What good is insurance

Discussion in 'Fibromyalgia Main Forum' started by karen55, Nov 21, 2002.

  1. karen55

    karen55 New Member

    if it won't cover your prescriptions? I brought my new scripts to the pharmacy last Saturday. They filled everything except the Provigil. The pharmacist said they indicated they needed "prior approval". Today is Thursday and the insurance has just gotten around to making a determination; the pharmacy has faxed the script in twice a day, each day. I was just informed that the insurance co. denied the prescription, so I asked how much it was to just pay for it, without going through the insurance co. "Only" $192.00 for 30 pills! That's one med I will do without, I honestly can't afford that. I was wondering if there was a way I could cover it at half that and couldn't do it, needless to say, I was totally shocked at that cost.
    And now there's the added worry about what my insurance company is going to do when our group policy comes up for renewal in February. I work for a small business and some of our employees are ex-military and are covered by other policies, so there are actually only 3 people, plus my dependents on the policy. Last February they increased our rates by 58% due to "exposure", which meant how much money they paid out in claims for us, and most of the claims were paid on me. My company pays $400 a month for my coverage and I pay an additional $400 a month to cover my kids! I cannot imagine what will happen in February now. I'm so afraid of not being able to get coverage in the future because of my medical record, and it looks as if the insurance company is pulling back on which meds they will pay for.
  2. karen55

    karen55 New Member

    if it won't cover your prescriptions? I brought my new scripts to the pharmacy last Saturday. They filled everything except the Provigil. The pharmacist said they indicated they needed "prior approval". Today is Thursday and the insurance has just gotten around to making a determination; the pharmacy has faxed the script in twice a day, each day. I was just informed that the insurance co. denied the prescription, so I asked how much it was to just pay for it, without going through the insurance co. "Only" $192.00 for 30 pills! That's one med I will do without, I honestly can't afford that. I was wondering if there was a way I could cover it at half that and couldn't do it, needless to say, I was totally shocked at that cost.
    And now there's the added worry about what my insurance company is going to do when our group policy comes up for renewal in February. I work for a small business and some of our employees are ex-military and are covered by other policies, so there are actually only 3 people, plus my dependents on the policy. Last February they increased our rates by 58% due to "exposure", which meant how much money they paid out in claims for us, and most of the claims were paid on me. My company pays $400 a month for my coverage and I pay an additional $400 a month to cover my kids! I cannot imagine what will happen in February now. I'm so afraid of not being able to get coverage in the future because of my medical record, and it looks as if the insurance company is pulling back on which meds they will pay for.
  3. Carlacat

    Carlacat New Member

    I went to have my Bextra filled and it costs me 45.00 and it should have only cost me 25.00 at the most. My ins co does not cover that med so I'll have to get another script from my doc to subsitute it. I think their getting pretty picky myself.
    Carla
  4. Newswoman

    Newswoman New Member

    Some drug companies will give you the medicine for free if you can prove you have an economic need. When I was unemployed and needed meds, my rhuemy filled out the proper paperwork so I could get them for free. I'm working now, so I didn't need to send in the paperwork. Also, try searching for "free prescriptions" on the internet. There are several other programs out there. Just a heads up, many of them are for senior citizens, but there may be some that would help you.
  5. karen55

    karen55 New Member

    Carla, I take Bextra too. I am taking the 10mg Bextra and 30 days costs me $45 on my rx plan. My Dr. had me try the 20mg Bextra about 8 weeks ago and my rx plan would only cover 20 of them (almost 3 weeks worth) for the $45 copay and then I would have to get a refill. I didn't find that 20mg worked any better than 10mg, so I didn't refill that rx, and went back to the 10 mg.

    Newswoman, I doubt if I could get free meds since my husband and I both work and we are insured. I wasn't positive I wanted to take the Provigil anyway. I have MVP and even though the Dr., pharmacist and the literature I've read on that particular med indicated I shouldn't have any problems, I've taken 1/2 a dose each day from the samples my Dr. gave me, and I felt great during the day, but late in the afternoons I've noticed a flutter and at night I've noticed some flutters and some rapid, pounding heartbeats. So maybe this denial is sort of a blessing in disguise? Either way, the cost of the med is what made the decision ultimately. It just infuriates me that the ins. coverage is costing so much and now they pick and choose what they are going to cover. Medical care is priced out of reach these days and that's a hot topic with me. I feel like telling all these drug companies if they didn't spend millions on advertising campaigns where every time you turn on the TV or read a magazine you see their drug ads, and they left it up to the Drs. to prescribe what's appropriate, more people would be able to afford the darn meds in the first place.
    [This Message was Edited on 11/21/2002]