Company just switched to UHC insurance claiming it would be cheaper. It isnt.
Anyway.....they also dont cover Humria which is needed. That stuff is $7000 per month. They force you on to their biosimulars from a pharmacy they control/own (Optum). That means the drug for them is cheaper and the cost to you? They can charge whatever they want. It looks like its going to be around $1075 per month for the first 3 months and then it goes into %20 coinsurance where they cover only 20% of it until you reach your max out of pocket of 6k. Either way...im banking that its going to be 6 grand plus premiums each year or around 7700 per year.
Also, it doesnt sound like they cover preexisting conditions so any future colonoscopies which you have to have every few years are not covered. I would argue those are preventative but they wouldn't. Those are probably $7k or more. I dont understand how they can force you to continually have these every few years if you are symptom free but that's their rules. In addition to that there are simple labs they have to take every 3 to 6 months. Probably not covered. Can you ask the doctors to code either them as preventative or whatever so you get covered by insurance? Probably not.
Is there anything that can be done here or that i am not seeing? At this rate ill be fully drained of all life savings in just a couple years time. Not sure how they call this insurance. I didnt ask to have this problem. Its not self induced other than from maybe stress. and getting another job on top of my 50 hour a week job just to pay for insurance isnt going to lead to less of that. . Thankfully im symptom free and experience no issues. This is also very frustrating. Why do you need all this crap and a 6k bill if you have no issues? Nobody knows. They just keep telling you if you dont take it, you die.
Wondering if there are any tricks or things that can be done here to help save money while using this new insurance plan or if im just stuck.
Have you checked with the drug maker yet about price help? Is the plan united health care? My Kaiser Permanente hmo plan just went up 25%. . got the payment coupons on monday. So that is now just over 500 A month or 6k per year. Luckily I have 2 other coverages with one being 200 per month.
I know its a pain in the butt,, but you should get a meeting with you HR department and or the health plan administrator to see if there is any help from the company . good wishes to you
I know its a pain in the butt,, but you should get a meeting with you HR department and or the health plan administrator to see if there is any help from the company . good wishes to you
Yeah United Health.
I doubt HR cares. Their interests are for the company. Not me. If i complain or start asking too many questions my fear is they will get rid of me. I dont want that. My fear is if i even tell them i have this or need this drug ill go from an asset to a liablity and get axed at the next round of layoffs. Employers dont like cronically ill people. You might say, well thats illegal and they cant do that. Sure they can. Its the same as ageism. You would never be able to fight it and lawyer fees would get you in the end if you tried.
As far as checking with the drug maker i assume not. its just generic Adalimumab. The prescription on the uhc site shows ADALIMU-ADAZ and a simple google search shows thats made by Sandoz which is maybe callled Hyrimoz. Perhaps i need to be reaching out to Hyrimoz? Looks like they have a copay card but i think thats for people without insurance.
THe only other option they have is a 200 dollar one time rebate which is worthless if the drug is 1000+ per month...and even the 200 dollar thing apparently is no good if you are from the states of MI, MN, MA, Mississippi, or RI for some strange fine print reason.
I doubt HR cares. Their interests are for the company. Not me. If i complain or start asking too many questions my fear is they will get rid of me. I dont want that. My fear is if i even tell them i have this or need this drug ill go from an asset to a liablity and get axed at the next round of layoffs. Employers dont like cronically ill people. You might say, well thats illegal and they cant do that. Sure they can. Its the same as ageism. You would never be able to fight it and lawyer fees would get you in the end if you tried.
As far as checking with the drug maker i assume not. its just generic Adalimumab. The prescription on the uhc site shows ADALIMU-ADAZ and a simple google search shows thats made by Sandoz which is maybe callled Hyrimoz. Perhaps i need to be reaching out to Hyrimoz? Looks like they have a copay card but i think thats for people without insurance.
THe only other option they have is a 200 dollar one time rebate which is worthless if the drug is 1000+ per month...and even the 200 dollar thing apparently is no good if you are from the states of MI, MN, MA, Mississippi, or RI for some strange fine print reason.
Post Edited (simon71) : 1/22/2026 5:17:21 PM (GMT-5)
Well good luck anyway simon🤗