7.25.2008

My Co-Pay Is WHAT???

I finally filled the prescriptions the doctor had written for me on my last visit & procedure before we left Los Angeles. I decided to wait until we got to Virginia to fill them as I knew there was a CVS around the corner from our hotel that's open 24/7, and if I did it in California I wasn't sure if the nearest pharmacy would have enough on hand, or if they'd make me wait. Patience is not my long suit.

I dropped off the prescriptions on Tuesday and decided to give them time to fill them. We were busy all day Wednesday with the dog stuff, so I went back yesterday to pick them up. They put one part of the prescription on the counter, but were scurrying around to find the other. While waiting, I took a look at the blue shaded area where it tells me what I owe, and I almost fell over in shock. My co-pay was $587. Five Hundred Eighty Seven Dollars??? What the ...???? I told the lady that there must be some kind of mistake, that I spoke with my insurance as to why I need it, and I know this prescription is covered. I told them that I was not going to pay for it and I needed to call my insurance again to straighten this out.

Outside of the pharmacy, with my heart pounding, I quickly dialed the pharmacy number on the back of my insurance card. I explained to the technician what had happened and she researched the drug. Yes, it is covered through the mail order program with a $35 co-pay for a 90-day supply. However, as I'm trying to fill it in a retail pharmacy, my cost is 25% of the prescription. Whoa... a serious difference in price. Why would I even consider filling it in the pharmacy if I could get it for a mere fraction of the price.

I stayed on the phone with her through the endless transferring process and began the "paperwork" to order this prescription through the mail. I gave all of the pertinent information - name, date of birth, address, credit card number to charge my prescriptions once they're sent. Everything went smoothly, until they told me that I needed to send in my prescription and it would take 5 - 7 business days to process the prescription, and I would receive it within 4-6 weeks. My heart sank yet again.

For once I was extremely calm, yet I'm sure the woman could hear the trepidation in my voice. I was seriously on the verge of tears. While I don't need this prescription immediately, I would really LIKE it sooner rather than later. And let's be honest, from experience, I know that if I don't follow up on things like this, they don't always get done correctly, or in a timely manner. Am I really going to have time this once I get to India next week?

To speed this story along... The doctor's office re-called in the prescription to the mail order specialty pharmacy. And after hearing my story (to which I completely admitted it was all my fault), the representative at Medco wanted so badly to help me out, that he personally expedited the prescription, and circumvented the entire process. Within 3 hours called me back to tell me that everything has been approved and they would FedEx the 90-day supply to my hotel so I would have it no later than noon the next day (today). All for the low, low price of my $35 co-pay. Oh yeah, shipping is free! There were no additional charges for the overnight FedEx.

True to his word, at 9:30 am this morning, the front desk at the hotel called me to let me know I had received a box. A rather LARGE box. Filled with my 90-day prescription that is WAY too big and bulky to fit in the remaining space we have available. So off to Target we will go to buy another suitcase (we needed one anyway to fit the "stuff" we bought here in Virginia). And thank you notes. Because I need to let this amazing customer service representative understand my appreciation.

14 comments:

Heather said...

I have to order my meds through a specialty pharmacy too and they've always had pretty good customer service. I'm so glad everything worked out!

mary said...

I am SO happy it all worked out. But, again, I don't know how you do it. By this point I would be on the verge of a nervous breakdown. You are one strong girl! :)

Tenakim said...

I've never heard of these mail order pharamacies. I'm glad it out worked for you. With my last pregnancy, I was prescibed Zofran for morning sickeness and I felt that same heart racing and thinking WTF? 12 pills for $742!!! This is a pill for people suffering from effects of chemotherapy and they charge that much! They didn't have the proper insurance on file- but still!

Hairline Fracture said...

Oh, thank goodness for that understanding guy! I can't even imagine trying to get ready to go overseas with no guarantee you'd get your medication.

Mom24 said...

Why should any of this be easy, right? I am so sorry. Just what you didn't need to deal with right now. Congrats to you for keeping your cool, being persistent and getting it taken care of. I told you you were a strong woman! Good luck tomorrow. What a story. How great it is that every person along the way truly wanted to help you. That makes you feel good about our fellow humans!

The Mom said...

HOLY HECK! What stress!

Tena, i had 2 of those pills too and after that I said, i'll just stick with the nausea, thanks!

Today is the day isn't it? Jill I wish you the safest trip!

Clare Frederick said...

Oh, I am so happy for you! A person shouldn't have to go through this much for prescriptions in this country, but they do, and it's wrong on so many levels. BUT, on the bright side, there is always a better way to rectify the situation. It's just a matter of digging deeper and finding the right person. Isn't it amazing how easy it is once you find him/her? Thank God for FedEx overnight too.

Heidi said...

Wow! I guess sometimes you just got to do stuff yourself. You are my hero for figuring it out & getting it done.

Tara R. said...

*whew* that could have been a disaster. It's nice to hear about an insurance company going those lengths to help a client.

Jen said...

Isn't nice to know that there still some people out there that are really good at the service part of costumer service and will go above and beyond when needed?
I just love that.

C said...

Wow--how often does that happen? Good for you! Patience with those things is not my strong suit either & I think I would've done a lot more freaking out than you did if I knew I was moving out of the country!

~Christy

Hyphen Mama said...

Wow-getting customer service like that is a one in a million! Glad it worked out. One less thing to stress about.

SPMAN said...

www.cancerrxassist.com

SPMAN said...

The way insurances cover and who and what is covered can be a mystery.
The RX Assist programs are a real way to see what you would have to pay. Unfortunately, retail pharmacies are not trained to look for your complete benefit, just what the drugs will cost you for using them. BioPlus created RX Assist programs so that people facing high cost prescriptions could find out every detail about their benefits.
You can have your medications delivered if you choose to, but at least you have all your options clearly presented to make a good decision for what is best for you.

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