purfik
02-15-2006, 04:05 PM
O.K., I've heard from the medical company today. I was told that everything has been cleared with the insurance company (after over a month of waiting). Now it should be 1 1/2 to 2 weeks to set up meds. Hope I still have a pulse by then. The real shocker came when I was told the price of the copay. It will be a $300 copay every 3 months. We have "very" good insurnace so can anyone tell me if this is within normal range or is it rather high. I called the insurance company to inquire about the copay and they are giving me different numbers than what the medical company has. (Guess I should mention that it was the medical company that said the insurance company gave them the $300 figure. The insurnace company is telling me that number can vary, but cannot give me an exact figure.) How can I get a straight answer? Any suggestions? Thanks! :bouncing: >"My last nerve"
Sponsor
JulieDe
02-15-2006, 04:25 PM
I live in PA and have Highmark PPO Blue. I used to pay (up until March 2006) $40 every three months. Now I have to go through a different company but it will only be $20/month.
purfik
02-15-2006, 04:52 PM
I have the same insurance company and coverage. I think someone is trying to lead me by the nose. Guess I'll just have to ring their phone and make more noise. :eek:
purfik
02-15-2006, 04:56 PM
P.S. Do the insurance companies and medical companies know that stress is bad for MS?????? :confused:
Punkdizzle
02-15-2006, 05:09 PM
I live in PA and have Highmark PPO Blue. I used to pay (up until March 2006) $40 every three months. Now I have to go through a different company but it will only be $20/month.
same here... $300 sounds like a high copay to me.. are your sure you dont have a high Rx deductable that has not been met yet? my first month of rebif was $100 because i had to meet the deductible before the $10-generic $20-Brand copay kicked in..
same here... $300 sounds like a high copay to me.. are your sure you dont have a high Rx deductable that has not been met yet? my first month of rebif was $100 because i had to meet the deductible before the $10-generic $20-Brand copay kicked in..
StephanieAnne
02-15-2006, 05:33 PM
purfik
That does sound like a high copay, like $100 a month, check your policy for injectible drugs, sometimes injectibles are a little more for copay, but not that much more. Also, how are you getting the drug, from the pharmacy or is it sent to you via fed ex or ups? Because maybe the ins company is looking at your Home Health Care [HHC] benefit when figuring your copay and not the RX benefit, if a company like Caremark is sending your rx to you, they can be confused by some people [like the ins cust svc rep] as HHC.
When you call an insurance company for the price or your cost for anything, it is like calling the IRS you get a different answer every time, and yeah they want to cause more stress, then the sicker you get and the more claims that get sent in to them, it is a viscious circle :)
The funny thing will be when the RX claim is paid, how much you wanna bet the co-pay is not $300.00 :rolleyes:
At least you have been approved and will start on the med's, so that is a good thing, let's us know what the copay finally turns out to be
Steph
That does sound like a high copay, like $100 a month, check your policy for injectible drugs, sometimes injectibles are a little more for copay, but not that much more. Also, how are you getting the drug, from the pharmacy or is it sent to you via fed ex or ups? Because maybe the ins company is looking at your Home Health Care [HHC] benefit when figuring your copay and not the RX benefit, if a company like Caremark is sending your rx to you, they can be confused by some people [like the ins cust svc rep] as HHC.
When you call an insurance company for the price or your cost for anything, it is like calling the IRS you get a different answer every time, and yeah they want to cause more stress, then the sicker you get and the more claims that get sent in to them, it is a viscious circle :)
The funny thing will be when the RX claim is paid, how much you wanna bet the co-pay is not $300.00 :rolleyes:
At least you have been approved and will start on the med's, so that is a good thing, let's us know what the copay finally turns out to be
Steph
Natatude
02-15-2006, 08:42 PM
I am in PA and also have Highmark PPO Blue, my hubbys company switched to it back in october,,, the first script i had to get at my local pharmacy,, i got one box of betaseron,, there were 15,,, i paid 35 dollars,,, i then switched to medco's pharmacy, and they sent me 3 months worth 45 shots for 70 dollars, it was like buy 2 get one for free deal,,, now they sent a letter that they switched from medco to medmark,, and i called the number and the lady said she would send them out the end of april since i have enough right now due to major problems between the insurance company and medco,, that i have enough to get me thru till april along with a huge bill! they have corrected it since,,, this lady said my co-pay would only be 20 or 25 dollars she was not sure,, so i have no idea how much it will be till after i get a bill,,,, i would say it's gonna be 35 dollars,, cause our co-pays for meds, is 10 dollars for generic,, and 35 for name brand. i think the 300 is high,, but it depends on what insurance company u have, and what the co-pays and deductables are,,, i know ours,, we have no deductable,, everything other than meds in paid 100%,,, ER is only 50 dollars unless u are admitted then that is waved and it will be covered 100% 10 dollars for all drs and specialists and the co-pays for the meds i told above. good luck i hope u can talk to someone thru ur ins comp, that knows what they are talking about!
curiousforever
02-16-2006, 02:12 PM
call the pharmacy and ask them...they might know.