Insurance companies stink!!!

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Does anyone else have BCBS? I want 4 epi pen's for my ds, they said they would only pay for 2. Two is just not enough, especially when he wears one in school, there is one in the school office, and I want one at home and one for grandma who he is with at least 2 days a week.

They did say they would see if they could get me 2 more. Well, they did call today and did approve 2 more "this time". I said what did that mean. They said more than 2 pens was considered a "convenience". I asked how is it a convenience to have life saving medicine on hand for your child? This really burns me!!!!!!!!!!!

This is a new insurance company as of this year, so it's the first time having to deal with them. Our other insurance would always ask how many we wanted, I always have gotten 4.

Anyone else having this problem? I just don't get it! It just makes me want to cry.

Jan

On Aug 15, 2007

We've got the exact same situation going on here as well.

On Aug 15, 2007

I have BCBS and it all depends on how the doctor writes the script for it. I the doctor only writes the script for two then you are only going to get two that month unless you go through a lot of loops. But if you can get your doctor to write the script for 4 then you will get 4. This is what I have done and it works great for me.

On Aug 15, 2007

be thankful you got rx...we have Kaiser and with my kids asthma/allergies(considered pre-exisiting) they woulnd't cover ANY prescriptions, so I pay out of pocket for ALL rx(and yes, I just bought 4 Epi's!!!)

I've heard this is pretty common though, were you trying to fill them all at once? You can request more, they will just drag their feet...or, just wait a month and call in a refill, they do allow you 2(if you get the twin pack) a month(most insurance does, not all...disclaimer), so wait a month and refill it again!

Or if you have multiple kids, I fill Jake's and Carson's, so I have 4 right there, but I carry them for everyone...then right before school, I call in a refill for each and I have enough for school and enough for home. Good luck!!!

------------------ Chanda(mother of 4) Sidney-8 1/2(beef and chocolate, grasses, molds, weeds, guinea pig, hamster & asthma) Jake-6 1/2(peanut, all tree nuts, seeds(all-sesame, sunflower, poppy, pine nut) beef, chicken, eggs, coconut(also avoiding legumes), trees, grasses, weeds, molds, cats, dogs, guinea pig & eczema & asthma) Carson-4 (peanut, tree nuts, milk, soy, egg, beef and pork, cats, dog, guinea pig, hamster, grass, mold, dust mite and EE) Savannah-1 1/2 (milk, beef and egg, dog(avoiding peanuts, tree nuts, strawberries, seeds, legumes and corn)

On Aug 15, 2007

Our pharmacy coverage only covers 2 per month, so I always make sure that all 4 never expire at the same time.

On the odd occasions where I know I'm going to need to replace both sets (we get them in twin packs) I just plan ahead.

------------------ Cheryl, mom to Jason (9 MFA including peanuts, tree nuts, shellfish, coconut, sesame, squid) Joey (7 NKA) Allison (4 milk allergic, suspect shellfish, avoiding PN/TN for now) Ryan (1) nka *knock on wood*

On Aug 15, 2007

I'm fairly sure, but I'd have to double check, but my insurance only covers one Epi a month. Since I require three (it used to be four), I had to space out the ordering of them, especially if they all expired at the same time.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

------------------ There but for the Grace of God, go I.

On Aug 15, 2007

Tufts did the same thing.

We have Oxford now and I have to go to the pharmacy tomorrow and pick up Epis for school--I'm expecting to have to pay for at least a couple out of pocket---grrr.

We had BCBS and they were awful about paying for my DD's asthma medication, as well as steroids when she needed them due to a contact reaction from peanut butter.

On Aug 15, 2007

We have BCBS prescription coverage and have never had a problem getting four epis--two for home, two for school. I didn't think the insurance company was able to second guess the doctor's prescription? Our prescription is written for four, so that's what the pharmacy gives us and that's what BCBS pays for.

Sarah

On Aug 15, 2007

My insurance company told me one epi-pen a year!! I had to have a letter of medical necessity written and was able to get a twin-pack for DD daycare, I paid out of pocket for the other two. Healthcare is terrible! I feel for all who have to pay out of pocket for all meds.

On Aug 15, 2007

Get doc to write letter of medical necessity stating that each "location" (school, separate care providers, and so on) should always have *2* Epipens! There should always be a backup Epipen at each location due to misfire or problems when administering (like injecting thumb due to incorrect grasp & now Epi won't work . . .) or in event patient needs second Epi before ambulance/EMS arrives.

Twinpacks meant to stay together as a PAIR!

These insurance companies are actively discriminating against the insureds in the name of the almighty dollar. Their arbitrary restrictions are not based in ANY WAY on sound medical practice. They also have ZERO business overriding what a doctor (THE CERTIFIED, LICENSED MEDICAL CARE PROVIDER) has ordered.

Insurance companies are in the business of making money, first and foremost: NOT in the business of "paying benefits". Yes, they stink in their mistreatment of their insureds.

------------------ ~Eli[b]Z[/b]abeth, Mother to 2: DD age 5, NKA, treated as though PA/TNA DS age 8, PA, possible TNA, Latex, legumes? (PA diagnosed & ana reaction 1999) Member here since 2000

On Aug 15, 2007

Thanks for all the info. I will be sure to stagger my rx's for the pens next year. I will also make sure his doc writes a new rx for 4 or more. I could easily use 6, one for the bus, karate, etc. I just don't get how the insurance companies can deny to pay for anyone's needed medication. It is total discrimination.

I am sorry for those of you that have to pay out of your pocket for yours. I did't know anyone had to do that. It's really a shame.

Jan

On Aug 15, 2007

I have BCBS insurance and I have Dr. write a script for 6 EPI pens and that is what I got was 6 EPI pens at one time for one copay amount. Have the Dr. write the prescription diffrent and see if that works. We always get 6 at a time. 2 at home, 2 at my daycare, 2 in his allergy bag that we take everywhere with him.

On Aug 15, 2007

Thanks! I wonder why the lady I spoke to said more than two was unnecessary?

On Aug 15, 2007

Quote:

Originally posted by seanmn: [b]Thanks! I wonder why the lady I spoke to said more than two was unnecessary?[/b]

Because they are trained with this stock answer -- that a certain denied medication or procedure is UNnecessary. Written right into the policy exclusions is the exclusion of anything the insurance deems "NOT medically necessary". This is a catch-all way to exclude all sorts of things. Unless and until you & your doctors "prove" the medcial necessity sufficently to them (&/or take them to court).

I worked for a TPA (third party administrator) for medical insurance for a few years. Believe me, the policies are written to benefit the insurance company, NOT the insured. Hated that job. Hated what it asked of me. Was very glad to be able to quit. But it sure did teach me alot about the med insurance industry.

Sounds like the BCBS rep just wanted you to think they were "doing you a favor" or a special exception. PIGS.

------------------ ~Eli[b]Z[/b]abeth, Mother to 2: DD age 5, NKA, treated as though PA/TNA DS age 8, PA, possible TNA, Latex, legumes? (PA diagnosed & ana reaction 1999) Member here since 2000

On Aug 15, 2007

Yes, SWINES!!!

On Aug 19, 2007

I work in Healthcare and often the person you are dealing with on the phone only has a high school education and they are making decisions based on a written list that they were given. As long as something fits their list they will deny it because that is what they are held accountable for. It is worth while to throughly read your policy, because often you have things in there that the case manager doesn't even know. They may deal with 15 different types of policies all with different coverages eventhough it is all BCBS. However, they all have a supervisor. We kept copies of all our emergency room visits and the subsequent treatment. Whenever I have an arguement getting pens filled I ask for their fax number and I immediately fax them copies of our ER bills with the personal info numbers black out. I tell them to put in it their file so that when I call next time to argue about them covering an ER visit I have proof that I tried to save them a few thousand dollars initially. So far, it has worked every time.

On Aug 19, 2007

Quote:

Originally posted by SafeMomNow: [b]I work in Healthcare and often the person you are dealing with on the phone only has a high school education and they are making decisions based on a written list that they were given. As long as something fits their list they will deny it because that is what they are held accountable for. It is worth while to throughly read your policy, because often you have things in there that the case manager doesn't even know. They may deal with 15 different types of policies all with different coverages eventhough it is all BCBS. However, they all have a supervisor. We kept copies of all our emergency room visits and the subsequent treatment. Whenever I have an arguement getting pens filled I ask for their fax number and I immediately fax them copies of our ER bills with the personal info numbers black out. I tell them to put in it their file so that when I call next time to argue about them covering an ER visit I have proof that I tried to save them a few thousand dollars initially. So far, it has worked every time.[/b]

Thanks for the information. I will look at our policy and see exactly what it says.

On Aug 19, 2007

Quote:

Originally posted by chanda4: [b]be thankful you got rx...we have Kaiser and with my kids asthma/allergies(considered pre-exisiting) they woulnd't cover ANY prescriptions, so I pay out of pocket for ALL rx(and yes, I just bought 4 Epi's!!!)

[/b]

We have to pay OOP too. We had state insurance for the past 3 yrs but we recently lost it. Before it expired I picked up 4 epis (we were going on a car trip). I just got them at least 30 days apart, 2 at a time, and it was fine. After this (longest date is a year from next month) we'll be paying 100% OOP for them [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

------------------ ============== [b]~Gale~[/b]

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