Doing the insurance dance today...

[kellyt]

I received a call from the specialty pharmacy today stating that my insurance (Aetna, who is currently secondary to Medicare until the end of Nov) has stated that my specialty pharmacy (CVS) is no longer "in network" (this must have happened in the last 20 days, cause they were "in network" last month).  And in order for Aetna to pay their 20% cost of my Prograf and Cellcept after Medicare pays I have to meet my "out of network" yearly deductible of...are you sitting down?....$12,000.00.      Needless to say I'll be switching to the Aetna specialty pharmacy which is "in network" (go figure).  This is all such crap.  And how outrageously stupid...$12,000.00.  Who would opt for an "out of network" pharmacy with that deductible?  WTH?
And now I have to get my other 4 meds from my "local pharmacy", which is okay except I have to physically drive there every month to pick-up instead of having them delivered to me via UPS.  This may sound trivial to those who don't get their meds delivered, but I'm telling ya, delivered is THE BEST!    

grrrrr!  I did get some information on the drug company that makes Prograf, as well as registered for some Prograf discount card.  However, I can't use the discount card until I'm off the Medicare, but apparently it saves me $200 a month.  I'll take what I can get.

[Chris]

Can you look into a local pharmacy that offers delivery? Not sure if you have Walgreens out by you, but you can choose between delivery or pick up and delivery is free.All prescriptions you have with them can be accessed via computer to reorder or have set up as auto refill.
 
I have had problems with CVS also with nsurance and idiots behind the phone there, but have had similar problems throughout the years with mail order pharmacies and insurance. Think I am on either my 5th or 4th mail order pharmacy in 11 years.
 
Good Luck Kelly

[kellyt]

This isn't a problem with CVS.  It's an insurance problem.   Aetna has been wanting me to switch to their specialty pharmacy with home delivery for a while and I've always passed cause I was happy with CVS.  Well, $12,000.00 out of pocket deductible changed my mind. lol

[jbeany]

I'm doing an insurance dance today, too.  One that involves a lot of stomping...

Got my Medicare "this is not a bill" in the mail today.  Love the charges for the 7 different different docs on my "Pain Management" team - 300 bucks a pop for every time one of them popped in my room for 3 minutes to ask me to name a number between 1 and 10 - who also managed to pop out of sight every time the pain meds going into my epidural ended up running out because no one bothered to answer the buzzer....   

[Chris]

Do they have a list of pharmacies to choose from Kelly so you could decide?

[RightSide]

And now I have to get my other 4 meds from my "local pharmacy", which is okay except I have to physically drive there every month to pick-up instead of having them delivered to me via UPS.  This may sound trivial to those who don't get their meds delivered, but I'm telling ya, delivered is THE BEST!   

Not for me.

I'm not home much of the day when the delivery guy comes.  So I'm always having to arrange with the property manager or a neighbor to sign for the meds package in my absence.

Whereas my nearest CVS is located less than 3 blocks from my home.  The pharmacy there would hold the meds for me, and I could walk over to pick them up at any time.

[jbeany]

Yeah, I get deliveries here from my transplant pharm.  I hate it, too.  It's UPS - and they tap on the door once, so lightly you can barely hear it, even if I am home, and then run back down the stairs and dump everything at the complex office.  Then I have to find a time to go get everything.  PITA.

[kellyt]

You two are right.  I work from home and am usually home during the day (or my husband is), so home delivery is convenient for me, but not for everyone.   For a while there, though, if the front gate was closed they UPS guy would either put the cardboard box of meds in a rather large plastic bag and tie it to my gate, which wasn't too bad, but on more than one occasion he just put them in the bag and tossed them over the gate.  WTH?  Once, when we had the donkeys they got ahold of the box, but thankfull didn't destroy it!  I had to make a complaint.  They bring it up to the house now.


Chris, I don't know if I have a "choice" if I decide to use the "Aetna Specialty Pharm".  I haven't heard back from them yet.  I need to call them tomorrow.  I think, however, they said they would do the 90 day scripts for me though.  I hate all this!!
Thankful to be one of the fortunate ones that have insurance, but still hate all the hassle.

[Chris]

Another thing I noticed is that some require a signature, so if no one is home, you do not get medications. However after having problems of meds missing, this was good for me unless I have several doctor appointments that whole week. So that would be something to inquire about of their delivery procedure.

[kellyt]

i called them today and it ended up just being a totally confusing conversation.  First off they couldn't find me in their system.  Second, they were telling me copay amounts.  When I asked if those copays would be affective in December after my Medicare runs out, she just kept telling me she didn't work for Medicare.  I finally said "Thank you.  Go to lunch, cause you need it".  She was crabby.  Now I wait for them to contact me to discuss delivery and such.  I hate change. 

[Chris]

Hindsight here talking, should have asked for her manager