Prescription drugs can play a major role in a successful recovery from a work-related injury. And fortunately, prescription medication is one of the benefits available through New York's workers' compensation program. But if you want to make sure that you have your pharmaceutical needs covered, you need to understand how the system works.
First, in order to get the medicine you need, you have to file a claim. Some insurance carriers have contracts with pharmacies or pharmacy networks. When this is the case, the insurance company is required to provide you with all the information necessary for you to pick up your medicine.
Once you file your claim for reimbursement or payment for your medicine, the insurance carrier has 45 days in which to pay the costs as outlined in the Pharmacy Fee Schedule. However, if the insurance carrier determines that the prescription is not intended to treat a work-related illness or injury, the claim may be denied. The carrier must let you or the pharmacy know that the claim is not being paid and why this is the case.
At this point, you may be held accountable for the costs of your medications. However, all is not lost. The insurance carrier may also ask you to provide more information that could help you establish your claim.
As we all know, prescription medication can be extremely expensive. But if it is necessary for your recovery, you should not have to do without. Nor should you have to pay for something that you are rightfully entitled to.
If you have filed for workers' compensation benefits, only to have some or all of your claim denied, you may want to seek the representation of a New York attorney who has experience helping injured workers get what they are owed.