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Ulcerative Colitis
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Posted 7/31/2023 2:32 PM (GMT 0)
Hi all! Well, good ole BluedoubleCross/Blueshield is at it again. I called in my Rinvoq refill, which was given a prior approval for a year last December. CVS Specialty said they would ship it and it would arrive July 27th. It didn't. I checked with them and discovered that my co-pay had suddenly been raised from $140.00 to $1,050.00. Contacted insurance co. and was told they didn't understand that. They started a 'case' to find out the reason and said I'd get an answer in from 24 to 48 hours. I'm still waiting and have 8 days of my Rinvoq left. sheesh IF I didn't have Tricare also, I could qualify for their copay assistance program. Sometimes I think one is better off without insurance!!! Sorry for the post but had to vent someplace. LOL You guys have a good day and be well....or in remission at least.
Posted 7/31/2023 3:56 PM (GMT 0)
Rx insurance issues can be a royal pain, Geezer, no question! I'm required to get my UC med by home delivery from out-of-state pharma, with 3 refills permitted. Then I have to submit a new script to pharma HQ in yet another state to continue on this same insurance. The dispensing pharma had been enclosing the paper script form with my 3rd refills, but now they stopped doing that and require me to either have my doc e-prescribe or download the script form from insurance Website in order to snail-mail along with doc's paper script. (Doctor does not stock/download this insurer's script forms so cannot e-prescribe. I don't have a printer at home so I need to go outside to download/print the insurance form from now on, which, of course, makes the process of reordering my med more cumbersome.) However, handling the insurance form myself enables me to add a note requesting that my med be dispensed by their pharma branch closest to my home state. Otherwise they would have it shipped from 800 miles away and be short on total med supplied, besides! *** Wish you good luck toward resolution ASAP of your current problem!!!!! / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
Posted 7/31/2023 7:36 PM (GMT 0)
geezernow, don't give up, keep after them. It is mind boggling what some of the specialty pharmacies & insurance put patients through.

Keep us posted please.
Posted 7/31/2023 7:43 PM (GMT 0)
LOL Old H...I hate it for you! It's bad enough to have this illness, but to have the additional stress involved to get our drugs....crazy! I 'think' my issue is resolved....we'll see. My insurance says they under charged my copay in the past, so now it's over a thousand every 90 days. I think we need to sign a dang contract with them when we get a new prescription stating exactly how much we will have to pay and how long the prescription will last. Your ordeal with all the extra paperwork sounds like a nightmare! Funny how insurance companies have made such a simple thing as filling a prescription by a doctor....an ongoing, endless quest for both the doctor and patient. Hang in there Old and best of luck
Posted 7/31/2023 10:39 PM (GMT 0)
So now you have to come up with over $900 extra every 3 months ($3600/year)? That would be a hard no for most people. Is there any assistance you can get?

United Health Care decided to stop covering my Dexilant (ppi) and that's going to be over $300/month but I might be able to get co-pay assist. I briefly looked into it and I have to send a pay sub or my last tax return and that irritated me so I haven't gone any further yet. I have enough to last for several months so I will get to it eventually. I think I tried every other PPI available and they didn't work for me. So annoying.
Posted 8/1/2023 12:57 AM (GMT 0)
This should be illegal....that extra stress is not good for us.

I got a bill from my infusion place for18k.... Insurance denied. I cried for 3 days. I'm still trying to figure it out. How they can go from approved to denied without them contacting you is just wrong....or suddenly raising the amount or changing how they do business.

It's sad that we have a love/hate relationship with our insurance.

I feel like it's that shell game...can you guess where or what your benefits really are? And their week isn't a week...it's actually almost 2.
Posted 8/1/2023 2:44 AM (GMT 0)
Geezer, some time back I posted here on the forum about my insurer pharma sending my UC med from a dispensary several states distant from mine. Luckily, another forum member, Deltaforce, read my message, and immediately advised me that he lived 20 miles north and got delivery from a dispensary much closer to our region. Then I was able to request use of that branch pharma to the insurance HQ! They seem to enjoy keeping us "in the dark" about locations & procedures that facilitate access to our crucial meds. *** In your case, it's totally outrageous that they raised your co-pay w/o prior notice, but now Big Pharma is suing the federal govt. trying to overturn the recent law requiring them to negotiate drug prices with Medicare. Pure greed on their part!!!!! / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
Posted 8/1/2023 3:16 AM (GMT 0)
Geezer....

Have you verified their amounts on the drug tiers? My BCBS has a 90 day amount that is less than the monthly amount. I had to diligently pursue and demand they honor those amounts.

I'm sorry that you are going thru this.

On the Medicare non negotiable suit.... I believe the large companies were complaining because if they refused to negotiate Medicare was penalizing them by utilizing other medications from other companies (that are used for the same disease/symptoms) that were willing to negotiate with Medicare. So they refused to negotiate and then sued when their "customer" went elsewhere.

Clo
Posted 8/1/2023 9:53 AM (GMT 0)

clo2014 said...
On the Medicare non negotiable suit.... I believe the large companies were complaining because if they refused to negotiate Medicare was penalizing them by utilizing other medications from other companies (that are used for the same disease/symptoms) that were willing to negotiate with Medicare. So they refused to negotiate and then sued when their "customer" went elsewhere.

This is disheartening. Instead of insurance picking which meds we can get, now Medicare will. All drugs of the same class are not the same as we all well know. Corporate greed vs government administrators. While I am all for Medicare being able to negotiate, I am not on board with denying drugs to punish non-negotiators. I don't know what the answer is, but patients are caught in the middle. We are screwed.
Posted 8/1/2023 9:58 AM (GMT 0)

clo2014 said...
I got a bill from my infusion place for18k.... Insurance denied. I cried for 3 days. I'm still trying to figure it out. How they can go from approved to denied without them contacting you is just wrong....or suddenly raising the amount or changing how they do business.

Wow! What happened? You've been getting these infusions for a long time. How can they suddenly, with no notice, deny the claim? I would suggest you contact your state insurance regulators and your congressmen, but you are in Texas so not sure how much they would help you. Maybe I would be surprised. I hope so. Fingers crossed you can get this straightened out!
Posted 8/1/2023 11:20 AM (GMT 0)
CC....Oh NO!!! I think...LOL a bad thing indeed....the insurance companies are trying to kill us off with added stress! LOL Did you contact your prescribing doctor about your insurance denial? When I was first prescribed Rinvoq, my doctor had to go back and forth with BC/BS to get a prior approval. Had it not been for his diligence, I would not have been approved. I do hate it for you and hope they will approve it. It is, so unfair that the insurance can grant approval and then just flip. Best of luck to you CC.
Posted 8/1/2023 12:58 PM (GMT 0)
Blue Cross/Blue Shied sucks I am so glad to be off that hellish insurance policy. Do you have an option for other insurance companies?

Post Edited (beatUC) : 8/1/2023 12:19:53 PM (GMT-8)

Posted 8/1/2023 8:03 PM (GMT 0)
CC,

That was my thought too...that's why I said "customer" the way I did.... Threatener just didn't sound quite right. Medicare should not have an "all or nothing" format to negotiate...and the insurance companies shouldn't be so greedy. I'm very concerned. My Mom used to say that Medicare and the insurance companies were in cahoots together trying to kill off those patients that weren't healthy....

On the BCBS we are working with them. Maybe it is a coding error. We did everything the way the Insurance specified. I even called prior to my appointment to make sure my doctor, nurses and the infusion place was on my policy. I've been going to the same place since 2015.... I had this happen a long time ago... but it's scary each time. My fear is that the infusion place refuses to do the infusion if your outstanding bill is not paid. Last time they had this happen they held a check in my file in case it wasn't resolved--it was the only way to get my Remicade. (They promised not to cash it without giving me notice...lol... although it would have bounced to the moon if they'd tried to cash it.) Thank God my notifications occurred just after my Infusion...now I have 6 weeks to get it straightened out. The stress has caused me to have horrible nausea and diarrhea....(plus I have now developed another UTI.) Not a good week. Stress is not our friend.

Clo
Posted 8/1/2023 11:20 PM (GMT 0)
Hope it gets straightened out quickly, Clo.

There must be something in the air -- I got a call from my specialty pharmacy today saying that my next Inflectra was going to be delayed because they needed a new prior authorization. I asked them why because they just got one in June that is good through December. They looked and said "oh yeh, nevermind" (not in those exact words). What is up with these companies? Sure got my heart beating fast lol
Posted 8/2/2023 2:14 AM (GMT 0)
CC....you made me giggle. That will get the heart thumping.

I just went in for a CT scan today....it was preapproved. BCBS even sent me a notice approving it. (After the Remicade scare I'm being extra cautious. I pestered a call center manager so much she was desperate to get me to stop calling her....lol..so she emailed a copy of the approval to me... ) I got to the check in counter and they said it was denied. We had to try to get it worked thru insurance again so the imaging company would do it. I had to threaten to go to the ER.... But they are both pointing their fingers at the other one saying they did it...they messed it up.... Agggh!

I'm so 😡😡😡! Two hours later I was able to go in. My appointment wasn't until 5. I showed up at 3. (Misread the text confirmation for appointment...) Thank God I was early or I would have had to make another road trip the next day.... Cause insurance does not fix problems at 500.

I think it the heat. Its fried everyone's brains down here.....

Clo
Posted 8/3/2023 5:00 PM (GMT 0)
So frustrating!!!! And there’s absolutely nothing that can be done to fix the system. Which is even more frustrating.

I honestly think the insurance companies deliberately screw things up for us hoping we’ll just fade away and not fight to get the treatment we need.
Posted 8/3/2023 5:04 PM (GMT 0)
FlowersGal,

Yep! I think that too sometimes.

Clo
Posted 8/4/2023 3:06 AM (GMT 0)
I hope they get it resolved soon. Sounds like some BS. My doctor left the practice in early June. Never had any issues before but I had been told in early June and again in early July that my new GI, at same office, would be calling in my prior approval before it expired July 11. DIDNT HAPPEN. So, I got to talk to them and CVS multiple times to fix their incompetence. Cvs told me they had faxed my doctors office the prior approval form FIVE TIMES last month with no response.
Posted 8/4/2023 10:31 AM (GMT 0)
That's crazy, Sarah. Glad you got it straightened out though, but it shouldn't have taken that much effort!

Clo, I just shake my head ... it's like the insurance gods are laying in wait to spring some new game for you to have to play. How did the scan turn out?
Posted 8/4/2023 2:18 PM (GMT 0)
Thanks. His office was always so efficient before so it makes me worry.
Posted 8/6/2023 6:16 PM (GMT 0)
OptumRx is who handles my drug coverage. I called them last week so see if there was any way to get a special pre-auth to get the Dexilant covered even though it wasn't on the formulary. They told me to try having my doc submit a request, but there were no promises. So I sent a message to my doc, they sent the pre-auth request and it was approved! So now I am covered again. I swear these insurance companies just try to do things to see if people will just comply or if they will challenge anything to be covered.

Moral of this story: if insurance denies coverage, appeal. You have a 50/50 chance you will win.
Posted 8/6/2023 8:37 PM (GMT 0)
Scan supposedly approved and will.be paid. Results were disheartening...2 kidney stones. Both over 3mm.1 in kidney and 1 in urethra. I have been uncomfortable. The urologist said it should pass with no problem but if I find myself with severe pain to go to the ER..

Between insurance and the kidney stones and UTI I've been really grouchy.
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