Thursday, January 7, 2010

Round 24 ***Updated***

January 1st...first day of new insurance. Again. However, this time it's not NEW insurance, it's merely changes to our existing.

In November we were told that our premiums would go up and that there would be some other stuff involving co-insurance. Nothing that would affect us.

Early this week I called to order the boys' medicine; several hours later I received a call asking for the new insurance numbers (that came with the new insurance cards we received in December).

The following day I received a phone call from the home care pharmacy that delivers the boys' meds. They verified coverage with our insurance company and passed along the information to me. It seems that we will now be subjected to a $1,500.00 per person/$3,000.00 out of pocket maximum deductible for the boy's medication through the major medical portion of our policy. This information was NOT given to us when we received notice of changes to our policy in November.

The boys' medicine is a prescription drug so I called the pharmacy portion of our policy to see if we could get the meds prescribed that way and then only have to pay the $50 co-pay. The answer is NO. Because only medications one can "walk up to a pharmacy and receive" are available on our pharmacy plan.

Well, CVS isn't going to stock this stuff so we're fucked.

We have a pharmacy benefit with applicable co-pays. But we can not use it under this circumstance because the drug is a specialty drug. SO instead of $100 per month for their medicine, we will be paying $250 per month.

We're in the process of making some phone calls to see what we can do. But as it stands, our premiums when up and our coverage went down.


***After a few more emails and phone calls, we think we've got it squared away. It appears that it was a matter of semantics as well as a couple different departments not being clear. $1500/$3000 IS the out of pocket max, but since the boys' meds are covered 100% under major medical with no co-pay, there is no out of pocket, ergo no worries.

The morale of the story? Don't stop with the first phone call. Or email. Or even the second phone call. Also, always make sure to take notes of when you called and with whom you spoke.

I take back the "Fuckers" statement. For now.

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