Wednesday, August 29, 2012

Stress Relief

Remember my last post?  Well...
After a few sleepless nights, some crying, and tentative plans made for the future,  I was finally able to get a copy of my current insurance coverage.  I studied it line by line, combing over my policy and all the little microscopic footnotes.   I could clearly see that I did have coverage for the injectable drugs that two of my boys need and they were covered under the medical portion of my insurance, not prescription.  Despite being told on no less than five occasions something to the contrary, it means that they are subject to deductibles and out of pocket maximums!!  
I promptly drove to the Altius offices and spoke with a representative, showing her what my policy clearly stated.  She apologized for all the confusion and promised that she would get my account straightened out. The root of the problem seems to be outdated computer programming that does not allow the medical side of your plan and the prescription side to be seen at the same time.  (C'mon people, this is 2012!)  After having had so many customer service people get it wrong, it was nice to talk to someone who appeared to know what she was doing.  She did not disappoint!  Within 3 days, all my screwed up claims were fixed, my account had been sent to the proper billing teams, and a check had been issued back to me for overpayment on Mason's medication. 
I could kiss that girl!
So, a payment of a minimum $30,000 per year, which would only increase as the boys get bigger, has now become a maximum out of pocket of $9,000!!!
I never thought I would be so excited about paying $9K in medical a year!!   A few weeks ago, I was complaining about how high my out of pocket maximums were.

Reminds me of the saying "How do you make a man happy?  Take away everything he owns...And then give it back to him." 

Monday, August 20, 2012


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.