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Please read this letter from the Editor first:

"Letter from the Editor"
Loyd V. Allen, Jr., Ph.D., R.Ph.
Editorial: Insurance Discrimination! Time for a Class Action xyzxyz?


Universal Claim Form and Explaination of Customer Rights (make note of page 2 the last 2 sentences of the article)

This is for everyone that has a prescription benefit as part of their health insurance.
If your Dr. orders a prescription compounded medication for you, and you have a prescription benefit as part of your insurance coverage, your insurance has the obligation to reimburse you less your copay after you have met your deductible for the year.  Period! If they give you any hesitation whatsoever, send them this letter from Dr. Allen(see attached).  Dr. Allen is not just someone with an opinion.  He is a Full Chair on the United States Pharmacopeia Committee ( the USP committee).  This committee is the Gold Standard in the U.S. and even parts of the rest of the World for developing pharmaceutical standards.  Dr. Allen is also the Editor in Chief of the IJPC peer reviewed Journal.  If anyone in the world is an expert on these subjects, he is.  If they still give you any problems, simply tell them that they leave you no choice but to file a complaint with the “state commissioner of insurance” in your state.  In Colorado, if you Google “colorado commissioner of insurance online complaints” you get http://www.dora.state.co.us/pls/real/Ins_Complaint.Submit_Form .

VERY IMPORTANT!!  DO NOT, I repeat, DO NOT file the complaint unless they refuse to help you (ie. Reimburse you)  There is no need to if they suddenly change their minds and decide to reimburse you.  If they will not, go right ahead and file it. Just be sure to let them know clearly that they can avoid the complaint if they simply reimburse you like they should have in the first place.  Be certain that they understand it is entirely up to them (complaint or no complaint).  You (or someone on your behalf, maybe your employer) paid them money to provide you a prescription benefit.  All you are asking them to do is provide the benefit that has been paid for.  The insurance company does not want a complaint filed against them (a black eye for them).  They are also required by law to respond to the Commissioner about the complaint that is filed (this requires their time and money to do so).  It is far less problematic for them to just reimburse you.

 
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