Trouble in Paradise
Damik
member
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Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
If you have questions about this, please email help@theknot.com.
Thank you.
Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
Aargg, my insurance co refuses to pay for my drugs.
They refused to pay for my Prozac because it's not "formulary". PROZAC
is non-formulary. You know the sh*t they are going to start adding to
our water in a few years time. Luckily it was pretty cheap so last time I
was able to pick it up anyway, but the insurance co's refusal to pay in
intolerable. They won't pay for my Welburtrin or my Saphris either.
I contacted my pdoc to call and give them he!!, but he never got back to me so I don't know if he did or not. But they have been pulling this crap from the moment we signed on to them. They refused to pay a bunch of bills because of pre-existing conditions even though they are a work based insurance co and they aren't allowed to do that here in the state of Utah.
And I was stupid, I admit that. I fought with them about it. I took so long fighting about it that the bills went to collections and just tanked my credit. They still wouldn't pay. I'm about ready to track them down and set fire to their office, and I'm crazy so I'll get away with it.
(I'm totally kidding folks. They wouldn't know it was me, I have "The Arsonist's Guide to Faking an Electrical Fire".)
I suppose I could appease myself with a sternly worded letter. We can't switch cos. They are the only one DH's work offers.
Grrr.
I contacted my pdoc to call and give them he!!, but he never got back to me so I don't know if he did or not. But they have been pulling this crap from the moment we signed on to them. They refused to pay a bunch of bills because of pre-existing conditions even though they are a work based insurance co and they aren't allowed to do that here in the state of Utah.
And I was stupid, I admit that. I fought with them about it. I took so long fighting about it that the bills went to collections and just tanked my credit. They still wouldn't pay. I'm about ready to track them down and set fire to their office, and I'm crazy so I'll get away with it.
(I'm totally kidding folks. They wouldn't know it was me, I have "The Arsonist's Guide to Faking an Electrical Fire".)
I suppose I could appease myself with a sternly worded letter. We can't switch cos. They are the only one DH's work offers.
Grrr.
Re: Aargg, my insurance co refuses to pay for my drugs.
Call your H's HR office (I think I gathered at the end that the insurance is through his work) and schedule a meeting.
They can work with their rep at the insurance company on your behalf. They'll deal directly with the sales and underwriting departments, not the 20-year olds in customer service.
I work at an insurance company. Believe me, the best way to get the insurance company to adhere to the plan is to go directly to the people who sold and underwrote the plan, which is something only HR can do.
http://pandce.proboards.com/index.cgi#general
I'll have DH call his HR.
They aren't just jerking me around. DH got a spot of cancer removed from his arm and they wouldn't cover that because it was pre-exsiting.
They also had us pay $7,000 more then our deductible.
If we do get them to work with us should I still consider the money lost or will they reimburse us?
Is that $4 with insurance or without? I get my drugs at Costco because it was cheaper when I didn't have insurance and I just haven't shopped around now that I do.
Do you have all of your EOBs (explanation of benefits - the paper you get in the mail when a claim has been processed) or can you print new copies from their website? That'll be a record of what you were charged and why.
If you don't have them and don't have access to print them online, you can call the insurance and request that they mail a copy of all of the EOBs for whatever range of dates that you need.
The HR person can can go through each EOB with their insurance contacts and make sure the claims were processed correctly. If they made you pay more than you should have, then you should get a reimbursement. It might take some time, but there's no reason you should be out the money if they made a processing mistake.
It is best that his HR is made aware of what they're doing. They'll have the most leverage to get everything straightened out.
Good luck Danie! Keep getting better.
http://pandce.proboards.com/index.cgi#general
My housemate gets prescription assistance through the manufacturer of the drug in question. You can google the pill to see who makes it, and they have bunch of information they are going to ask you. You can still try to fight it through your insurance but in the meantime you need your drugs.
1.) Income
2.) Insured
3.) Eligible for medicaid or medicare
4.) Copy of most recent tax return
5.) Since you are insured you might have to submit proof that the insurance won't cover it. That is so there is verification that your insurance won't cover it so they will help.
My housemate gets a 3-month supply at a time and picks them up at his shrink's office. It doesn't cost him anything and he is not insured.
I hope that helps Damik. This is the last thing you need right now. ((hugs))
I'm on Prozac as well.
With insurance I could get it at Rite Aid for $4. Without insurance (now) it's still $4.
If you find a way to get Welbutrin cheaper please let me know. :-(
There are some things that are cheaper at costco but I dont remember if Costco has a generic list like Target and Walmart do but you could totally check into that. Also, I dont know if you have checked into mailorder by my script through mailorder for 90 days is what it would cost me for 1 month at the local pharmacy.
Target and Walmart's $4 generic list is for everyone, insurance or no. Since there is a generic of Wellbutrin, it is unlikely that the drug company will have a patient assistance program (these usually disappear when the generic becomes available). However, there are several versions of Wellbutrin/bupropion (generic, SR, XL), and you may be able to switch to a version that is less expensive or is on your insurance formulary. Being extremely new, Saphris does have a patient assistance program, although, for some of these programs, you aren't eligible unless you are uninsured: http://www.merck.com/merckhelps/patientassistance/whats_covered.html
I believe it's with or without insurance. Might be worth checking on the website.
Call your H's HR office and schedule a meeting.
They can work with their rep at the insurance company on your behalf. They'll deal directly with the sales and underwriting departments, not the 20-year olds in customer service.
This. I had issues with H's (crappy) insurance not covering my medication and talked with his HR who then figured everything out for us.