- Compounded Prescription Reimbursement (pdf)
- ERISA Claims and Appeals Procedures (pdf)
- Reimbursement Suggestions and Resources (pdf)
- Sample Letter (pdf)
- FDA Compounding Letter (pdf)
O’Brien Pharmacy cannot bill insurance directly, but we are happy to provide you with a claim form to help with reimbursement.
You deserve the safest, highest-quality compounded prescription possible. That is our primary concern, but secondary to the insurance company. Billing insurance directly requires a contract that effectively lowers our standard of care. We will not compromise your health by having someone other than a qualified pharmacist make your prescription, or by using anything less than the best drugs, formulas, techniques and equipment available. That’s why we are a PCAB-accredited pharmacy for all levels of compounding.
When you submit the bill, we can continue to provide the highest level of quality, safety, accuracy and service. If you receive a rejection or denial, information on this webpage and the attached documents might help. Erroneous rejections are common and can be challenged.
Virtually all policies have some level of coverage for compounded medications. A compounded medication is still just a prescription and under the terms of your policy, it should be covered. However, there can be restrictions in you benefits that may exclude a particular kind of compound. It is best to check your benefits manual for this information. A phone call to your insurance carrier may result in misinformation and leave you with no documentation. Written communication is always best, and the Insurance Commissioner for your state is there to protect YOUR RIGHTS, not the insurance company. Please see the attached documents.