Payments to Elgin pharmacy withheld amid constant audits

Payments to Elgin pharmacy withheld amid constant audits
The audits haven't found anything, but that hasn't stopped the audits. (Source KSWO)
The audits haven't found anything, but that hasn't stopped the audits. (Source KSWO)

ELGIN, OK (KSWO) -An Elgin pharmacy believes they are being forced out of business by a national insurance company they say is treating them unfairly.

Since December, the Elgin Discount Pharmacy says every prescription filled for Blue Cross Blue Shield customers has been audited. The manager says auditing does happen in the pharmaceutical world, but it generally happens less than one percent of the time. The manager says he has reached out to the insurance company and the pharmaceutical company it owns, called Prime Therapeutics, but has never received any response as to why they are constantly being audited.

On top of that, the manager says Blue Cross Blue Shield is withholding all payments to the pharmacy, including those from other insurance companies by telling the third party used to connect the groups that they cannot give any money to the pharmacy until their audit is complete.

Voice mails were left and emails were sent to Blue Cross Blue Shield and Prime Therapeutics, but neither company has responded. This is exactly what Elgin Discount Pharmacy manager Dusty Deevers says he has been dealing with for the last seven months.

"It's to the degree that if something doesn't change very soon, and I don't find a solution, we will have to shut down. It's debilitating our business," Deevers said.

Deevers says in 34 years of business, they have never had this problem with any other insurance company.

"This is the only one that's doing this to us, all of the others are just standard audits. We get the documentation back, they get us the response, timely…this is not timely," Deevers explained.

Deevers says this has been happening for seven months and is escalated by the fact that he cannot get any answers about why the problem continues.

"We've sent in all the necessary documentation that shows legitimate prescriptions and we're still awaiting a response. During that time, they're withholding all of our payments, so we're having to self-fund everything that goes on at the pharmacy," Deevers said.

The pharmacy works with the insurance companies through a third party business. Deevers says right now, Blue Cross Blue Shield is telling that third party that the pharmacy might owe money to them when their audit is done and that they must withhold money from every other insurance company until the problem is sorted out. Deevers says the business is struggling to get by with paying employees and still serving customers the prescriptions that they need.

"You're looking at all these small towns around this area being serviced by our community, and there's a lot of folks that won't or can't drive to Lawton and need the immediate care of a local independent pharmacy," Deevers said.

Deevers doesn't believe he is asking too much of those auditing him.

"We just want a response…to be treated fair, it's unjust. It's repressive," Deevers said.

Deevers says they have reached out to Blue Cross Blue Shield by both telephone and mail for the last few months, but have yet to receive any explanation for the 100 percent audit rate. He says they just want things to get back to normal so they can continue to serve the Elgin community.

Deevers believes this is a problem that several other independently run pharmacies have also encountered.

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