Medco strikes again!

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Zanne
Veteran Member


Date Joined Apr 2005
Total Posts : 3763
   Posted 6/21/2010 8:06 AM (GMT -7)   
I just picked up my new supply of B12 and syringes and my insurance didn't cover either of them. So of course I had to call to find out why. So the customer service rep just says, We don't cover injections. WHAT? How many drugs are by injection? I think if we try we could come up with 10 or more with out even trying. Blanket statement, we don't cover injections, she said it over and over. So I snapped. I made her look up 3 different injection drugs and guess what, they were all covered, then I made her get a supervisor to explain to me how much of an idiot she was. I had to make my point.

The supervisor was an idiot too, he wanted to find me an alternative drug that might work that would be covered. Hello, nothing else will work. If you are the supervisor for a pharm co, shouldn't you have a basic knowledge of drugs! I had already told him what it was and what it was for.

So now I have to write a letter of appeal and try to get prior authorization, or I have to start going to the doctors office every other week again for the shots. I wonder which is cheaper: $30 in supplies for a years worth of B12 shots, or an office visit every other week?

This is why I will avoid mail ordering all medication from Medco for as long as humanly possible. I HATE MEDCO
Suzanne

CD 20 years officially, 30 unofficially. 3 resections '93, '95 '97
Managing with strict low residue diet, keeping symptoms to a minimum. All test show small amount of ulceration, still have occasional blockages. But still have a great time with my 2 daughters and husband!


Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 6/21/2010 8:12 AM (GMT -7)   
When I was getting Mtx, Medco would cover the vials of Mtx but not the syringes.  They didn't even carry them to where I could pay full price for them.  What's the point of getting the meds if you have no way to get the meds in your body??!!  So, I had to pay for them out of pocket at a local pharmacy.  I totally feel your pain...I cannot stand them either but our insurance makes us use them for anything we take for more than 3 months.   

Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 


grumpygi
Regular Member


Date Joined May 2010
Total Posts : 266
   Posted 6/21/2010 6:46 PM (GMT -7)   
Zanne: Wow! New levels of incompetent insurance companies - can't wait for this to be happing at the national/governmental level.

I would think that you could complain to the better business bureau or complain at the state level (part of the reason insurance companies can't cross state lines). If you are employed, you can complain via filing a formal grievance process to your employer, this helps the company make different decisions when negotiating annual contracts. Keep a running list of the issues, the dates and names of who you talked to, keep written letters, maybe even ask this insurance company to mail the statement to you about specific covered meds and treatments. Get as much in writing as possible, save all correspondence and start talking to upper managers, find one that you can consistently talk to. Sometimes companies farm calls out to resource centers with marginal English skills. You have the right to ask to be routed back to the United States (I do this with Sallie Mae). This type of business practice certainly flirts on the edge of negligence, provides a consistent pattern of intentionality to deceive the consumer while preserving insurance profits all at the expense of human pain and suffering.

My other suggestion: call your congressman or senator with this type of issue. They have office staff dedicated to intervening on behalf of their constituents to affect meaningful change. Good luck and stick to your guns! (and I am guessing you are a U.S citizen)
newby

Post Edited (grumpygi) : 6/21/2010 7:58:42 PM (GMT-6)


tewcute
Regular Member


Date Joined Mar 2010
Total Posts : 300
   Posted 6/21/2010 6:48 PM (GMT -7)   
I have a similar situation with medications. I am not on injections but they consider anything taken for more than 3 months in a row to be a maintenance drug. Unfortunately they sent me no letter or anything explaining this so I kept going to the pharmacy. On the fourth refill the girl at the pharmacy got this worried look on her face and said "um..how much do you normally pay for the Lialda" I just knew something was coming. Get on the phone with insurance and I find out I was supposed to get this and all other meds online. Gee, thanks for the notice! Luckily our customer service lady was super nice and overrode the denial to get me my meds and give me time to get this handled. The sadest thing of all?? I work for the insurance company and I did not see this coming. So I totally get your annoyance on this one!
Dx with crohns February 25, 2010. But suspect I had it since 2002 with very mild symptoms.
4 lialda a day.
3 entocort daily for the next few months
hyosamine for daytime
Bentyl for evening
Multigen


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 6/21/2010 7:50 PM (GMT -7)   
Geez. As if you don't have anything better to do.

That's really not good enough.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


Sniper
Veteran Member


Date Joined Feb 2004
Total Posts : 6518
   Posted 6/21/2010 8:11 PM (GMT -7)   
Been there done that. I had one tell me that a certain med was not covered after they told me it was. I said to her, how was I to know this when I was told just before I got it that it was covered. She said, well, you know now. They never did pay for it either...@#%&
If we would read the secret history of our enemies,we would find in each mans life sorrow and suffering enough to disarm all hostility.


sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 6/21/2010 8:16 PM (GMT -7)   
Gosh! that's terrible! And, completely senseless. Oddly I also have Medco and have felt them more reasonable than Blue Cross/Blue Shield was when it comes to Rx. They cover my needles for my osteoporosis med (they are a prescription themselves, aside from the Forteo). They don't cover my mtx needles/syringes, but they are only 25 cents => $1 per month, so I don't press it. When I had the B12 shot, they did it at my doctor's office, so it was covered.

I had plenty of problems with Blue Cross' Rx program though! I would constantly have to call/appeal.

Hope it gets resolved quickly! It's crazy that we have to spend extra time doing stupid stuff like this.
1 fistula, crohn's colitis, limited to large intestine
Compounded budesonide 3mg/daily, Cimzia, MTX . Dx Osteoporosis 10/08 started Forteo 1/27/09


lamb61
Veteran Member


Date Joined Jan 2005
Total Posts : 1718
   Posted 6/22/2010 3:34 AM (GMT -7)   
yes, they ARE jerks. And no they don't have to have pharm knowledge to supervise -- just able to manage people. As I've said in the past I used to work for a division of Medco --- the CSC's only know what's in front of them on the screen unfortunately. Could they tell you why they were previously covered and not now? If there was a change why weren't you notified. I'd try back again today and see what answer you get this time --- JMHO.

Good luck --
 


Zanne
Veteran Member


Date Joined Apr 2005
Total Posts : 3763
   Posted 6/22/2010 5:15 AM (GMT -7)   
Everything was covered under my old insurance, which was the last time I filled the script, but my husband's company was bought out in January and all our insurance options changed. I picked the high deductible option for many reasons, but one of them was because I didn't want to be forced to deal with Medco. After getting started I found out that while I get all of my RX's at the local pharmacy and don't have to do mail order, Medco is the administer of the pharmacy part of the insurance, so I have to deal with them anyway.

I worked in customer service/sales for over 20 years and it just is my personal pet peeve when people just read from scripts and don't even hear what they are saying. At first I was being told they don't pay for injections, then it was they don't pay for vitamins, its all crazy because at this point they have awoken the sleeping beast. I will toy with them just for the fun of it. The cost of the syringes and the B12 is negligible, but I wanted to find out if it was a mistake or if in fact it was not a covered drug. Now that I have their "reasons", let the games begin. devil
Suzanne

CD 20 years officially, 30 unofficially. 3 resections '93, '95 '97
Managing with strict low residue diet, keeping symptoms to a minimum. All test show small amount of ulceration, still have occasional blockages. But still have a great time with my 2 daughters and husband!


Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....


CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 6/22/2010 6:58 AM (GMT -7)   
Its been several years now, but Medco did cover my B12 and the syrnges from my local pharamacy.

When I first started Forteo Medco didn't pay for my syrnges, but my local pharmacy told me to have my doctor write a specific script for them and Medco did cover them. I was on Forteo for 3 years. I had tremendous improvement of my osteoporosis the first two years, negligible improvement the third year so had IV bisphosphonate the next two years and lost ground drastically so was fortunate to be approved for a fourth year of Forteo - and Medco is not covering the syrnges again. Will try having my doctor write a specific script for the syrnges and see wha' hoppens.
My computer says I need to upgrade my brain to be compatible with its new software.


lamb61
Veteran Member


Date Joined Jan 2005
Total Posts : 1718
   Posted 6/22/2010 7:15 AM (GMT -7)   
C2 is right, have your doc write a script with specific diagnosis. Forgot to mention that. I'm going to have to have my DH endo do that for his Vit D script -- vitamins aren't covered under his plan. But he needs due to osteo and hypercalcimia.
 


Zanne
Veteran Member


Date Joined Apr 2005
Total Posts : 3763
   Posted 6/22/2010 7:27 AM (GMT -7)   
I forgot about that. I'm pretty sure they covered my script for Vit D. Now I'm really fired up. I do have a specific script for both the B12 and the syringes and they still didn't cover it. I have an email in to the rep who works specifically with my husbands company at the health insurance company, so when she gets back to me I will make all of these points. Thank you all. As I said, the cost is almost beside the point because both the drug and syringes are cheap, its the principal and for sport now.
Suzanne

CD 20 years officially, 30 unofficially. 3 resections '93, '95 '97
Managing with strict low residue diet, keeping symptoms to a minimum. All test show small amount of ulceration, still have occasional blockages. But still have a great time with my 2 daughters and husband!


Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....


Sniper
Veteran Member


Date Joined Feb 2004
Total Posts : 6518
   Posted 6/22/2010 8:38 AM (GMT -7)   
Thats what I'm tallkin bout. Love the thrill of the hunt . If they cant stand the heat , they sould not be in the forest fire thats coming. Way to go Suzanne. I had a battery charger stolen from my boat long ago, and they caught the guy and he was supose to pay restatuion for the things that he had stolen or damaged . Well, I didn't get anything so i found out who his probation officer was and called him. He told me he doubted the guy would pay me as the judge seldom worried about such things as long as he payed the fine. I told the probation officer that I would be payed , and he was not doing his job and making sure the guy met the terms of his parole . He hung up on me soooooo I made a call to the judge that tried the case. Hey, its all public record all you have to do is look it up at the court house .....Got a check the next week. As you said, its the principal.
If we would read the secret history of our enemies,we would find in each mans life sorrow and suffering enough to disarm all hostility.


HabsHockeyFan
Veteran Member


Date Joined Jan 2006
Total Posts : 3130
   Posted 6/22/2010 9:05 AM (GMT -7)   
I just went on MEDCO site as I have them too.  They have a price and availability.  They also covered it at my retail store.

Dx'd '90 (emergency rupture), symptoms ignored long before that, '03 fistulas and bad flagyl reactions, B12 weekly, Pentasa, cholestyramine, iron and vitamin supplements. 
Prepare for the future, but live in the present


sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 6/22/2010 9:46 AM (GMT -7)   
It's funny how the same Rx insurance can be so different for each of us! If you have a script they should cover, end of story! When I first found out that the high risk insurance pool in WA had Medco (just moved from OR, high risk pool is run by Blue Cross), I heard all sorts of nightmares about how I needed to get Rx mailed to me to be covered. I've just gone to my local pharmacy and they cover. in fact, I've met my out of pocket, so I don't pay for anything Rx anymore. Even Forteo, which I used to pay a $50 co-pay. Now it's covered 100%. Call and give them heck Suzanne!

(Side note, ChronieToo, can I email you about Forteo? I was told I could only stay on it for 2 years. I'd so much rather continue longer. What an amazing drug. Though, I haven't had my second DEXA yet...)
1 fistula, crohn's colitis, limited to large intestine
Compounded budesonide 3mg/daily, Cimzia, MTX . Dx Osteoporosis 10/08 started Forteo 1/27/09


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 6/22/2010 10:06 AM (GMT -7)   
I had a prescription for the syringes and Medco actually mailed it back to me saying that they don't cover syringes or carry them.  I can get up to 3 months of prescriptions at local pharmacies and Medco is the one who pays for it, but they still would not cover any of the cost of the syringes at Walgreens, so I paid out of pocket.  The really bad thing is that is cost a whole lot more to get them with a prescription than it costs if you just ask to buy a pack of syringes for "diabetic" purposes without a prescription.  Granted, they keep a log of your name and may end up questioning someone who buys what they consider to be too many, but it's still cheaper than buying the specific ones the dr. writes a script for.  And, my script was for a few hundred and I found out I had to stop taking mtx right after I bought them.  So, I have a huge supply now and no use for them...isn't that the way it normally works?  =) 

Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 


grumpygi
Regular Member


Date Joined May 2010
Total Posts : 266
   Posted 6/22/2010 7:20 PM (GMT -7)   
Sniper: you are a gem! There is right and then there is right.
newby

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