So my family has insurance through my husbands work, and today I went to get my sons prescriptions and one that's ALWAYS been $30 came up as $50. I told the lady that must have been a mistake because I've never paid that. Well I get on the phone with the insurance and find out they changed the meds to a tier 3 because a generic is now available. No problem I just wish i wish they would have notified us. The insurance won't cover this med until its out, so when I went to get the generic they said it would have to be ordered! And won't come in til thurs! So I had to pay out of pocket for the 2 days worth. My question is should the insurance have to reimburse me the money off the next prescription because they didn't notify us of the change?
@ christine no it cost me right around 20$ for 2 days. His meds aren't cheap! I had to buy a weeks worth while waiting for authorization and it cost about 145$. And no the generic is still 30$ because it's still a tier 2.
@marda the 145$ was remburshed on my fsa card already I made sure of that. And no I didn't get any kind of notice I don't just toss mail without looking at it especially if its from drs or insurance because I'm waiting on authorization for a blood test for my son as well.
Nope, doesn't work that way. And, to add, it has been this way since BEFORE President Obama even came on the scene.
Sorry, M..
Dawn
I work for an insurance company and did a lot of work on the prescription side. We would routinely put notices like this out on the website, and sometimes if it is a very popular drug we would send a notice to those we have a record of receiving the drug. However, we have tons of members, and they are all under different numbers, and there are tons of drugs that may be changing tears at any given time. It would be possible for someone not to be notified. If I were you I would send a claim form with the 2 days worth of medication to the company for reimbursement. Your pharmacist can also forward you the medication and adjust your copay. Ask them to do this, it is the easiest way for you to get your money back quickly.
wow people.... formularies exsisted a LONG time before Obama. I get if you don't like the man...but you sound uneducated when you blame everything under the sun.
Also....while I realize it is very easy to be angry at insurance companies, really having you pay LESS for generics actually makes sense. I don't know about you all ... but I have not used brand name tylenol or zyrtec in years.... we can't have it both ways... do you want lower healthcare costs or do you just want everything you want when you want it?
Sorry M.... i know that did not answer your question... but just getting frustrated with the lets blame the president for everything we don't like that goes on.
I would call the insurance company. Normally formulary updates are sent out either via email or paper depending how you have you information sent to you. Also as another poster pointed out... the wed site is a great place to keep updated.
In meantime contact them and ask how to file an appeal for reimbursement
also it sounds like your son may have chronic illness, ask them if you are eligible for any case manger programs, it will give you a single person to call o help navigate all of these issues
good luck
No. They can change without notifying you. At my last job, people complained constantly about their copay's changing. There was simply nothing that could be done about it. When you sign the paperwork and contract, it's in the fine print. Heck, I'd take only paying $50...but that's not your question...and I can see why you're irritated. It's unfortunate insurance companies operate like the do.
How would an insurance company notify all of the patients proactive that are taking a medication? You will save money on the situation after all, it couldn't have cost you more than $3.25 for the two days and the generic will be less than the original $30. That's not how it works and it's not worth the time to be bothered.
I have been dealing with a similar situation....and this has nothing to do with Obama. I am in the middle of a battle to get the actual medicine I need because my new insurance is forcing me to try other meds first, even though my doctor did not prescribe them first....very very frustrating.
About the $145 you paid while waiting for approval. You can take that receipt in to the pharmacy and they'll get approval now and refund the difference between a co-pay and the whole amount you paid.
I've done that a couple of times for my daughter at a Fred Meyer pharmacy.
I have Kaiser Permanente insurance and they've sent me a new formulary list when they change it. Is it possible that you received it but didn't realize what it was?
Nope. They can makes changes anytime they want without notice. All ins companys want you to get generic cause its cheaper. Our ins will charge us $75 if we get a name brand and $85 if we r given a name brand when there is a generic brand. You just cant seem to win anymore. Thanx Obama care!
You can call the insurance carrier, but it's my bet they will say there was a notification of some kind sent out.
If nothing else, you need to check the drug formulary for your plan. It will tell you what is available in generic and what tier each medication is on.
You should be able to find this information online.
Best wishes.
