Can my insurance company covers zero of the only medicine I have ever been prescribed to control my asthma?

The last 3 years I have been asthma free thankfully and have not needed an albuterol inhaler hardly at all. This past week I came down with bronchitis and was prescribed to use the medicine again. Although I have not had symptoms the past 3 years because I have had asthma attacks in the past my doctor like me to have one always just in case of emergency. Today I went to the pharmacy and was informed that provider actually covers not 1 cent of that medicine which they had never seen before. I work hard and try not to complain so this is hard for me but it just seems so unethical. How this can be a legal practice?

Asked on November 29, 2018 under Insurance Law, California


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 1 year ago | Contributor

An insurance, including health insurance, policy, is a contract. The insurer has to pay for those things or medicines, and only those things or medicines, which the terms of the policy and any attached schedules require then to cover. Ask the insurer to explain why they believe they do not have to cover this medicine and provide any supporting documentation; if you disagree with their assertion, contact your state's department of insurance to inquire into filing a complaint.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.