posted
for you verterans who may be able to help... i started lyme tx in 8/08. have been on mepron/zith for babs and iv rocephin for lyme since 2/09. LLMD wants 4mo at least to hit babs. ok--got it.
our health ins (that we pay privetly for i may add, out of our checking acct every mo. at over $700) has 500 rx deductable on non-prefered. ok, we r used to this.
in jan i meet my $500 ded. on rx. no prob. mepron was 300 something first time, paid that, next 2 refills were $25. Went to pick up refill today and get, "ok that will $900 on express pay?" had to yell a "NNNOOOOOO!!"" before she hits that button!! come on $900??? and pharmacist says this with straight face and not asking if that seems abnormal and just half-second from hitting the button that links our bank acct to walgreens?
so-- any advice? i had them print me out the rx prices and fill dates since jan/feb where i met my deductable. will obviously call them monday
anyone with simialar exp?? advice??
take any help, knowledge, advice i can get before i call them mon.
oh...and just as the topper...hubby just test + and have to pick up $400 rx for levaquin today...yeah..need stock in walgreens i think
thanks in advance !!!!! appreciate yall always having info to share...will be posting few. things this wkend looks like
-------------------- i am not a Dr. any info is only for education, suggestion or to think/research. please do not mis-intuprest as diagnostic or prescriptive, only trying to help. **
dx in 08:lyme, rmsf, bart, babs, and m.pneumonia. Posts: 422 | From TX | Registered: Oct 2008
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AZURE WISH
Frequent Contributor (1K+ posts)
Member # 804
posted
Are you absolutely sure Walgreen ran it through your current insurance info? I would call them up and make sure your mepron coverage was deinied (which is why it would be 900 - thats like full price)
The other possibility is that there was a limit on the amount of the medicine they allow to be covered in a certain period of time. Its also possible they changed their formulary and it is no longer covered. You may even be able to acess the formulary (list of meds covered and how they are covred) online.
The other possibilty is that i know some insurance companies have a gap where they dont cover for a certain dollar amount. (i know this is true of at least some medicare part d plans)
I hope you get some answers and dont have to pay $900 a month for your mepron
I recently received a letter from my insurance company (Cigna) saying they would only pay for 2 months of meds from the local pharmacy of 'maintenance' drugs (anything with a refill). To have them continue paying I needed to send in my prescriptions to their mail order service.
This probably isn't what happened to you, but might be worth checking out.
Posts: 11 | From Maryland | Registered: Jan 2009
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posted
no mail order needed. that would be toooo easy
did make sure was right ins.- is correct. have had this prob. with LabCorp LOTS of times. they always try to bill and old policy, like 3 yrs old policy that was aetna from my employer back then. have given new info- they even copy the card.
just found out friday, Lab Corp is "out of network" for aenta and have to use quest. never been told this before and lots of our labs have been lab corp...thats gonna be aheadache. all hubby testing was lab corp- and they NEVER said anything aoubt being out-of-network, just this lcoal one i went to fri to get labs for probable gallbladder gone bad issue. as for the limit on amt of ht emedicine they allow to be covered---that me the case??
would'nt there be some kinda law against that??
we pay for private ins. so we HAVE ins. and now gonna deny mepron??
i am on IV rocphin as well.
anyone know if there is a "standard of practice" for babesia tx i could use as reference if needed??
they recently sent letters too about case mngt for disase process, i want nothing to do wtih that thank u very much. they sent 2 letter to LLMD about "need for rx review for this patient" as ins. felt meds may be conteractive. hmmm...well they were changed and not taking those now.
we have not had big problems until now. our premium went up this month to $750. seems like we should not have to fight this or have them butting in about what they think my LLMD is doing wrong.
Pharmasicst printed off the ins. response. it said somthing about..patient has exceeded $825 and will be reposnsible for $910 of rx.
i know our health part has a 5 mil max per yr per person and have not hit that for the medical stuff, Thank you Lord
i just was looking for any insight. thanks yall for the replys and taking the time to look, and think it through.
-------------------- i am not a Dr. any info is only for education, suggestion or to think/research. please do not mis-intuprest as diagnostic or prescriptive, only trying to help. **
dx in 08:lyme, rmsf, bart, babs, and m.pneumonia. Posts: 422 | From TX | Registered: Oct 2008
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
Azure did a great job of detailing the possibilites.
We had to pay for many months of mepron out of pocket so I feel your pain. If you do end up having to buy out of pocket, Costco generally has the best prices. You don't need a membership to buy from them.
Depending on the issue, sometimes your doctor can help get it paid for through insurance.
I hope you can get them to pay.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
just to post results of conversation with our insurance company.
pretty much went like this. you have a 5k max on rx of brand meds. u have reached that. so, now meds without generic too bad. she actually sugested not taking them!!!
so, my reply of had no idea, we pay for private ins. so we ARE covered and now, for rest of 2009 if there is not a generic i cant take it or i pay full price. of course we cant afford that...come on ?? $910 for mepron, thats just one of the 4 without generic. on top of the $750 monthly premium we pay. and the $500 rx per person to start with
-------------------- i am not a Dr. any info is only for education, suggestion or to think/research. please do not mis-intuprest as diagnostic or prescriptive, only trying to help. **
dx in 08:lyme, rmsf, bart, babs, and m.pneumonia. Posts: 422 | From TX | Registered: Oct 2008
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