Insurance companies stink!!!

Posted on: Wed, 08/15/2007 - 1:19am
seanmn's picture
Joined: 10/01/2003 - 09:00

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.


Posted on: Wed, 08/15/2007 - 1:28am
mistey's picture
Joined: 01/18/2004 - 09:00

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

Posted on: Wed, 08/15/2007 - 1:32am
raven's picture
Joined: 07/23/2007 - 09:00

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.

Posted on: Wed, 08/15/2007 - 1:35am
chanda4's picture
Joined: 12/14/2006 - 09:00

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)

Posted on: Wed, 08/15/2007 - 1:40am
solarflare's picture
Joined: 02/07/2002 - 09:00

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*

Posted on: Wed, 08/15/2007 - 1:52am
Anonymous's picture
Anonymous (not verified)

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][/img]
There but for the Grace of God, go I.

Posted on: Wed, 08/15/2007 - 2:27am
PinkPoodle's picture
Joined: 06/12/2007 - 09:00

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.

Posted on: Wed, 08/15/2007 - 3:34am
Sarahfran1's picture
Joined: 12/01/2006 - 09:00

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.

Posted on: Wed, 08/15/2007 - 3:56am
lilysmom's picture
Joined: 07/20/2007 - 09:00

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.

Posted on: Wed, 08/15/2007 - 4:28am
ajas_folks's picture
Joined: 04/28/2000 - 09:00

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.
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

Posted on: Wed, 08/15/2007 - 4:41am
seanmn's picture
Joined: 10/01/2003 - 09:00

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.


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