Alexandria, VA asked in Civil Litigation and Insurance Bad Faith for Virginia

Q: Can I sue my health insurance company or the pharmacy if they refuse to provide or cover items listed under my plan?

I pay into a health plan that is supposed to give me a discounted rate through a specific pharmacy. However, this pharmacy has on numerous occasions refused to provide medical equipment for diabetes, that is clearly covered under my contract. The additional money that I pay monthly is supposed to ensure that I not only receive the equipment, but also that I get a specific rate on that equipment. I have been denied services at multiple locations, even though I meet all of the necessary criteria. The reason given thus far is due to the "pharmacist's discretion." However, after speaking with the health insurance company and the corporate office of this pharmacy I was reassured that company policy has not been followed. I have very strong reason to believe that this issue also involves racial discrimination (on the part of the pharmacy), due to being told I was denied due to appearance. What should my next move be?

1 Lawyer Answer
F. Paul Maloof
F. Paul Maloof
  • Alexandria, VA
  • Licensed in Virginia

A: I think your next step is to contact the Office of the Attorney General of Virginia and make a formal complaint. They can investigate your claims and bring an action if they find a violation of your rights, and more importantly, they do not charge for their work. If you cannot get satisfaction from the Office of the Attorney General, you may have a right to bring a civil rights lawsuit in a federal court in Virginia.

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