Monday, September 15, 2014

It's Official- Kids' Life-saving Meds No Longer Covered

Today's the day! Our boys' life-saving medications are officially no longer covered. 

Luckily, I got refills a week before coverage ended. Last week. I received the physical copy of the letter their doctor had previously emailed to me. The second letter. The first letter never reached the intended folks at the insurance company. Their physician faxed a letter again on September 4th. Pictures of the doctor's second letter, the letter stating we can't appeal until our plan changes (back), and pictures of what we will now have to pay instead of a $150 co-pay.

I've really enjoyed reading the comments on Twitchy and the Daily Caller. Some people are worried about the left attacking me or the IRS auditing us. The left thinks I'm lying, as usual. What can I say!? I post receipts/invoices, the letters, doctor's letter and still they think I'm lying. If what they see here doesn't convince them that I am telling the truth, I don't know what will.

I thought if I put everything here, with the exception of the 11 letters stating which meds were being dropped from coverage, folks might actually believe it. Well, rational beings. The 11 letters from insurance stating which meds are no longer covered can be found here. Sorry for links just being cut and pasted. Writing this as we head to second doctor appointment of the day!

And here:

Doctor's letter trying to appeal the meds no longer being covered:

Below is the letter stating we can't appeal until our plan changes ( again? Changes back? Because these meds have been covered for years):

We used to pay a total of $150 in prescription copays fir the compounded meds that are no longer covered. Now we will pay $653.58. One med is available from a pharmaceutical company which will cost us $33.33 each month ( total for both boys) plus the $513.50 and $106.75 monthly - I did mock orders to see how it would change costs for us. Keep in mind that we already pay $150-$200 each month for the other OTC portions of the mito cocktail already. This on top of all the other prescription copays that Obamacare has increased. 


Anonymous said...

I'm sorry to read about the struggles you are living.

I'm confused about something. You include the note from Express Scripts indicating the denial, but Express Scripts is just the benefits manager for many insurance companies, they are not deciding what is approved or not they are simply relating to you that your request was denied by the insurance company and that you need to talk to the insurance company to appeal (not them, Express Scripts). There are various means to appeal health insurance decisions first with the health insurance company and next with the state regulator. You may be doing all of this, I was just confused because that doesn't seem to be mentioned and I thought it would be if it was being done.

All the best.

Anonymous said...

It is not true that "Obamacare" is increasing your payments or ending coverage of certain drugs. That is your health insurer's decision. I do not think you are lying, but I do think you are misplacing the blame. Absolutely nothing in the health care law requires the company to do this; it's their business decision to do so. And in fact, BECAUSE of Obamacare, you now have the option to kick that company to the curb and go with a competitor, without any worry that your childrens' pre-existing condition will prevent it.

Pattie Curran said...

You Apparently have never read the law and it's thousands of pages of added HHS regulations. Go read it and get back to me. It increases costs for employers, employees and insurance providers. It is absolutely the fault of the law. Explain to me why the meds were covered from 2005 through September of 2014 when the law's implementation hit full swing? Why would the greedy company pay for the meds for ten years and then stop? What in the world caused it!? Obamacare.

Post a Comment