Insurance is really a funny thing now these days… Either you have it or you don't.
Our company was taken over by Xerox and now we are covered under Blue Cross Blue Shield of Texas that have their prescriptions through Medco. Before we had insurance with Blue Cross Blue Shield of North Dakota and our insurance policy was a good policy. No complaints.
Although, now that we are under Xerox and have Blue Cross Blue Shield of Texas - our insurance is horrible. Actually horrible is the best word I could come up with…
For starters… I go through 8 vials of Humalog a month with my insulin pump and my cost with the new policy is $900; infusion sets aren't covered under my medical for the 80/20 for durable medical equipment, they are concidered as a prescription with medco and can only have 2 boxes of infusion sets at a time. They are at full cost for the infusion sets and reseviors, my test strips for One Touch are at full cost of $200. my heart medications, even though they are generic meds along with blood pressure are at full cost and running $160 - $300. Won't bore you on details of the type and the cost.
I had went to fill my meds at the beginning of the month and pharmacy had said there is something wrong with your new insurance.
We had gone into the office and called the insurance company and they said that is not a mistake. Our deductible is $6000 out of pocket and $1400 deducible.
All my meds go directly toward out of pocket expense and none of it goes toward the deducible. I have been on the phone frantically with the insurance, the new HR, on the phone in trying to see if I can get prescription assistance. There is no way in the world, I can come up with $900 to $1200 a month for my meds a month. That is basically two paychecks a month to cover my meds.
I had consulted with another diabetic at work who had it all figured out when we got the new insurance and went to talk to him. I had told him of what is happening and he said he got the same issue and reply from the insurance company.
He is on the insulin pump with medtronic. He was going to cash out his funds from different bonds to take care of the deducible at the beginning of the year. Along with get all his meds and supplies and wipe out the deducible.
Due to the cost of his supplies, medications he has to take, insualin he had to go off the insulin pump and go back to injections.
He is still paying off his pump with Medtronic since he had just got the insulin pump.
Other people at work had said it' can't be that bad that we were getting too excited. Now lot of the ones who were critizing that we were getting too over excited are coming back that their meds also costing them in the hundreds are upset also.
I had wrote a letter to the New HR department and expressing these concerns and still waiting for a response.
My question and concern is, what options are there for me. My heath care cost just went up to about 300% - 350% more. It is like I said a whole paycheck in half to just cover my medical expenses that use to be all covered from last year.
Just really at lost. I need meds to be filled next month and have no idea where to turn. Even though I have tried resources from different people, like lilly cares and other agencies. It all was a dead end….
Just wondering what is there to do??
It really seems like you not have what is termed a High Deductible insurance plan. These plans are great for people who are healthy and don't have chronic conditions but they can be pretty harsh for us. Often these plans are tied with a Health Savings Account which lets you put aside before tax dollars to cover the deductible. While the initial costs are high, once you reach your out of pocket limit, your insurance should cover things. So while it seems like your costs have skyrocketed for the first part of the year, some of it should even out. What you need to figure out is what happens when you reach the out of pocket limit. If you are 100% covered, then this may not be as bad as you think.
Hey Chadd, I'm so sorry that you're in this position - my worst fear. My insurer is Blue Cross-Blue Shield of Louisiana. Call and ask Blue Cross-Blue Shield of Texas if they offer any special "disease management" programs for people with chronic diseases such as diabetes and heart disease. In Louisiana it's called "In Health: Blue Health".
Basically the way it works is that you're assigned a "health coach" and if you talk to your health coach on the phone once every couple of months, you get an additional discount on your meds like insulin.
I was with Blue Cross for some time before I accidentally found out that this program is available so maybe it's available to you also. Good luck. My thoughts and prayers are with you.
That is just disgusting. Do they realize that if they don't cover these things, you'll constantly end up in the ER, which is way more expensive for the insurance company. Part of me almost wants to suggest doing just that (check what your ER coverage is first!) I am sure ER visits are covered, and the irony is that ONE ER visit would probably be the same as covering a years' worth of insulin.
When I went to refill a series of prescriptions right after the turn of the year, I was shocked to find that I was being "charged" hundreds of dollars more than I expected. I complained to HR to no avail. Then I pressed on my insurer. After much digging, I found that the mail order pharmacy was "quoting" me a price that included my deductible applied to all the prescriptions. That was incorrect, I only pay the deductible once. And all the tools that the insurance plan provided for pricing prescriptions included the deductibles in a way that didn't reflect the proper plan implementation. In the end, I was convinced by the insurer that I would only pay the one deductible and that is how it worked out. So there may in fact be errors in what you are being "quoted." In the end, I found that Aetna could not in fact explain how they quoted prescription order costs or provided prescription drug cost estimates. Their systems were flawed and they didn't even understand what they did.
Do you know if you have a combined deductible/out of pocket for both services(Dr appts, etc) and Rx ?
You say your deductible is 1400, and out of pocket max is 6000.
So assuming you have a 20% copay AFTER deductible is met, you should see the cost come down considerably once you hit the 1400 deductible. (my company has a 1300 deductible).
Most likely you are NOT paying any weekly contributions, or a much lower contribution for you health benefits, compared to your previous year. So there is a 'tradeoff' of high deductible which many (non-diabetics) won't ever spend, vs premiums that are paid regardless. The unfortunate part is that high deductibles can hit all at once, instead of spread out over the year as premiums are.
If you have just spent 900 on insulin, then after another 500, you should only be paying 20%, which should apply to the 'contracted' price, not list price.
Once you begin paying only the 20%, that will add to your $1400 paid so far for out of pocket. When/if that total reaches 6000, then coverage would be 100%, and you owe nothing (on items that are covered by your plan) .
Incorrect billing IS common. You need to understand your plan, and then make lots of phone calls to get it corrected. But at this point, it is likely correct that your deductible has not been met, and therefore you pay 100%.
Some plans have different rules for Rx, Diabetic supplies, DME, and office visits, etc. Check if you have access to an online site for your plan information, and get the details you need to challenge it if you think it's incorrect. For example, for my plan, DME is only covered when acquired from an 'approved' DME provider, and diabetic/pump supplies are considered RX, rather then DME. But every plan is different.
As mentioned, most employers offer a way to use 'before tax' dollars to be deducted from your pay, and put in an account, and used only towards your out of pocket medical costs. Check with your employer regarding this, since it reduces your 'true' cost.
Hi Chadd, The problem here is not BCBS of Texas it must be with your employer and the type policy they have chosen for you. I have BCBS of Texas and get really good coverage. My company offers several different levels of coverage going from low deductable up to high deductable which is what it sounds like you have. High deductable is cheaper and you can use the savings to save up the deductable cost before hand and total cost is near the same.
Of course this doesn't help when faced with these cost without warning.
You might want to ask if they offer a better plan. I hope you find a solution because I hate to see someone struggle like you are having to.