United Health Care Bites
Posted: Mon Dec 01, 2008 5:41 pm
I've got a problem and I hope someone on here responds who has some knowledge of handling these types of situations. As some of you know, I just started Tysabri. So you have to enroll in the TOUCH prescribing program. They not only tell you about PML about a thousand times, but they also 'do your insuarance stuff'. This all happens before you get your first dose so you know what to expect and all that, so it's kind of like having a coordinator in a trial; one person handles your case and so on.
Well I get the call in mid-late October that my UHC is covering it all and all I will have to pay is my office visit specialist co-pay which is $50 dollars. Keep in mind this is not only the dispensing pharmacy, but also Biogen. So I say "cool" and proceed to get my infusion. Well about 2 1/2 weeks goes by and the CVS/Caremark pharm. that handles this calls me and says I owe them $1,300 dollars. Well after I picked myself up, I call and they give me this song and dance about it not being a "medical benefit", and it's and injectable and they only cover allergy injectibles. Now granted they are going to pay 70%, but they say I'm on the hook for the other 30%. Now the lions share (900) of that amount is just satisfying the rest of my deductible, but that leaves me thinking I'm paying $420 every month.
Now if my policy only covers it that way, then so be it. But I feel like I was misled initially and they need to cover this first one. If they prove to me that what they are telling me is true, then so be it. However, there's a back story. Some of you who know me also know my wife just got her RN. Well her insurance will kick in the day she steps across the threshold on her first day (in about 2 weeks once she get auth. to take her state board). Well had I known that I was going to be hit up for $1,300 dollars, I would have waited. We have already looked at the coverage, and it will only be slightly more than my Avonex was per month.
So I make a decision to purchase goods based on the information presented to me by not only the drug co., but also the dispensing pharmacy. Like I said, going forward, my coverage is as it states. But I feel like they should pay for this one. I have my ass covered six ways from Sunday. I talked to the guy who left me the message from CVS/Caremark, and he said when he looks up the coverage, he still sees fully covered; so does Biogen. So the gal at Biogen gives me the exact time and the name of the person who verified coverage at UHC. And to boot, they did it twice about two hours apart. It's a shame they have to do that, but it's good they do. So now I have the names from Biogen, and also the guy from CVS/Caremark all saying the same thing, and UHC saying another. If I was litigiuous (I know that's spelled wrong), I'd sue their ass off for emotional damages. You guys know how high strung I can get, and this has had my BP up. And to be truthful, I am incredibly distressed. I'm going to kill myself for saying this, but I think it may be helping. Now I say that pessimistically. I would say cautiously optimistic, but after the Tovaxin debacle, I just don't know if anything works very well after seven years. Lots of people at work have said in the last two weeks "are you feeling better?". That's all I'm going to expound. I already went down 'knee jerk to a couple of good days road' and don't plan on going back down it. Too big of a letdown.
So even if they prove that what they say is true, I think they are at least liable for the $1,300, and I'll abide by my coverage (even though I'm dumping them) going forward. But they armed me with information about the drug, and it's not like I can take it back like a Christmas sweater.
Does anyone agree based on what I just laid out? That's all there is; 100%.
Well I get the call in mid-late October that my UHC is covering it all and all I will have to pay is my office visit specialist co-pay which is $50 dollars. Keep in mind this is not only the dispensing pharmacy, but also Biogen. So I say "cool" and proceed to get my infusion. Well about 2 1/2 weeks goes by and the CVS/Caremark pharm. that handles this calls me and says I owe them $1,300 dollars. Well after I picked myself up, I call and they give me this song and dance about it not being a "medical benefit", and it's and injectable and they only cover allergy injectibles. Now granted they are going to pay 70%, but they say I'm on the hook for the other 30%. Now the lions share (900) of that amount is just satisfying the rest of my deductible, but that leaves me thinking I'm paying $420 every month.
Now if my policy only covers it that way, then so be it. But I feel like I was misled initially and they need to cover this first one. If they prove to me that what they are telling me is true, then so be it. However, there's a back story. Some of you who know me also know my wife just got her RN. Well her insurance will kick in the day she steps across the threshold on her first day (in about 2 weeks once she get auth. to take her state board). Well had I known that I was going to be hit up for $1,300 dollars, I would have waited. We have already looked at the coverage, and it will only be slightly more than my Avonex was per month.
So I make a decision to purchase goods based on the information presented to me by not only the drug co., but also the dispensing pharmacy. Like I said, going forward, my coverage is as it states. But I feel like they should pay for this one. I have my ass covered six ways from Sunday. I talked to the guy who left me the message from CVS/Caremark, and he said when he looks up the coverage, he still sees fully covered; so does Biogen. So the gal at Biogen gives me the exact time and the name of the person who verified coverage at UHC. And to boot, they did it twice about two hours apart. It's a shame they have to do that, but it's good they do. So now I have the names from Biogen, and also the guy from CVS/Caremark all saying the same thing, and UHC saying another. If I was litigiuous (I know that's spelled wrong), I'd sue their ass off for emotional damages. You guys know how high strung I can get, and this has had my BP up. And to be truthful, I am incredibly distressed. I'm going to kill myself for saying this, but I think it may be helping. Now I say that pessimistically. I would say cautiously optimistic, but after the Tovaxin debacle, I just don't know if anything works very well after seven years. Lots of people at work have said in the last two weeks "are you feeling better?". That's all I'm going to expound. I already went down 'knee jerk to a couple of good days road' and don't plan on going back down it. Too big of a letdown.
So even if they prove that what they say is true, I think they are at least liable for the $1,300, and I'll abide by my coverage (even though I'm dumping them) going forward. But they armed me with information about the drug, and it's not like I can take it back like a Christmas sweater.
Does anyone agree based on what I just laid out? That's all there is; 100%.