMPS from them, but not for ALA which is over the counter except I needed very small dosages. But then I shopped around and found The Compounder in the midwest U.S., a very reputable firm that beat the Falls price by about a third. I gave Falls the option of matching the price but they could not and I switched pharmacies. Medco needs an 11 digit # (I forget right now what it is called)for any compounded med. Once they got that which the pharmacy provided, they were very happy and payed 100% minus my co-pay of $15. Also, Medco offers a direct ordering service from them especially if you have a recurring order. They will provide 90 day supplies overriding the 30 day max. you usually get. So I gave them my typical script for DMPS to see if they could fill it for cheaper, and their pharmacists could NOT fill it so I continued to use the Compounder. (So if they encourage that, tell Medco someone else inquired and it's a non-starter). Compounder's # is . Their site is http://www.thecompounder.com/ Good luck with the Falls - sounds like Medco should cover if you can get Falls to comply with their rules. Really not sure why they are not listing the filler - that's their business. Let me know how you do. --Jeff > > Hi, > > I am trying to fill out my insurance company's paperwork for > reimbursement for Falls Pharmacy compounded DMPS. Falls refused to > submit it or the nystatin they compounded for my daughter (despite > saying they'd do the latter) because " insurance companies never pay > for DMPS and almost never for anything compounded " . I have Medco > coverage and the form has explicit instructions for what to do with > compounded presriptions, which implies there must be coverage for them > in at least some cases. > > Falls is being less than helpful in supplying all the info I need to > submit the claim. (The insurance company wants all ingredients listed > on the receipt. Falls has given me just a handwritten note with no > signature listing active ingredients only. I'd like to know what the > fillers are for my own sake, but I haven't gotten that yet.) The > total bill is $455, so I'd at least like to try. > > Is this just a waste of my time and theirs? says some > people have been able to get coverage, but not many. > > Thanks, > > W. > > P.S. I suspect the DMPS filler is FOS. Does anyone know if that is a > bad idea with a Citrobacter infection? > Quote Link to comment Share on other sites More sharing options...
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