BCBS (of IL) is jacking me around, any advice?

[afidz]

When Humira was first approved, it was approved through TNH pharmacy. I paid $5 a month, everything went perfect. This week, the week of my shipment and dose, they called me and told me BCBS won't pay for them to fill my rx anymore and that everything was transferred to Optum RX. I called them today and they told me that they do not accept the Humira card and if I want the rx then I have to pay $250 for it and then request a rebate from the manufacturer. I told them that that is not reasonable for me to do so, and they had a few other options/suggestions
1. Open a credit card. (yea, with the thousands and thousands of $$ medical debt, poor credit and lack of income, I'm sure I could easily get one!)
2. Borrow money from family every month. (cuz my parents don't really like paying their own bills, they would rather pay mine)
3. You can go on a different med, there are a lot of cheaper meds out there that do the same thing-- I am not even going to comment on that.

So I have called all the resources I know, I have tried calling the insurance company but I get bumped from one automated line to the next. I am screwed.
This is why health care needs to be reformed in the US. People can't afford to be sick because the health insurance companies rule the market.

 

[Adam1971]

That's pure evil. I would get your doctor to help. If the drug is approved by bc/bs, they can't suddenly "un" approve it. A bit of outrage from your doctor/ibd nurse may help. Good luck.

 

[Clash]

So sorry to hear this, afidz. We have BCBS of IL as well and have never had issues with testing, meds or otherwise for C and his IBD....but

Last year, I started experiencing tachycardia. The electrophysiologist/cardiologiat explained that I had postural orthostatic tachycardia and the test to dx was a tilt table test. Postural orthostatic tachycardia means that your heart rate increases more than 30 bpm when you go from lying/sitting to standing and remains there. I went to the ER several times with hr in the high 160s. But when I felt like I was going to faint I would sit down and not pass out. Because I hadn't passed out BCBS of IL would not pay for the tilt table test. I paid 700 dollars out of pocket, had the test, verified the dx, appealed and they still won't pay!

I have to have another tilt table test in a month or so. I have not Sat down twice to ensure that I passed out(while facing bed) and had doc document it so this time they had better pay! Ridiculous!

 

[afidz]

It's not necessarily that they are unapproving it, but making it so I can't afford it anymore. My GI's nurse is giving me the spare dose that they have on hand, so I have a month to figure out what I'm going to do.
Jennifer, before you say anything I'm going to try to get on medicade tomorrow, the humira ambassador told me they pay 6 something for humira.
Bcbs is one of the better companies, but this really blows

 

[Droopy Drawers]

I have the same insurance & was just approved for Humira

Specialty pharmacy called me @ work & wanted to know where I wanted it shipped before I had even heard from the Rheumy about my blood work

They quoted me a $5 copay & I asked if I could possibly have it filled @ work, thus cutting out all the nonsense about ordering & shipping
The response was the call was being recorded
What does that have to do with the price of green beans ?

Had a pharmacy tech run it through the computer to see what copay came up & it was $50

I see the Rheumy tomorrow & will make my final decision then as to if I even want to start Humira

She's been hounding me about using it for almost a year & 6 months of mtx injections aren't doing much for me, so she wants to add the Humira into the equation to see if it helps

The last thing I need is grief from the insurance company
I pay a hefty premium

 

[M West]

I take Humira.. My doctor's office set up the drug through Avella Pharmacy. The Dr. mentioned problems such as yours with other suppliers jacking you around.

I am on COBRA, Blue Cross/Blue Shield. $5.00 copay per month's supply.

Try Avella. Your Dr. office will need to get involved. phone number is 877-546-5779

Good Luck.

Miles

 

[afidz]

Droopydrawers, was it optum rx that called you?

 

[Lisa]

Have you double checked your specific plan on line to see if there are any changes noted? Normally they should make notification of any changes, especially such as yours - in advance.....I know when our plan makes any changes, we get notification about a month in advance.

 

[Droopy Drawers]

Droopydrawers, was it optum rx that called you?

Think so
Why do they bother me @ work ?
They rang again today when I was out on break
Left a callback # with a cashier

See the Rheumy tomorrow & need to make the final decision as to if I want to use it
I'm afraid if I'm being honest
Had a skin cancer removed 2 weeks ago & don't want to rile anything else up

 

[Droopy Drawers]

Just had 5 minutes to myself & checked the # they left
It's Walgreens specialty that rang
Sorry for the wrong info

I hope you get this mess sorted soon

 

[afidz]

This whole thing is incredibly stressful.
I just applied for medicare, but I am not sure I will get it because I have insurance already, but I don't have an income, so it could go either way. Plain and simple, I can't afford the costs of my dad's insurance so if I have to get off of my dad's plan, then so be it.
My GI has given me (flat out) a month worth of Humira so I have time to figure out what I am going to do.

 

[poopaholic]

I wish you and I were closer . I have a dose of humira still in my fridge that won't be used. It will probably go just like the cimzia, keep it until it expires and throw it away. I also have several of the methotrexate . They had me stocked up on those before stopping due to liver enzymes complications. Anyway I hope things work out for you. Sending positive thoughts your way.

 

[Shari]

Careful... some of us work for those "dreadful" insurance companies....

 

[Shari]

Oh and I would like to mention that My RX is almost $1000 amonth...

 

[afidz]

What is there to be careful about? There is nothing bad being discussed. I am not going to monitor what I say because someone works for an insurance company. Its not a secret that insurance companies are money hungry with all of the reform going on and laws changing as much as they have.

 

[Shari]

Not all of them... All I'm saying is...let's make sure it really is the issue before we accuse the insurance company. I saw how others are still paying low copays...wish I was still given the option of low copays instead of a high deductible plan.

 

[afidz]

I don't have an income. I am too sick to work. Maybe $250 for a med is cheap for you, but its not a contest, I can't afford it, or come anywhere close to affording it. It is the insurance company. They switched the rx company that I can go through to get the meds. Because of them I can't afford my meds. I don't care who you work for, I am going to express my distaste for my insurance company. Because of them I am about to go back to a life full of nothing but pain and depression.

 

[alyssa519]

I have BCBS of IL as well. While it wasn't humira, they recently denied some pain meds I was prescribed, which was a bummer. There are flaws with everything (not just insurance) but it's super frustrating when us sick people can't get what we need to stay healthy because of them! I have tried explaining to them over and over that if they dont pay for X, I will probably end up in the hospital because I will get sick, and that's just not their problem. Hang in there! hopefully you can figure it out soon

 

[Jennifer]

Insurance companies are a major problem in the US. There are a lot of people who go without care and even die because they can't get any insurance. They either make too much money or somehow get screwed like in Afidz' case, people who don't even have an income, the insurance company decides they don't want to pay as much (like switching pharmacies to save money). Even in Clash's case they decided they didn't want to pay for a test so they could get proper treatment. Even I've had that issue where I couldn't get a medication or test done because my insurance didn't want to pay for it ("other meds do the same thing and are cheaper..." ********, or "you don't need that test," again, ********).

We could easily blame it on the cost of tests and medications as well but you can't say that insurance companies aren't a factor at all.

Hope you get approved for Medicaid Afidz. My Humira was covered 100% when I was taking it. That doesn't mean you won't run into walls with Medicaid in the future though so make sure your doctors are willing to fight the insurance companies for you. They refused to pay for my pill cam because they said it's a test used to diagnose Crohn's and since I already have a diagnosis then I don't need it. It's ******** but with a good doctor on your side, they will get them to pay for what you need.

 

[afidz]

Health and human services called me this morning to let me know that I have a phone interview today at 4 for medicaid. Fingers crossed, this is my last hope to be able to stay on Humira

 

[afidz]

Welp. SO much for that. I am not eligible because I don't have a child.
The Humira Ambassador in my area called me and told me about a patient support foundation, she said its going to be hard to get approved because I have insurance, but if I write a letter with my application and explain the situation I am going through then I might be able to get help with the copay.
Once I get approved for disability I can get medicare, and then things will be a lot easier for me because I will have an income again, but trying to get to that point is next to impossible it seems

 

[my little penguin]

One thing to look into is your out of pocket max on prescriptions.
Not saying its cheaper but after paying the full copay for x number of months then the drug is completely free as are all your other drugs for the year .
After three prescriptions of humira - DS ends up hitting the max.
Not that it is cheap at all for three months but it's not a 12 month thing kwim.

 

[afidz]

I can't pay for one month, let alone several. Really, I just have to wait it out and see if I get approved for disability or not. I don't see how they could possibly deny me, but I am trying not to get my hopes up.

 

[Kittee]

I have BCBS and they set up my humira through wallgreens special pharmacy. They call once a month to verify my address etc. Costs me $5.00.

Are you sure you understood them correctly?

 

[afidz]

There are several different plans, as well as a BCBS for every state, I don't know where you live, but mine is out of Illinois and I have to fill my prescription through Optum Rx, who does not accept my humira discount card allowing me to get it for $5. Instead, I have to pay $250 and after I pay that, I can ask the manufacturer for $245 of it back every month. Yes I understand that I would be getting it back, but I don't have the up front money to begin with.

 

[Catherine]

Do you know how long it would take get the money back from the manufacturer?

I don't know you or your family situation but would hate if my daughter come off necessary medication due cost without asking whether I could help out.

 

[afidz]

As I stated above, my family can't help. I don't know how long it will be for the manufacturer to refund the cost to me, but I'm sure I'm not the only person in the world that would make such a request. My guess it would be more than a month

 

[Catherine]

:ghug:I'm sorry Afidz:ghug: