On state insurance, pharmacy says I have other coverage, am unable to get info on what it is - "G.H. Commercial?"

[dither]

Hey everyone, I'm hoping I can finally get some answers here. I turned 26 last spring, and got on a state health insurance plan that June (Apple Health, WA state.) I also work at at Kroger/Fred Meyer store, but declined being signed up for Kaiser through work as I had already signed up for state insurance at that time.

When I go to pick my prescriptions up, the pharmacy is unable to bill my insurance properly, and they are getting an error on their computers that I have other coverage. I've called my union, called Kaiser, talked to my HR person, talked to people at Apple Health and Coordinated Care (my provider). \

I was able to get an override through the pharmacy solutions line, and they were able to bill my insurance only with a one-time override, but I obviously don't want to have to do this every month. The weird thing is, this only happens at the pharmacy, and not for other appointments where my insurance is billed. My state insurance coverage is fine otherwise, I have a card, I have a proof of coverage letter and have had other appointments since this issue has been happening.

I thought it might have been the pharmacy at first, but I switched to the Kroger pharmacy, and am getting the same error. I called my provider again and they did some digging, and were able to give me a bin number and told me that I have extra coverage under "GH commercial", but I'm unable to find any information about an insurance company of that name or why I'm signed up for it, and I've talked to everyone I can think of.

Is this some sort of separate coverage through the state that I'm supposed to be using at the pharmacy? Has anyone else ever ran into this issue? It's been so frustrating, and nobody I talk to at my work or the pharmacy or my insurance provider seems to know what to do! Thank you for any help.

 

[mountaintrip98]

@dither Did you at one time have a commercial policy under your parents? If this is referring to "G & H Administrators" it's a secondary commercial policy some smaller employers buy to supplement a boilerplate primary policy that they buy. If that's the case G & H should have terminated you at the same time as the primary, but they may not have, or they did and the pharmacy didn't update the record.

 

[dither]

@mountaintrip98 Yes, I was under Premera from my mom, and she works for the school district. I’ve talked to them and they said they terminated me, but maybe I can call back again and ask about the other one. Thank you!

 

[resjudicata]

@dither Call Customer Service for Apple Health 1-800-562-3022. Describe the issue and tell them you need help reporting you have no third party insurance.

 

[dither]

@resjudicata I talked to Premera, my old insurance, once again and they told me to firmly tell the pharmacy that I have no other coverage and for them to delete anything other than Apple Health from my account- they told me they would take care of it, and that it's usually up to the customer to get it sorted, but I've already talked to everyone and they all told me it couldn't be done! So weird. I'm also wondering why the pharmacy never told me it was that easy before. Must have been some weird miscommunication going on.

 

[resjudicata]

@dither Does Apple Health have the third party insurance listed on file within the billing system? Because if they do, no matter what the pharmacy does, the claim will get kicked back.