I can't find my old thread where I was complaining about
finding out the cost of a prescript
ion drug before enrolling in a healthcare plan. Well, low and behold, here I am enrolled, dramatic as can be, and about
to run out of my medications.
I'm off the wonderful ride that is medicaid since changing jobs, and now under NYC's healthfirst Bronze plan. $120+/mo, $4000/deductible, covers nothing, welcomes disease to flourish...
Before enrolling, I contacted their pharmacy, my doctor, my CVS pharmacy, examined the drug formulary, anything I could to understand what my cost of Asacol HD or Rowasa might be. Nothing, no one could tell me. Couldn't even access a 'dummy member ID #' to estimate costs. I knew I would have to do a prior-authorization for these medications just like I did while on Medicaid.
Prior-auth and appeal have both been denied by Healthfirst, simply said my plan does not cover them. Now we're submitting a verbal appeal where I let them know I've tried many medications without fair results, caused side effects, and require the medications I'm asking. The formulary does not list any crohns/colitis medications.
I spent 45 mins on the phone with Healthfirst trying to present my case, as my doc recommended.
It's unconscionable that this company would deny my doctor's written request for coverage of these medications, and further suggest I consider 'other options'. This isn't a god darn diet, this is a patient's health. I'm irate over this, and the fact that if this next appeal is denied, I have to submit another to the state of New York, possibly wait 90 days and pay a $25 fee to do so. Unbelievable.
Anyone encountering similar issues? I can't catch a break. I'm in the beginning stages of my career -- one of those people admittedly who works 2 jobs day and night to barely provide, has student loans lined up along with this healthcare mess which is now threatening my ability to thrive. How I was making a similar amount per year and had access to medicaid, while now making just a bit more and have no access to what I need, is absurd.
Post Edited (stereofidelic89) : 6/27/2017 12:59:54 PM (GMT-6)