I have Blue Cross Blue Shield HMO insurance. If I get acne medication from a different doctor (not my primary), will I still receive coverage for it? Is acne medication even covered?
First an HMO requires that you get referrals from your primary care physician. If you did not get a referral to see a different doctor you may not have coverage for the doctor bill.
Second, is with regard to the prescription. Every HMO I am familiar with includes prescription drug coverage but this coverage is subject to the HMO's drug formulary. A drug formulary is a list of drugs that are covered by the HMO. If your drug is on the formulary you will be covered subject to the provisions of your prescription coverage (i.e. copay, generic vs name brand)
~~Yes as long as your doctor is a BCBS provider all meds will be covered under your insurance.
Acne medication is covered, there is a little glitch on some. There is one that women use to lessen their wrinkles, Retina-A. If you are over 30 your doctor may need to "justify" the reason for it to be prescribed is for Retina-A. It is something your doctor would know how to do.
Some name brands medications may not be covered (this would depend on your policy of covered medication). If it is declined for coverage, then you would need to ask the doc to prescribe a generic or one that is listed under your covered meds list. If none of this applies, then no worries you will be covered.~~
Comments
You have presented two issues in your question.
First an HMO requires that you get referrals from your primary care physician. If you did not get a referral to see a different doctor you may not have coverage for the doctor bill.
Second, is with regard to the prescription. Every HMO I am familiar with includes prescription drug coverage but this coverage is subject to the HMO's drug formulary. A drug formulary is a list of drugs that are covered by the HMO. If your drug is on the formulary you will be covered subject to the provisions of your prescription coverage (i.e. copay, generic vs name brand)
~~Yes as long as your doctor is a BCBS provider all meds will be covered under your insurance.
Acne medication is covered, there is a little glitch on some. There is one that women use to lessen their wrinkles, Retina-A. If you are over 30 your doctor may need to "justify" the reason for it to be prescribed is for Retina-A. It is something your doctor would know how to do.
Some name brands medications may not be covered (this would depend on your policy of covered medication). If it is declined for coverage, then you would need to ask the doc to prescribe a generic or one that is listed under your covered meds list. If none of this applies, then no worries you will be covered.~~
Do you have prescription coverage? If you do, it's quite possible it will cover even your acne medication.