Aa
Maxed Out Prescription Insurance!!!
I got a call last night to confirm shipment of meds and they asked me should they bill me for co-pay. I said yes..thinking it would be around 15.00. Nope...they told me the computer shows that I had maxed out my plan and now I have to pay... well I can't afford it. Anyone have any ideas. I an on my 7th of 48 weeks... I didn't think I was covered (script wise) but when It was approved I figured maybe 'cause this was life threatening and I was getting it through Aetna Pharmacy...I just thought it was a blessing. I figured they wouldn't approve it if they weren't covering for the full script...oh well. I know I gotta get on the phone with them but I figured you people might have some ideas... If NYGirl sees this...please tell me the name of the company that helped you out with tx. Thanks all
Yvonne
Yvonne
I am in West Chester, PA....you got that right...no way can I afford to continue tx without assistance.
Also sometimes people here have left over meds they can give you or your dr. may have some that were donated. What part of the country do you live in?
What a hassle, this tx is too expensive to pay out of pocket for your average working person. Waaaay to expensive if I didn't have ins.
Bug
What a hassle, this tx is too expensive to pay out of pocket for your average working person. Waaaay to expensive if I didn't have ins.
Bug
we had bc/bs and was refused tx because they where injectables. Commitment To Care came to the rescue and provided 100% free interferon and offered to supply riba also. i declined on the riba as bc/bs would pay for that. Thank you Commitment To care. contact them asap. there is help out there.
I am not under my employers plan. I pay for it and it is an individual plan with a $2500.00 annual prescription plan. Right now I'm on hold with Aetna....and hoping there is a loop hole somewhere.l
I have my own insurance through Blue Cross, as a retired person. They refused to pay ANY of the injectibles. I did appeal, to no avail. Roche does have a plan for those who qualify, but they do want a lot of personal information. So far my treatment after 48 weeks is over $30,000. For a middle class person, making over 50,000........I was stuck. , including my husband's retirement. This is a very expensive treatment for drugs that cost the pharmacutical companies very little. Nikki
You might consider investing a little phone time with your insurance co. In my case, the tx meds we considered under the 'Pharmacy' section of my policy. After 'further review' the cost and coverage of the meds were applied against the 'medical' part of my employer's coverage which allowed me to to do tx #1 (24 weeks) and now tx#2 (48 weeks). I also get my meds from Aetna pharmacy.
Hi..thanks for all of your helpful responses. Aetna is gonna call me back. This shipment..the injection was 100% paid for...and 70% of ribo which leaves me a bill of 378.00. The person on the phone said.."uh oh"...I don't know why we paid for the pegasys since you have maxed out...I'll call you back. I said to her..it sounds like I might be sorry I called..huh? She just said she would be in touch some time today. Bobby..that was the name I was thinkin about. Commitment to Care...I'm gonna try to google them. Then I shall call Roche..again thanks everybody...you guys are God sent!
Commitment to Care (Schering's patient assistance program) can be contacted here: 800 5217157.
They are very generous with their income qualifications, they qualify based on after tax income, they do not qualify you based on other assets like someone said here. Those assets would have to be income assets. In other words, they won't consider say, your stock portfolio value to qualify you, at least they did not 2 years ago.
I too have BCBS and they managed to avoid paying for my drugs. Eventually ( a year and a half later) Commitment to Care was able to get them to start covering Riba but still no coverage of Interferon.
Try not to worry too much, if you take Peg Intron, call the number above and they can help you out. If you are on Pegasys they have a website at Pegassist.com.
I'd Act quickly though, you don't want to miss doses and Aetna might stall on you. I'd apply to Commitment while you try to pursue Aerna but it sounds like you are maxed out already.
They are very generous with their income qualifications, they qualify based on after tax income, they do not qualify you based on other assets like someone said here. Those assets would have to be income assets. In other words, they won't consider say, your stock portfolio value to qualify you, at least they did not 2 years ago.
I too have BCBS and they managed to avoid paying for my drugs. Eventually ( a year and a half later) Commitment to Care was able to get them to start covering Riba but still no coverage of Interferon.
Try not to worry too much, if you take Peg Intron, call the number above and they can help you out. If you are on Pegasys they have a website at Pegassist.com.
I'd Act quickly though, you don't want to miss doses and Aetna might stall on you. I'd apply to Commitment while you try to pursue Aerna but it sounds like you are maxed out already.
I second what the Floridian Guy said. Spend some time -- supervisor level only -- confirming what your policy actually does or does not cover. Often it's something as simple as talking to the wrong deparment -- medical versus self-injectibles -- and sometimes rx's aren't paid because a doctor forgot to send in a routine questionaire that the insurance companies send out. If it still turns out that you're not covered, then the drug company help lines are a way to go.
All the best,
-- Jim
All the best,
-- Jim
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
