ALFs and health insurance

mabelgirl

I finally am moving my mom into an ALF in a couple weeks. I knew I would have to change her physician simply because of location but wasn’t expecting issue with prescriptions. The ALF has an in house pharmacy they work with and if we don’t use them it’ll be additional charge to get her prescriptions filled elsewhere. I contacted the health insurance company because I can’t find the in house pharmacy listed as one of their providers. That was like a waste of TWO hours! I was just curious of others experience with changes like this when moving into an ALF.

H1235

My mom has great prescription coverage, but prescriptions must be filled at a few particular pharmacies. The AL facility works only with one pharmacy that her insurance company will not work with. So mom can pay full price at their pharmacy or I can continue to get her prescriptions filled at her pharmacy and bring them in. Of course there is an extra charge for this (not sure why, I’m doing all the extra work). It’s a lot of extra work for me. They don’t give me any kind of receipt so I’m always concerned they will claim I never gave them the medication. I take a picture of the medication next to the sign in page. I also never expected this. Hope you can work something out.

Anonymousjpl123

That’s so frustrating! I did have to change my mom’s prescription provider but fortunately her AL worked out the insurance information for me. I can’t actually remember when or how it happened. They do so little (see other posts) but somehow this they took care of. I’m so sorry you have to deal with this in addition to all the stress of the move! I would talk with their resident services manager or nursing director it seems they should be able to at least help you navigate it.

psg712

This sounds typical of many facilities. My mom's MC doesn't have an in-house pharmacy but has all meds for residents supplied by a mail-order place that is local (so they can call them to deliver short term meds for acute needs). The facility just changed their pharmacy contract to someone else, so I had to sign electronic forms to supply insurance information, credit card for balance billing, etc. The only other choice is for me to get them filled myself and deliver them. It seems safer to stick with their system.

JeriLynn66

Talk to the Business Office person. State Laws about prescription medication administration differ depending upon which State you are in. The business office should be able to assist.

harshedbuzz

Laws around filling prescriptions vary state to state and different carriers do have preferred pharmacies.

At dad's SNF, the meds were ordered in through their provider as would happen in a hospital. At his MCF, you could use their pharmacy or your own, but they wanted pills made into pill packets. Mom elected to let them handle it as she transferred his care to their affiliated doctor.

If you can't get answers from the business office and you otherwise like the facility, I'd look at which is the lower cost— meds through them (full price) or providing your own and paying both their fee and her copay. I'd also investigate whether you can get any cheaper paying out-of-pocket. I have pretty good prescription coverage, but I can get my generic BP medication for less paying cash than using my plan at the same pharmacy and I can get my Synthroid via the manufacturer's direct to patient plan for $5 less than with my insurance.

HB