Prescription Insurance Mixup...Who's responsible?

Anyone out there who can give some advice on this?

SWMBO got a new job last year, and since we were on her insurance our prescription drug insurance changed. We made the change at our pharmacy (big, national chain) and our new insurance also supposedly called them to verify the change.
Well sometime around October we got calls from the old insurance company trying to collect money. Apparently for several months after the insurance was supposed to be changed prescriptions were still being charged to our old insurance, and the old insurance was paying for them. So then they figured out the error and wanted us to repay them by collecting the money from the pharmacy ourselves, we even got letters from a law firm hired to collect the debt.
To me this doesn't sound like our responsibility...of the three parties involved it was the pharamacy who billed the wrong insurance and the old insurance company shouldn't have paid them, yet they are expecting us to do all the legwork in having the charges reversed. And of course because we are dealing with a huge chain this is not as easy as it may sound.
Anyone out there with an law/insurance/pharmacy background that can give me any insight on how to handle this? It's not a lot of money, around $500, but I certainly don't want to pay it out of pocket and it's also become a very time consuming and stressful situation to try to resolve.

How much is it? if it can be handled in small claims pay the old company (get documentation of everything) and sue the pharmacy in liars court (small claims). If the amount makes that prohibitive, talk to a lawyer. That would probably be smart since attorneys are already involved.

Also, try talking to the current insurance company as well. Maybe they can work it out. (I know it seems like a long shot).

Keep me updated.

This is absolutely the pharmacy's fault. Additionally, they divulged private information (prescription information) with the insurance company after you had ended business with them, this could get them in trouble. You should write a letter to the local manager. If he/she cannot fix the problem, write a letter to the corporate legal department.

I asked my wife about this because she does medical billing for a hospital. Here is her advice:

Call your current insurance company. Ask them why they haven't been paying for the prescriptions all this time. Most likely they will tell you that they never received a bill from the pharmacy for it.

What most likely happened is the pharmacy billed the wrong insurance in error, and the old insurance paid in error. So now the old insurance company wants their money back.

What the old insurance company needs to do is request a refund on what they paid to the pharmacy. Then the pharmacy can bill the correct insurance.

Or the pharmacy (since this was their error) can just send a refund to the old insurance company for what they paid out, and then rebill the correct and current insurance.

I would make the pharmacy responsible for this since it was their error. You advised them about the change and they chose to ignore it. It's not your fault and I'm sure there are government agencies you can contact that might be in your favor. I'm not sure who, but maybe the insurance commissioner can direct you who you would contact. I would also put in a complaint to the pharmacy and make them resolve this with the old insurance company. And any collections agency, credit reports etc. If they refuse to, look into hiring an attorney. This was not your fault.

But first, start by calling your current insurance company and ask them why they haven't been paying for this all this time.

Hope this helps!

Thanks for everyones input.

The charges were from scrips early last year, I think from Feb-April, so thats whats causing some of the hassles in trying to get the money back.

We've just been dealing with the lawyers that the old company hired to recoup their money (and again, it's not a ton of money, just under $500), so maybe we need to bypass them and call the old insurance company and tell them they need to go directly to the pharmacy, it was their error. The new insurance company has been getting the bills for quite some time, so I'm not sure that contacting them at this point would do anything...would it?

More advice from wifey:

To someone who does not deal with insurance companies on a daily basis, (like I do) I know this will be hard to understand. The health insurance industry keeps it confusing on purpose so that we, the patients, will hopefully just give up and pay.

Yes, the old insurance company should have not paid out. Yes, they should have sent a denial to the pharmacy stating, "coverage terminated."

I have worked in medical billing for 5 years now. I do billing and collections for one of Oregon's largest and well known hospitals. I have seen insurance companies pay in error and then request a refund from the provider they paid it too.

Insurance companies paying in error is not uncommon. From their perspective it was not their fault they were billed in error. The only error they made was paying out when they shouldn't have. I have seen Medicare, Medicaid, Blue Cross, VA, United Healthcare and a variety of other insurance companies do the same thing. It happens.

You have to realize that insurance companies have many clients and they can't always catch their mistakes right away. I have seen insurance companies request refunds on accounts 2 years after they have paid out. And legally they have a right to request that money back from someone. And if your current insurance
company isn't going to pay them, they can come after you. That is why you need to start with your current insurance company. Ask them why they are not paying. This was more the fault of the pharmacy than your old insurance company. If the pharmacy hadn't screwed upand billed the wrong insurance, the wrong insurance wouldn't have paid.

Give the attorneys that are working for your old insurance, the phone number for your current insurance. Have your current insurance work as an attorney for you, because your current insurance company is responsible to pay. You pay your current insurance company to take care of your scrips. That makes you their boss.

Yes, it sucks and I hate it when insurance companies, or providers screw over people who don't know anything about how all this insurance stuff works. Don't cave in and let this insurance company get your money even if it is under $500. Would you like me to help you write a letter to them? An attorney will also advise you to start out by writing a letter.

Thanks again for all the info. After my earlier reply to you I talked to someone else who helped me understand why we should contact our current insurance provider. We are either going to get our current insurance and old insurance on the phone together or the old insurance and pharmacy on the phone together. We'll most likely start with the new insurance company.