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CVS Carmark Prescription Service


electronic prescriptions to caremark cvs

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CVS Caremark
Painesville, Ohio
United States
I had a doctor send a prescription for Prednesone to CVS Caremark Pharmacy. The pharmacy checked my insurance administrator (CVS Caremark) and rejected the insurance billing. I was provided a rejection notice that stated 70-Product/Service Not Covered- physician -diagnosis required. Now mind you this was sent from a doctor with an EMR system (I know the code was in their system). But, CVS just rejected the insurance payment and didn't really explain why. I needed the medication and paid the out of pocket (a peasly amount). Perhaps that rejectiion code is a tipoff that it may be a drug covered by Medicare B. But as a consumer, how do I know. And, I was told that if it was covered by Medicare B, it would be handled by my signing an additional form. After two days of working with CVS Caremark Plan Administrators handling AT&T retirees, I'm still not clear why the insurance failed (company or Medicare). I know my doctor's system had the Medicare number. I know my doctor's system had the diagnosis code in it. Why wouldn't a company able to process a Medicare B prescription not have a fully functional EMR prescription interface? It makes me believe they have backroom problems with their systems (opinion). I'm still waiting for an answer. One today was maybe the pharmacist should have caught it. Maybe...but if we are all going to electronic records and drug ordering, should they have to when their focus should be on the correct prescription and not billing? I have no faith in the CVS Caremark backroom billing processes or their Administrative efforts. Why? Their processes are utter failures as discussed here. Unfortunately, as a consumer I'm locked into them as they are the plan administrators for AT&T (no real choice). Any company that goes with these guys, in my opinion, ought to have their corporate heads examined. Their processes aren't customer focused now. Just think when full EMR electronic processess gets really going! Even their website when you ask for a price of Prednisone, it comes back with physician diagnosis required. Unfortunately, there is no place to enter it on the site even if you do notice it. How does that help the consumer/your employees?
Complaint comments Comments (1) Complaint country United States Complaint category Drug Stores


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N  20th of Oct, 2012 by    0 Votes
I also use CVS pharmacy, only because its so close to where I live.

I also have had numerous issues regarding the pharmacy staff telling me my insurance denied to pay. And the last time I did this, I actually called and spoke to a management member of my insurance company. And they told me this prescription WAS covered by my insurance and that they never even received a request for payment on this prescription!

So, I think its not a case of your insurance wouldnt pay for it...I think its a case of CVS trying to bilk people out of money by lieing to them and telling them their insurance wont cover something. OR, its because thier staff is SO lazy, they cant be bothered to check to see if your insurance will cover it.

And yes, I DO keep them updated on my insurance changes.

If it werent for the fact they are only half a block away, I would switch.

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CVS Pharmacy / CVS Health Logo CVS Pharmacy / CVS Health
Customer Care Service
CVS Corporation, Customer Relations, One CVS Drive
Rhode Island
United States - 02895
+1 800 746 7287
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