Monday, August 20, 2012

STRESSSSSSSSS!!!

Seven little vials of medicine.  Seven vials delivered to my house once each month.  Medication my boys need to be tall enough to drive cars and get jobs.  Medication with NO generic equivalent, nor competing manufacturer.  Seven little vials that hold less that six teaspoons combined.  (The whole story behind the need for this can be read here.)

These little harmless looking vials have taken over the past three days of my life.  They have made me cry my eyes out, given me severe migraines, and sent me on wild goose chases through websites and paperwork involving insurance coverage.  They have caused me to look for part-time jobs that have great insurance benefits, and shop for home equity lines of credit.

Humph!   Maybe it isn't the drug that is the bane of my existence, but the insurance company.

Originally, my insurance covered the boys medication at the cost of $60 per boy, per month.  Excellent coverage actually, for a medication that runs over one hundred thousand dollars a year for the two of them combined.  It is so expensive that I almost felt bad for my insurance.  Almost...

Every year, our company takes a look at insurance and usually adjusts policies in order to keep insurance sort of affordable.  I begged my company (actually begged my brother in law who runs the place) to not make any changes this year.  I did not want to give the insurance company ANY reason to change the prescription benefit.  I was guaranteed that no change would be made to prescriptions.  We were getting a new plan despite my protest.  As you probably have guessed from the title of this post, things most definitely changed.

From $120 total per month to (drum roll please) $2300 PER MONTH!!!!  Yep, they decided that I need to pay 30% of the cost as a monthly co-pay.  As you may be well aware, co-pays do NOT count towards deductibles or maximum out of pocket costs.  I'm no mathematician but I can easily figure out that $2300 per month is going to cause a serious change in our standard of living.  (It may be a very cold winter...)

Tomorrow is Monday and I am hoping to find a ANYTHING in our policy that will get the insurance to at least count the money towards our maximum out of pocket, or even pay at a higher percentage since I have no other drug (generic or otherwise) available to me.  In all my digging around today, I may have found some verbiage to my advantage, but, I cannot find my actual policy in my online account.  (The policy they have listed is from last year, stupid huh?)

So, one more night of insomnia awaits me as I try to figure out just how we will pay for this drug. If  I find out that our policy specifically states that the drug cannot be paid under medical benefit and therefore is not subject to deductibles or out of pocket maximums, I may have to go to plan B.  Just got to figure out what exactly plan B is!

Wish me luck.

2 comments:

Amelia said...

Oh wow. I can't even imagine. I wish you all the luck in the world!

Amber said...

That is horrible! I am so sorry that you are going through this. I wish Mike could get samples for you. :( I guarantee they don't sample that drug though.