[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

Re: [IP] Insurance Problems with Prescriptions - Long

Bagwill Family wrote:
> Hi all:
> Okay, I received a notification from my health insurance (Alliance Blue
> Cross/Blue Shield) that prescriptoin coverage was increasing as of June 1st.
> They advised that for a $10 co-pay for generic drugs and $25 co-pay for
> non-generic they would provide a month's worth of supplys.  Well, last
> Thursday I took my prescription for test strips from my doctor to a
> participating pharmacy.  First, they refused to provide the 240 to 300
> strips as my doctor had prescribed (I test approx. 8 x's a day) they would
> only "allow" 200 test strips a month.  Then they told me it would cost $90
> because it is a non-preferred drug.  Okay there is some fine print that says
> if you purchase a non-preferred drug it is a $45 co-pay but I still don't
> see where they can charge me $90 and then only provide part of the
> prescription!

First off, since when are test strips a "drug"???? My insurance company lists
under "Durable Medical Equipment" (DME) and pays 100%. Suggest you check if
where they ACTUALLY classify them!

I've also been sent a different brand of test strips, with a matching meter, and
called them back immeiately. They told me it was all they could supply, and I
told them 
quite forcefully that since I had long since found that variety of meter very 
unreliable FOR ME, it was unacceptable. So, if they insist on only a certain
brand of strips as a "preferred drug(?)" tell them you will therefore need to
discontinue using ANY test strips, and they can expect to see you in the ER
several times  week, which should only cst them about $90,000 per year......
Besides which, your lawyer will be glad to call them in the meantime about
your lawsuit for malpractice, as will the state insurance commisioner.....
> 2 days later I realized I was almost out of Humalog so I went back to the
> pharmacy and handed in my prescription for Humalog.  My doctor had written
> it for 3 bottles which is more than a month's supply but I figured they had
> got their money for the test strips so I would try and if they argued I
> would take less.  Well that one came back that it would be a $50 co-payment
> because it was on the non-preferred list.  I didn't have $50 and asked the
> pharmacist how much one bottle would be, she advised me $33 and then said
> let's see what happens if we run just one through on this.  Well it came
> back $25 co-payment.  She then ran through 2 and it came back $25 co-payment
> so I got 2 bottles for $25.  How can 2 bottles be on the preferred list and
> 3 not?

Pure malarkey, plain and simple. If they can't manage to supply you with
direct need levels they are having their clerks or accountants practice medicine
on you, which happens to be illegal!
> My questions are:  Who do I write?  The company who does the pharmacy part
> of the policy or the main company.  

Go as high up as you can to the main company. Get their President or Medical
intimately involved as fast as possible, and be sure he/she understands you know
phone number of the local TV stations Help line....

How best should I word my complaints
> because this a load of garbage?  

Explain the cost benefits of allowing you what it takes to treat your diabetes
well, so you can stay well. The savings for them ARE going to be substantial, 
compared to the slim savings of the moment for a few strips or bottles of
It IS a business, after all.

How can they say Humalog is not a preferred
> drug when there is no alternative to actual Humalog?  

Simple, it isn't preferred because it costs more! According to insurance people
"everywhere" Regular is "just the same" as Humalog... Again, hit them in the 
pocketbook! If you use R with a ump the tail effect at 3 to 4 hours after taking
a bolus tends to lead to hypos, and there is NO reasonable way to counter it.
More hypos leads to more ER visits..... which COST THEM money. Also, since
gives much more precise control we tend to use less of it, which makes the
cost per bottle a non-existent savings.

How can they limit my
> test strips?

They can't, actually. Your doctor prescribed them specifically as being
for your care, and that's that. If they think a medical specification can be
changed by a clerk, then you will be happy to have them talk to your state's
insurance commisioner, etc. about practicing medicine without a license!
> Sorry this is so long but I know a lot of you have won battles with the
> insurance company and I would appreciate any help you can give me!

Hope this helps. Just remeber that insurance companies follow the
line of least resistance, based on forseeable costs. You just nee to open their
eyes so they "forsee" a little more clearly......
Ted Quick
email @ redacted
43 years Type 1
Insulin Pumpers website http://www.insulin-pumpers.org/
for mail subscription assistance, contact: HELP@insulin-pumpers.org