Will my insurance reimburse me for SingleCare?

In this article:

• Why use SingleCare
• Reimbursement eligibility

In this article

• Why use SingleCare
• Reimbursement eligibility

When you use SingleCare to save on your prescriptions, you’re opting for substantial savings instead of using your insurance. The choice is considered an out-of-pocket or cash purchase by your insurance company. However, there’s a silver lining: You may be eligible for reimbursement by your insurance company if you’re willing to do a little paperwork.

Why use SingleCare

Using a SingleCare coupon can help you afford medication if you encounter any of the following situations:

• You have a high deductible insurance plan
• Your insurance doesn’t cover a specific medication
•  Your insurance copay is higher than the SingleCare coupon cost

It’s important to note that this process differs from “split billing,” which involves using two different insurance plans. SingleCare is not an insurance provider; it is a savings tool.

Why is SingleCare cheaper than my insurance?

SingleCare’s prices can be lower than your copay because we negotiate discounted cash prices directly with pharmacies, which can sometimes beat the fixed copay set by your insurance plan. Insurance copays are determined by your plan’s formulary tiers and cost-sharing structure, not the pharmacy’s lowest available price. If your medication falls into a higher tier, is subject to a deductible, or is not covered at all, your out-of-pocket cost through insurance may be higher than a SingleCare discount price. 

The tradeoff is this: When you purchase medication outside of your insurance plan (also known as “self-pay” or “cash-pay”, the expense doesn’t automatically count toward your insurance deductible. Meaning, even if you save using a SingleCare coupon, you won’t be inching closer to your costs being more fully covered by your insurance.

However, there may be ways to enjoy the benefits of SingleCare while still making progress toward your deductible. Though it’s not guaranteed. Most major insurance companies have a prescription reimbursement request process. In other words, you can ask to be paid back when you pay for medication. Depending on your plan, the insurance company may either reimburse you or apply the cost to your deductible, or both.

RELATED: 5 health services to do after you’ve met your deductible

When are you eligible for reimbursement?

Whether you can receive reimbursement from your insurance company depends on your specific policy. Generally, you might be reimbursed if you:

• Used a non-participating or out-of-network pharmacy
• Paid for a compounded medication
• Were waiting for approval of a prior authorization request
• Didn’t have your insurance card at the time of purchase
• Purchased medication outside the U.S. (if your plan has international coverage)
• Were billed incorrectly by the pharmacy

You can also inform your insurance company that SingleCare provided a lower price than your insurance rate, which may open the door for reimbursement, even if you receive prescription benefits through Medicare or Medicaid.

How do I get reimbursed for a prescription?

To apply for a health insurance reimbursement, simply:

1. Complete the prescription reimbursement form.
2. Attach the pharmacy receipt for the prescription (and keep a copy for your records).
3. Submit the receipt and form to your insurance company, following the instructions provided.

Forms and addresses may vary by plan, state, and PBM (pharmacy benefit manager). Confirm the correct information with your insurance provider before submitting paperwork.

Keep in mind that most insurance companies have a deadline for submitting after you fill your prescription, so be prompt. Then, wait and see.

Insurance policies vary, and outcomes may depend on the agent handling your claim. Your request could be declined, or the company might apply your payment to your deductible, request more information, or issue you a reimbursement.