I finally feel well enough to talk about Christmas. Which I will do in a moment.
First, I have to say that the first time using my new BC/BS Rx insurance was NOT an auspicious one... I have a feeling that this may be even worse than Caremark, although I'll reserve judgement for the time being. The doc prescribed 12 antibiotic pills. They gave me, of course, the generic (I'm not going to quibble with antibiotics).... only, they would only authorize HALF of the script. For which I paid $10. I asked what I was supposed to do, and the guy said, 'Well, you could pay for the rest out of pocket." "How much will that cost?" "$57." FIFTY-SEVEN DOLLARS????? The six I got, including my co-pay and what they say the insurance company paid, only came to $25... so why, if I'm paying out of pocket, is it more than TWICE what they charge the insurance company?????? Makes NO sense.
Well, of course, there was no-one at the insurance company to explain this decision to me. So I have to try to find some time while at work on Monday (which is almost impossible, since I don't even get time for LUNCH) to try to call and argue with them. THEY should not be making medical decisions. THEY are not my doctor, and as everyone who has any knowledge of antibiotics knows, you HAVE to take ALL of them. ALL of them, or the infection will come back worse than ever. ::SIGH::
Meanwhile, I did get my cool little Visa card that will allow me to automatically debit my FSA account to pay for my scripts instead of asking for reimbursement. That's nice. Hopefully, it will save some money for me, since it's tax free funds that are put in there.
Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts
Sunday, January 6, 2008
Sunday, November 11, 2007
Caremark
Okay, the comment from Sean about Caremark was too much to answer in a comment reply, so here goes.
Please do your research before you start bad-mouthing certain corporations. Caremark is an ADMINISTRATOR of the plan that is created by YOUR insurance company or employer; CAREMARK does not increase your co-pays. They follow the contract created by YOUR insurance co. or employer.>>
Firstly, I believe the above is what I said. ::Looking back:: Yup, that's what I said. Perhaps YOU are the one who needs to read before you start shooting off your mouth.
The problem was that they took over without any notice, and ALL communication avenues led to them. There was no opportunity to speak with anyone at the insurance company, and yet Caremark refused to answer any questions because they were 'just an administrator.' If they are going to be the SOLE point of contact, they had better be prepared to take care of the customers that are paying them.
They took over without any notice, and raised the co-pays (without any notice), PER THEIR OWN REPRESENTATIVES. THEY are the ones who said they raised it, and they did not have a good reason for doing so in the MIDDLE of the contract period. The contract I agreed to was for a particular copay for the period of one year. They violated that contract, they did not follow it.
Secondly,
3-tier drugs are very expensive for your plan and 99% of 3-tier medications either have a generic or similiar, less-expensive brand name medication...so stop bitching about a $45 co-pay for a drug that your plan is paying hundreds or thousands of dollars for becuase you're unwilling to use the generic or a less expensive brand.>>
That's the point. There ARE no less-expensive brand names (and, by the way, this is a DIFFERENT prescription plan I'm talking about now-- the one we're GOING to have, not the one we have now)... EVERY SINGLE brand I looked at was a Tier-3, with only two or three exceptions.
As for generics, I HAVE tried them, I HAVE used some. But for thyroid, no, I will NOT use a generic, nor a different brand, because I have been advised by my doctor (as have most people who take thyroid medication) to NOT change from what you're using without a good reason. Any changes, including increasing/decreasing dosage, have to be monitored closely, and it's very difficult to titrate. It can take up to 6 months of adjusting dosages to get the right one when you start. Had I known when I began that they were going to do this, I might have started with a generic... IF I could have been guaranteed to get the SAME generic each time. I simply took the prescription and got it filled... and they gave me the brand. They didn't ask if I wanted a generic, they didn't provide a generic. So I took what I was given. Once started, however, I'm not now willing to risk my health.
They consider a 12% difference to be 'bioequivalent.' With some medications, that might be ok (although, IMO, that's too large a difference with ANY medication, but that's my opinion. I see no reason why their effectiveness should not be required to be EXACTLY that of the brand if you're going to call them equivalent). With thyroid, it's enough to put you in the hospital or KILL you. You'll forgive me if I feel that my health is that important, and something tells me that I wouldn't have saved any money with the office visits and labwork that would have been needed, anyway, even if I hadn't ended up in the hospital.
Having said all that, your statement above is kind of the POINT. With a $45 copay, PLUS the difference in cost between the generic and brand (and isn't that what we're paying the increased copay FOR in the first place?), they're NOT PAYING FOR ANYTHING. They haven't paid a penny for my thyroid medication for 2 1/2 years now. And they sent a letter (less than 30 days beforehand) almost two years ago, that they would no longer be covering another script AT ALL. Period. Full stop. And yet they have the NERVE to tell me when I can and cannot have it refilled, though they refuse to cover it. So, why, exactly, am I sending them money every month that I could be using to pay for my scripts?
Actually, I'll tell you why-- because it's bundled with the medical coverage, and if I want that, I have no choice.
Now, please, go tell your bosses at Caremark that you haven't convinced me, or anyone else I know who has dealt with them.
Please do your research before you start bad-mouthing certain corporations. Caremark is an ADMINISTRATOR of the plan that is created by YOUR insurance company or employer; CAREMARK does not increase your co-pays. They follow the contract created by YOUR insurance co. or employer.>>
Firstly, I believe the above is what I said. ::Looking back:: Yup, that's what I said. Perhaps YOU are the one who needs to read before you start shooting off your mouth.
The problem was that they took over without any notice, and ALL communication avenues led to them. There was no opportunity to speak with anyone at the insurance company, and yet Caremark refused to answer any questions because they were 'just an administrator.' If they are going to be the SOLE point of contact, they had better be prepared to take care of the customers that are paying them.
They took over without any notice, and raised the co-pays (without any notice), PER THEIR OWN REPRESENTATIVES. THEY are the ones who said they raised it, and they did not have a good reason for doing so in the MIDDLE of the contract period. The contract I agreed to was for a particular copay for the period of one year. They violated that contract, they did not follow it.
Secondly,
3-tier drugs are very expensive for your plan and 99% of 3-tier medications either have a generic or similiar, less-expensive brand name medication...so stop bitching about a $45 co-pay for a drug that your plan is paying hundreds or thousands of dollars for becuase you're unwilling to use the generic or a less expensive brand.>>
That's the point. There ARE no less-expensive brand names (and, by the way, this is a DIFFERENT prescription plan I'm talking about now-- the one we're GOING to have, not the one we have now)... EVERY SINGLE brand I looked at was a Tier-3, with only two or three exceptions.
As for generics, I HAVE tried them, I HAVE used some. But for thyroid, no, I will NOT use a generic, nor a different brand, because I have been advised by my doctor (as have most people who take thyroid medication) to NOT change from what you're using without a good reason. Any changes, including increasing/decreasing dosage, have to be monitored closely, and it's very difficult to titrate. It can take up to 6 months of adjusting dosages to get the right one when you start. Had I known when I began that they were going to do this, I might have started with a generic... IF I could have been guaranteed to get the SAME generic each time. I simply took the prescription and got it filled... and they gave me the brand. They didn't ask if I wanted a generic, they didn't provide a generic. So I took what I was given. Once started, however, I'm not now willing to risk my health.
They consider a 12% difference to be 'bioequivalent.' With some medications, that might be ok (although, IMO, that's too large a difference with ANY medication, but that's my opinion. I see no reason why their effectiveness should not be required to be EXACTLY that of the brand if you're going to call them equivalent). With thyroid, it's enough to put you in the hospital or KILL you. You'll forgive me if I feel that my health is that important, and something tells me that I wouldn't have saved any money with the office visits and labwork that would have been needed, anyway, even if I hadn't ended up in the hospital.
Having said all that, your statement above is kind of the POINT. With a $45 copay, PLUS the difference in cost between the generic and brand (and isn't that what we're paying the increased copay FOR in the first place?), they're NOT PAYING FOR ANYTHING. They haven't paid a penny for my thyroid medication for 2 1/2 years now. And they sent a letter (less than 30 days beforehand) almost two years ago, that they would no longer be covering another script AT ALL. Period. Full stop. And yet they have the NERVE to tell me when I can and cannot have it refilled, though they refuse to cover it. So, why, exactly, am I sending them money every month that I could be using to pay for my scripts?
Actually, I'll tell you why-- because it's bundled with the medical coverage, and if I want that, I have no choice.
Now, please, go tell your bosses at Caremark that you haven't convinced me, or anyone else I know who has dealt with them.
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