Aa
Sometimes I had insurance companies
So yesterday I got a letter in the mail from a third party company that my insurance had hired. The letter wanted to know if my recent visit to the surgery center where I had my injections had anything to do with an accident. They wanted to know so that if my injuries were cause by an accident they could file a claim against whoever caused it to get more money. I thought that was just ridiculous. My injections were about $1,500 each. My insurance only pain my PM center about $250.00 and my copay is $150.00. I think its ridiculous that they don't even pay half of what the injections cost and they want to get money from any source possible to boot.
Also I found out the reason they lowered my Norco from 10/325 to 7.5/325. My insurance will only pay for 90 tabs for the 10/325. I was getting 90 tabs for a month and it was written to take 3 a day. My next appointment is not for five weeks to I need more than a months supply. So they had to lower the dose to 7.5 and change the script to take 1 every 4-6 hours so I can take up to 4 a day and they gave me 105 tabs. I just find it really weird that my insurance will only let me have 90 tabs of the 10's but will give me 105 of the 7.5's.
Oh also the nurse told me when she gave me my script today that it usually takes 7-10 business days for insurance to approve the TENS unit. I'm on about day 5 if my PM filed the claim the next day after my last appointment. So I'm crossing my fingers that my insurance will approve it. Oh I also told her how my insurance ***** and they wont even approve Celebrex for me. She said the reason for that was my age. They hardly ever approve it for someone as young as I am. She said give it 20 years and I would have no problems. haha. Here comes my age again messing everything up!
Also I found out the reason they lowered my Norco from 10/325 to 7.5/325. My insurance will only pay for 90 tabs for the 10/325. I was getting 90 tabs for a month and it was written to take 3 a day. My next appointment is not for five weeks to I need more than a months supply. So they had to lower the dose to 7.5 and change the script to take 1 every 4-6 hours so I can take up to 4 a day and they gave me 105 tabs. I just find it really weird that my insurance will only let me have 90 tabs of the 10's but will give me 105 of the 7.5's.
Oh also the nurse told me when she gave me my script today that it usually takes 7-10 business days for insurance to approve the TENS unit. I'm on about day 5 if my PM filed the claim the next day after my last appointment. So I'm crossing my fingers that my insurance will approve it. Oh I also told her how my insurance ***** and they wont even approve Celebrex for me. She said the reason for that was my age. They hardly ever approve it for someone as young as I am. She said give it 20 years and I would have no problems. haha. Here comes my age again messing everything up!
I've never received a letter like that so that's why it was weird. Also the doctor said that my insurance would not allow for more than 90 of the 10's to be written in a month. The 7.5 is fine because I get to take 4 a day which is 30mg and I was taking 3 a day of the 10's so it's all the same. So I know that they are not trying to lower my dose because they don't want me to take 10's because this script is the same as my old one when you compare. The script is for 26 days if I take the max, if I take the minimum it's for five weeks. Maybe my company has a different kind of insurance through Blue Shield since we are a small business. Knowing my company we probably went with the cheapest policy.
Also my insurance sent me a letter stating why they would not cover Celebrex. They said that even though I've tried 4 other NSAID's they wanted me to add a proton pump inhibitor with the Mobic and that was why they were not going to cover Celebrex.
It just seems that our policy is not very good. My copay for anything other than doctors visits are outrageous. My doctor visit copay is only $15 and so are my prescriptions so that's good. But the injection was $150.00 and I think ER visits are $300. Maybe it's because I'm on and HMO. I don't know.
Also my insurance sent me a letter stating why they would not cover Celebrex. They said that even though I've tried 4 other NSAID's they wanted me to add a proton pump inhibitor with the Mobic and that was why they were not going to cover Celebrex.
It just seems that our policy is not very good. My copay for anything other than doctors visits are outrageous. My doctor visit copay is only $15 and so are my prescriptions so that's good. But the injection was $150.00 and I think ER visits are $300. Maybe it's because I'm on and HMO. I don't know.
Hi! I also have BC/BS and they have been great to me .They have a program called Chronic care .I think thats the name and it doesn't cost extra but they provide a variety of services for people in chronic conditions .Also, I recieved a thing in the mail about getting some of your scripts dosage doubled and then cutting your pills in half to take .You buy less pills a month so it costs you less.I hope I explained this right .I am thinking of doing that with my lipitor since it is so expensive .I have been really happy with them .Before we had United health care and I was not happy with them .They would not pay off on hardly anything .Since we changed insurance to BC/BS they have been just awesome .My co-pay is a bit high but on meds and tests they have paid out on everything I have had done .Also my hospital stays . I am just happy to have good insurance .Without it nowadays you are screwed on getting good health care .I feel bad for anyone who doesn't have it .Well I have rambled on enough .Sorry, Melissa
When I had to get the TENS unit I took it to my pharmacy and they gave me one while the insurance went thru. This is my Dad's pharmacy I was using at the time and my Dad is friends with the owner so this may be why he did this but you could ask your pharmacy.
You should have no problem with the insurance. they only cost around a hundred dollars or so.
You should have no problem with the insurance. they only cost around a hundred dollars or so.
I agree to have your dr call the insurance and say you need the 10/325s see if they will do it and tell them to tell the ins that you need that dose for 5 weeks worth since that is how long it take you to get back in.
Good luck to you
Jamie
Good luck to you
Jamie
Hi Kat,
I think that Mummy3too and dontunderstand are right. Why don't you call your insurance and ASK them if they will cover the Celebrex and the 10/325's and for how many and see what they say!!
Then you'll know what's going on here for sure.
Just a thought..:)
Anxiously waiting to see what you find out.....Sherry
I think that Mummy3too and dontunderstand are right. Why don't you call your insurance and ASK them if they will cover the Celebrex and the 10/325's and for how many and see what they say!!
Then you'll know what's going on here for sure.
Just a thought..:)
Anxiously waiting to see what you find out.....Sherry
I agree with dontundertand. We all have the same insurance (although I know there are different company agreements and plans) but regardless, I have a feeling the doctor may have put the restriction on the meds... not BC/BS.
I have BC/BS. Its fed but should not be that different. They were filling 180 10/500's. I don't think that's something the insurance can dispute. An amount. It's either yes or no. They denied me celebrex as well. But I really think that the doc has the only say if it's approved how much. Maybe I'm wrong. That just seems odd to think they'll cover it but they have a say in how many you can have
Did your insurance company tell you they only cover 90 tabs for a month of norco or did the doctors office?
is the 105 for a months supply or 5 week supply?
I also have the same insurance as you and take hydrocodone.
is the 105 for a months supply or 5 week supply?
I also have the same insurance as you and take hydrocodone.
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I get those letters from the "3rd party" every single time I need to go into the emergency room at the hospital and/or admitted to the hospital. Those are just standard forms that they send out after a situation like that. The ones that were sent to me from my car accident, go to my lawyer who takes care of them. But, I've been to the hospital for something unrelated recently and got one in the mail. I didn't even return it to them. Just want you to know that you don't have to worry about those forms. It is just standard procedure because the insurance companies want to collect money from other insurances companies due to a car accident or work accident. It does make sense though, because in your policy from the insurance company it states sometimes that it is able to collect on another insurance. Each person has different wording in their contracts. Mine for example stated they could collect only from a 3rd parties insurance, which meant the insurance coverage that the lady that hit my in my car accident. And I was very happy that they could collect on only from the 3rd party not my other insurance stuff.
I agree with the injection amount though. I couldn't believe how much of it my insurance DIDN'T cover... I can't complain too much though because my insurance has been really good to me otherwise...