Scared....Insurance changes

Discussion in 'Fibromyalgia Main Forum' started by granmama, Mar 25, 2003.

  1. granmama

    granmama New Member

    My husband's employer has once again changed our health plan. This past change prevented me from buying my Prevacid for my dx GERD. I have been without it for 2 weeks now. I'm taking Pepcid, mylanta, rolaids whatever I can get my hands on. Sometimes, I vomit bile or food without any warning. Food at times, just doesn't want to go down.
    The Prevacid helped stop all those above symptoms and I have been taking it since 1999. Plus, it healed an ulcer in my esophagus. I just could not afford the cost of the drug building up to my deductible. Before it cost me $15.00 copay.
    Also, it is believed that Prevacid (Cox 2 Inhibitor) prevents the absorbtion of iron in the gut. Which explains why I have not had to have a phlebotomy for my Hemochromatosis in over 2 years. It has kept the iron at bay!!! I have had to start eating bland foods, cut way back on soft drinks and now have a wonderful case of hemorrhoids.
    Next, will be Zoloft. Prevacid and Zoloft are my only drugs without a generic.

    I am so frustrated and when the Zoloft runs out....CRAZY!
  2. baby-bear

    baby-bear New Member

    First I am really sorry your having to got through this. Now ...tell me this...why will the new insurance plan not let you get your Prevacid? Who is the insucance co. and is it a HMO or a PPO? See I work in an insurance dept. and deal with so many types of insurance companies...so I know some on how they work and what to do. Is it that you have to start all over? Or is it that they do not cover pre-existing things? Let me know and maybe ...just maybe I can help or give you an alternative...also there are some on-line pharmacueticals that will give you these types of prescriptions and theyn are about 40% to 60% even up to 80% off the real high price. I will ersearch them and let you know...So write me back and let me know...Love and Hugs....Pammy
  3. granmama

    granmama New Member

    Hi Pammy,
    Thanks for your interest!! The new change is with Aetna. Instead of paying a copay for scripts, we now have a deductible to be met and then a $2500 cap on scripts. (I don't know if that includes doc visits) Copays after deductible are higher than previous plan.
    Many of the office employees that are covered are older and take many medications, so it will eventually hit us hard in the pocket book after the 2500 is used.

    BUT...I just heard from my husband this morning that the company is considering PHCS. There would be no deductible, and both my main docs (primary/gastro) are on the plan. YEAAAAAAAAAAAAAAAAAAAAAAAAAAA
    So, maybe there is good news coming and this policy would go into effect May 1. I'm keeping my fingers crossed.
    granmama



  4. baby-bear

    baby-bear New Member

    Im totally happy for you...let me know if I can help you in any way... Hugs.....Pammy
  5. Mikie

    Mikie Moderator

    Companies let out bids for their insurance every year, even small employers. They are looking to save money and this usually means the employees have to carry more of the financial load. The problems often come from the use of formularies, or lists of covered medications. Each insurance company has its own list of what is covered. Some have a three-tiered system for co-pays for generic, brand names, and non-formulary drugs. Mine is like this. If it's non-formulary, my co-pay is $50 for a 30-day supply.

    Most employee plans are guaranteed issue without pre-existing conditions. The new company has to take everyone who qualifies during open enrollment.

    I'm hoping you get the plan you want as it's totally unrealistic for people to have to juggle their meds every year based on their ins. coverage, but it's a sad reality today.

    Love, Mikie