Words of warning - everyone please read

iVillage Member
Registered: 05-02-2003
Words of warning - everyone please read
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Thu, 03-18-2004 - 12:37am

I had a run in with my health insurance company tonight.  I have Blue Cross, and I'm on a PPO plan.  All of my supplies are covered.  Or so I thought.  Last month, I got into it with them over my test strips.  Basically what I got out of them at that time was that my test strips (for the Freestyle) were considered "brand name", so I would be charged the brand name co-pay.  However because of a certain classification, they did not go toward my deductible.  This sounded like a load of BS to me, but I went with it.


Tonight, I go to pick up more strips.  I expect to pay $30.  I was charged $71.  I went through the roof.  I called the prescription company.  They said that it was a policy issue and I needed to call Blue Cross and complain to them.  I called Blue Cross, still furious and finally got some answers:


As of 1 March, Blue Cross changed their formulary without warning anyone which drugs/prescriptions would be affected.  The Freestyle strips were removed from the formulary, meaning Blue Cross technically no longer covered them, but because they cover "diabetic supplies", I was ONLY charged half-price, not full over the counter cost, despite having a prescription for them.  How generous of them.


While speaking with the pharmacy people, I found out that the One Touch strips are in the formulary, as are the Accu-Check.  So, either I purchase a new monitor and get my endo to call in a new prescription in a month, or I keep my monitor and allow them to gouge me.  I was considering the Ultra Smart (see below), but I didn't want to be forced to purchase one.


If your health insurance covers your supplies, find out if you can speak with someone regarding which supplies are "in the formulary" and which are not and if something may have changed since you last filled something.


A grievance was filed on my behalf.  I was the third person the poor girl at Blue Cross spoke to TODAY about the strips as this formulary switch has screwed a lot of people up, and not just us. 


I'm in a very bad mood right now.  And the day started out so promising.  I had been good for the last couple days so I could have a beer tonight, but I missed out because I spent so much time arguing with my insurance company.


 

 

Blueliner4
(aka The Pixie Princess)

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iVillage Member
Registered: 03-25-2003
Thu, 03-18-2004 - 9:33am
Gabby- Don't you wonder why we pay that insurance premium each & every month? I have the same insurane plan you do, since we are self employed, and it seems to be the most "affordable". We originally had it just for "major med" stuff, but since being diagnosed with "D" last yr, have used it more than I have in the past 15 yrs. It is really frustrating what they do & don't cover & the fact that we don't find out until we go to use it. I just had my DR switch me from 10 mg of Lipitor (which has a cost out the door of $98.00 & cost me $60.00, until my deductible cuts in, which is $500.00 of allowable meds)to the generic brand of a cholesterol med, which out the door is usually $68.00, & my cost went to -0-. (Great surprise!!! Not complaining here)) Explain that one!!!!My Dr. gave it to me for 90 days though & the insurance would only allow 30 at a time. Doesn't it work where the larger quantity you buy at one time is usually cheaper than individual supplies? Didn;t make any sense to me at all. Live & Learn.

The reason I wanted to reply to your post is that if you do have to switch to another brand of meter, be sure to call the company & tell them why you're switching & they might possibly give you the meter for free. I know I got a second meter for free from AccuCheck because my DR said the first one should have been covered by insurance (I was still new to this stuff & just paid for it)& I wanted to buy another one for my mountain cabin so I wouldn't have to remember to to it there & back each weekend. (I'm a really brainy person!!) Anyway, they sent me the 2nd one with no charge. So maybe they will for you too if you have to switch. Just a thought. Also wanted to let you know you're not alone with the " insurance frustrations". Even with that, guess we should feel lucky that any of our stuff is covered. "D" is not a cheap disease to have. Have a Miller draft on me. Isn't that the one with the least carbs? Marsha

Avatar for coldfingers
Community Leader
Registered: 04-30-2000
Thu, 03-18-2004 - 1:21pm

Please check with your local pharmacists.... when I got my accucheck compact last year the pharmacist had a coupon to get it free!

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Avatar for debstermom
iVillage Member
Registered: 03-25-2003
Thu, 03-18-2004 - 1:31pm
Im sorry they did that to you. I was using the one touch & paying out of pocket while i was pregnant (since they are not smart enough to realize it was type 2 not GD, they wouldnt pay for anything ) SO i called after & ins. will cover meter & strips, but only the Accuchek brand. We have blue care network (hmo) so im not sure how much the rx stuff is different from the ppo. But, my meter & strips are now free, THEY call ME to see if i need a reorder & i don;'t pay shipping. Accuchek calls me every so often to see how im doing also. I have the accuchek active - it was most like the one tough - results in 5 min, small blood sample.

i hate when they change formularys w/o tellign us. they did that to me w/ my zyrtec. used to be coverd at the brand co pay, $15., well, now that claritin is OTC, they figure i should be usigng that instead , so i pay brand co pay + extra, and it costs me $23. for zyrtec. Same w/ one of dh's glacoma drops. since there are other drops that have generics, they wont cover the one he uses at just the copay, since he "could" switch.

ugh. insurance co's!!

hugs






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Debi

iVillage Member
Registered: 05-02-2003
Thu, 03-18-2004 - 2:48pm

Marsha -


They cover One Touch and Accu-Check, that's it.

Blueliner4
(aka The Pixie Princess)

iVillage Member
Registered: 05-02-2003
Thu, 03-18-2004 - 2:52pm

Thanks for the advice Cheryl about the pharmacy.


Currently, One Touch is running rebate offers on all of their monitors.

Blueliner4
(aka The Pixie Princess)

iVillage Member
Registered: 05-02-2003
Thu, 03-18-2004 - 2:57pm

I spoke with BC again this AM, they cover the One Touch strips and the Accu-Check strips, but only the baseline models for monitors.

Blueliner4
(aka The Pixie Princess)

Avatar for debstermom
iVillage Member
Registered: 03-25-2003
Thu, 03-18-2004 - 3:14pm
The place where i got my meter originally let me use an accucheck complete w/the 'comfort curve' strips that take the blood in on the side. Just like the ones in the hospital theyve used on me . I dislike this one very much!!


The one i have, teh active, uses very little blood. I dont blame you though, if you have to pay - you may as well get the one you want!! I really wanted the palm pilot type one that one touch has , but since BCN was goign to cover any of the accuchek's, i couldnt really be picky!






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Debi

Avatar for cl_maryfrances40
iVillage Member
Registered: 03-25-2003
Thu, 03-18-2004 - 11:25pm

Gabby,


The same thing happened to me and my husband and I were forced to get a new meters also. I was equally furious. I saw my CDE and she gave me a Accu Check Compact. She asked me if I wanted one for my husband but I demurred because he was contacting the insurance company for his. Well, they made him pay and I got mine for nothing!


Try the Accu Check Compact. I think you will really like it and it has the nicest lancing devise on the market.


I have the same insurance PPO that you have and you won't believe how we were charged for our strips. The way my perscription is written I get one box which holds 6 strip containers. My husband's is written in such a way that he gets 4 boxes. Both of us had to pay $25 for our perscription. Now is that fair that he got 4 times as many as me for the same price?!


The reason I like the Compact is that you don't have to touch the strips or calibrate the machine. It also takes a very small sample and it is fast. It also saves 200 test results. It ejects the strip and so all you have to do is aim it at a waste basket and let it fly. It also can be used for alternative testing sites.


Well, I have calmed down again, how about you? It does seem that idots are running the insurance companies sometimes.


iVillage Member
Registered: 05-02-2003
Fri, 03-19-2004 - 3:17am

I'm

Blueliner4
(aka The Pixie Princess)

iVillage Member
Registered: 02-20-2004
Sat, 03-20-2004 - 9:21am
Insurance companies, especially HMO's, stink! I wouldn't expect a PPO like Blue Cross to screw you over.

I use the One Touch Ultra (want the next step up, though). My strips when I get them at Walgreen's are $6 for a month's supply. Oh, get this...my original prescription was for 100, but I was directed to test twice a day. So, my drug plan two months ago decided I only needed 50. Talk about being frustrated. Anyway, now I get 3 month's supply (testing 4x daily-new prescription) for $14. Don't know why it's $2 more. It's supposed to be 3 months for price of 2 months which would be $12. They're crazy anyway!

When I started testing a year ago with a diagnosis of insulin resistence, went to get my strips and lancets at Walgreens. They said that Express Scripts (my drug mail plan) said they weren't covered and that they'd total over $120 for the necessary prescriptions. I don't do well with poor customer service. I called Express Scripts and my insurance company and raised Hell with both of them. I'm like a little mosquito that buzzes and buzzes until I get what I want. Took me a day and a half to get it corrected, but took too much energy out of me!

If I were you, I'd take a deep, deep breath, and call Blue Cross again. Ask for last year's formulary and this year's. Ask to speak to a supervisor and ream their butt!

A grievance works quite well...I have one in process for their overcharging me for my Zocor. They charged me $80 when it should have been $50. I just hate dealing with the idiots!

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