First, we were forced to pick a new plan because Obamacare made our plan of ten years unaffordable. The transition has been anything other than smooth. Bumpy, crazy and exhausting. Our pharmacy benefit provider stayed the same. Which was helpful to a degree. We didn't have to renew pre-auths for the medications we recently went through pre-auth hoops for. IGG, the blood product my son infuses weekly, cost $4131 the first week of January. One month supply. As we don't have $4K lying around at any given time, we contacted the drug company. In the meantime, our pharmacy account was locked-even after we made arrangements for payment-and we were unable to refill any of our children's medications. We ran out of some of their medications before the account lock was removed.
We just refilled IGG and had to pay $1653, thinking that with the other prescriptions, this would bring us to our out-of-pocket max. That's when we discovered our insurance carrier wasn't communicatng with our pharmacy benefit. When I called BCBS, I was told that our employer signed up for the wrong plan, that instead of a $3,000 deductible and a $6,000 oop max, we had a separate deductible and out-of-pocket max for medical and prescriptions, meaning that we would have to pay $6,000 for a deductible and $12,000 would be our out-of-pocket max limit. Worked on that last week. BCBS was rude, not helpful and downright frustrating to work with. One manager sid they had researched our plan and refesused to research any further. Refused to contact the employer's BCBS person in the BCBS marketing department. Finally got a call Monday that we were right, that they would fix it, reprocess claims, etc. Still not fixed. I cannot order my son's catheters until BCBS gets their computer up to speed-- otherwise, Edgeoark will want $1K before they ship. It is impossible to get people to slow down, listen and understand the computer glitch messed things up. So, here we wait, hoping it is fixed soon and we can reorder those.
I'm also concerned about a muscle test, MRI and neurosurgery visit my son has in two weeks. If BCBS doesn't get up to speed, will I have to fght at the hospital because they wil want payment for my deductible and oop max?
The last blow of the week? Refilled a medication only to find out that some medications still have a copay above and beyond our out-of-pocket max. Received anoter one with a copay above and beyond our OOP max yesterday, as well. Again, Obamacare supporters believed the lie that here in 2015, all of your medication copays would go toward your out-of-pocket max. It simply is not true. Even with pre-auths for the medications, it doesn't go toward it. Our pharmacy benefit manager can't tel us what medicatons will still have a copay for the rest of the year above and beyond our out-of-pocket max, so we will be learning as we go, waiting for the other shoe to drop.
We are already close to $7K in oop medical for 2015. Remember, our children's lifesaving medications were dropped from coverage all together on Sept 15, 2014, so on top of al we pay, we will have tpo pay around $9600 a year for their mito cocktail-- much of which was covered by insurance until 2014.
I'm so mentally exhausted from the insurance battles the last 10 days that I haven't watched the news. My brain might explode if I turned it on. I've read a few articles, but that's it.
Please check out my new website www.pattiecurran.com if you get a chance. It is a work in progress.