Insurance foul-up!

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/21/2012 5:23 PM (GMT -6)   
To add to my bad day (my PM wouldn't give me a stronger time-release med and just wanted me to up my BT meds again), my prescription benefits are all screwed up.

I went to the pharmacy to fill my prescriptions and they would only fill for 30 days at a time. The pharmacy said that that is all my insurance allows. But that was never the case before and I haven't changed plans.

I read through my benefits package and there is no quantity limit. The wording for the prescription benefits for 2012 is exactly the same as it was in previous years. I have a high deductible plan ($1500) and pay 100% of my prescriptions until the deductible is met. Thus it is only reasonable that whatever quantity the prescription is written for, since I'm paying 100%, I should be able to fill it in its entirety. (Though this might seem like a bad insurance plan, it actually works out great for me since the premiums are much lower and thus it costs me less in the end)

So, I called my insurance and despite the plan info I have, their system states that there is a max 30day supply. That clearly is an error. It is not part of the written plan nor is it even logical given the nature of my coverage.

I called my employer's HR office and explained what was happening. They confirmed that the plan has no fill limit and said that they will contact the insurance company (BCBS). I also just sent off an email.

Next: back to taxes.

What a crummy day.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 3/21/2012 8:04 PM (GMT -6)   
Hello Cogito!

Well…at least you're on top of it!…that's more than I would have known..or researched. rolleyes

I did notice that my Pharmacy automatically filled some of our scripts for 90 days…they must know what my insurance will fill.

We hope it all works out for you….and Oh!…were working on taxes as well….not fun either. shakehead

SE
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

fireflyhillary
Regular Member


Date Joined Jan 2012
Total Posts : 148
   Posted 3/21/2012 8:19 PM (GMT -6)   
BCBS is known to make changes to peoples plan without notification. But, if your paperwork and the paperwork your HR department has says there is no limit then you need to appeal this with BCBS. If they make a change to the plan, which they can't do until the plans year is up, they have to notify you and your HR department, and they have to do it ahead of time. So, if they change something they have to notify you at least 30 days in advance. I would not let this go and if I were you, I would call BCBS and not leave it up to the HR department. You may want to get their fax number and fax them the documentation you have that says there is no limit on your prescriptions. They are trying to screw you over and think that you will just go along with it, as most people do that know nothing about insurance, but you have to fight this. BCBS is known to do things like this. I hope this gets resolved for you soon.
Current: DDD L4-S1, Arthritis L4-S1, Facet Syndrome, Interstitial Cystitis, Vulvodynia, Restless Leg Syndrome, Bi-polar, IBS, Fibromyalgia, PTSD. In past 6 months have had epidurals, facet blocks and radiofrequency ablation.
Past: Endometriosis, Adenomyosis, Polycystic Ovarian Syndrome. 3 laparoscopies, 2 cystoscopies, total hysterectomy, appendix & gallbladder removal.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/21/2012 8:25 PM (GMT -6)   
While exploring whether I can deduct my zero gravity chair as an "impairment related business expense" I came across an IRS publication that others on this board might find helpful:
IRS publication 907 "Tax Highlights for Persons With Disabilities":

www.irs.gov/publications/p907/ar02.html#en_US_2011_publink10008646
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 3/21/2012 8:28 PM (GMT -6)   
Cogito…you just jared my memory!….how is the chair?….are you happy with it?

…I have been looking at them online…for a long time.

SE
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/22/2012 7:29 AM (GMT -6)   
Thanks for the support fireflyhillary. If HR doesn't resolve it, I'll certainly continue to push.

SE, I am very happy with the chair. I usually start my day with the chair upright. Then when I'm ready to get to serious work, I'll recline it about 2/3 of the way and pull my monitors, etc. into position.

The chair is very comfortable and fits me well, though I have added an additional seat cushion. I definitely can work better from it than anything else I have tried.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16751
   Posted 3/22/2012 4:36 PM (GMT -6)   
My insurance will not fill a script for 90 days unless its using their mail order which I refuse to use. I have had BCBS and Aetna the past 24 years. I tried mail order once and that was it, they changed up my medication claiming they called and talked to my dr when they hadn't. It saved them some money by doing this, so that ended all mail order with me.

I hope you can get this resolved.
Moderator, Chronic Pain Forum & Psoriasis Forum

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/22/2012 7:02 PM (GMT -6)   
Hi Straydog,

My employer offers 3 BCBS plans, two of which have low deductibles, prescription co-pays and 30-day limits (except via mail order).

But the third plan, the one I chose (and have ever since it was first offered in 2008), has a high-deductible of $1500, no prescription co-pays and the paperwork says no fill limits. I pay 100% of the prescription cost until I meet my deductible and then pay 20% of retail.

I tried their mail order once, since they charge less than CVS. It worked out fine, but I found the process stressful and precarious. My Ultram ER was left in my mailbox. I didn't even need to sign for it. Someone could easily have stolen it and it cost around $800! I'm not sure if they can mail schedule II or III meds like that, but it amazed me that no signature was required.

I sent a follow-up email today to my employer but still haven't gotten an answer. I'll give the process a few more days then call again. Very frustrating!


But I did finally file my taxes today. So at least one nagging chore has been taken care of.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 3/23/2012 5:35 AM (GMT -6)   
Hey cogito,

I think we are in one of those parallel universe things today....I have been having tax and insurance issue too...big ones!

My insurance is United, but they made me use their speciality pharmacy for my most expensive meds. The pharmacy is filing for two vials every month, but I only get one. They charge it as if my vial holds half of what they actually do...so it makes sense to them, but not to anyone else. The insurance company approved for two vials a month with no problem, but the pharacist won't fill it because he his lying to get an additional co-pay. He says that they can't break a vial (it's an injection) and that I was trying to get over because my medication would last longer than 28 days if he filled it as written by my Dr, but then he said the had to fill it as written and couldn't give me more than 25 days because that was what my insurance would cover. It makes no sense. I spent three days on the phone with everyone and even filed everything I could think of...but I promise I am not done with these folks.

Anyway, apparently United has some program where you can use a different specialtiy pharmacy after you have had so many issues with the one they make you use and I must have hit the limit, because they changed my speciality pharmacy yesterday. Of course, I'm still stuck with the co-pay on the 25 day supply, but I can't do without my medication (for my pituatary gland) while they continue to figure ways to cheat people.

Also, with insurance, I filed a complaint for fraud against a Dr a year ago and it was just "resolved". They got him.....but then decided I had to be the one to pay him for his charges...hello????? Why would anybody have to pay if the issue was determined to be fruad???? So now we are "working" on that too.

Lastly, someone in HR decided a year and a half ago to change my husband's federal tax withholdings to EXEMPT! We didn't even know and now we have to pay a LARGE chunk to the IRS by April 17th. Of course, we don't have it to send, but the IRS isn't interested in why you owe it...they are interested in you paying what you owe.

I appoligize for jumping into your thread with all my junk. I was simply going to say I understand, but it seems like I had an explosion when I started typing....lol

I honestly do hope things work out for you in this. These insurance companies are making it so hard on honest people by their own dishonesty. Take it as far as you can!!! You are blessed to be a very intelligent person and one who seems to be able to stand up for themselves on issues like this!

Good luck my friend! Give em heck.
Failed TLIF L5-S1, Miltiple Bulges/Herniations, Scoliosis, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, OCPD, GAD, MDD, CFS, TMJ, Migraines, HBP, Idiopatic Reactive Hypoglycemia w/Diabetic reaction to HGH, Bi-lateral CTS (now trigger finger), Edema, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis, Adult Onset Flat Feet, & Vision Issues

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 3/23/2012 10:22 AM (GMT -6)   
Go into your pharmacy and talk directly with the manager of your pharmacy as the
problem might be with them not wanting to fill your scripts your way...Something to check
into and just deal with the pharmacy manager and give him/her a copy of your plan as
they also might be filing it wrong and under a different way, make sure they have the
correct pharmacy numbers for you bcbs health insurance...Something for you to look into as they might have
errors at your pharmacy....Hope it get worked out for you soon...many well wishes, hope you can get
a low pain day soon...
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/23/2012 2:46 PM (GMT -6)   
Hi RetiredMom and Chartreux.

Retired Mom, I hope that the new pharmacy will work out better. Pharmacists should fill exactly as prescribed by the doctor. If insurance won't cover, then the consumer should have the option of paying the additional amount. But as you noted, your insurance covered two per month. Maybe with the new pharmacy, you can coordinate with them regarding the most you can get per your insurance and then ask your doctor to script it that way.

Chartreux, I just heard back from the HR person at work, who said that the BCBS rep claims that I shouldn't be restricted to one month's supply. So, they claim that the error was with the pharmacy. However, I phoned Prime Therapeutics, who is the middle-man between BCBS and pharmacies and according to Prime, my BCBS plan limits me to a month's supply. So, the problem is with Prime it appears and according to Prime, only my employer or BCBS can fix it.

So, I unfortunately have more calls to make.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16751
   Posted 3/23/2012 3:34 PM (GMT -6)   
Cogito, I have to use a specialty pharmacy for my Humira injections, and now have a new one to deal with on that. I always had it where the Humira had to be signed for because a 3 month supply is $24,000. 00. It comes in a styro like cooler with cold packs, has to kept refrigerated. I hope the new ones offer the signature option. I do not think a class 2 can be mailed.

I hope you can get this mess all straightened out.
Moderator, Chronic Pain Forum & Psoriasis Forum
New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, September 18, 2018 8:17 AM (GMT -6)
There are a total of 3,004,238 posts in 329,124 threads.
View Active Threads


Who's Online
This forum has 161731 registered members. Please welcome our newest member, gfdag8966988888@outlook.c.
187 Guest(s), 8 Registered Member(s) are currently online.  Details
OzLyme, PeterDisAbelard., Oligodar, getting by, mareish, ddyss, Mamatomypeas, straydog