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Author Topic: Insurance Open Enrollment Deadline February 15, 2015...  (Read 444 times)

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Offline OneTampa

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  • "Butterflies are free."
"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaíto frito."

Offline Kmg1947

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  • Posts: 36
Re: Insurance Open Enrollment Deadline February 15, 2015...
« Reply #1 on: February 12, 2015, 03:40:44 PM »
Hello...Poz family,

My son just enrolled himself on a silver plan that he could afford. He showed me the details and what they cover for his medications. Does any anyone have any experience with United Health Care Compass 2000. Also they show his specialty meds listed under tier 2 which is suppose to be less, but being as though they are specialty his copay on those meds will be 160.00$ does anyone know as to why they would have this listed under tier 2 but charge you the one priced co pay anyway for specialty drugs. There is no other alternative or generic, so I am just curious about the cost that's all. He said that he called member services and they told him that all specialty drugs are set at one price, and that he will be able to get his meds from a regular pharmacy instead of a mail order.

Thanks for any insight or help you can give me.


Kmg1947
« Last Edit: February 12, 2015, 03:49:26 PM by Kmg1947 »
Loving Life through the Ups & Downs.

K

Offline AusShep

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  • Posts: 320
Re: Insurance Open Enrollment Deadline February 15, 2015...
« Reply #2 on: February 12, 2015, 08:57:55 PM »
Insurance can do the tiers any way they want.

I've used UHC specialty pharmacy and they allow manufacturer co-pay cards which will pick up the monthly out of pocket cost.  Also, filling at a local pharmacy, they'll take the cards so his out of pocket cost should be zero. 

There are links up in the treatment section about where to get the co-pay cards if he doesn't have them.

Offline Kmg1947

  • Member
  • Posts: 36
Re: Insurance Open Enrollment Deadline February 15, 2015...
« Reply #3 on: February 15, 2015, 04:03:42 PM »
Thanks so much for that information Aus shep. My son does have the copay assistance for all 3 meds. Does UHCare specialty pharmacy work through mail order. Just curious???My son said he would rather go thru his local pharmacy as they do take co pay cards. He said they are a blessing to have.
Loving Life through the Ups & Downs.

K

Offline AusShep

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  • Posts: 320
Re: Insurance Open Enrollment Deadline February 15, 2015...
« Reply #4 on: February 15, 2015, 06:35:38 PM »
Yes the specialty pharmacy uses OptumRx, which is mail order.  They ship either next day or two day at no extra cost.

I think to use his local pharmacy he will have to opt out of the specialty pharmacy first.  I'm not sure how that works, he'll need to call the pharmacy benefit number to figure that out.


Offline Kmg1947

  • Member
  • Posts: 36
Re: Insurance Open Enrollment Deadline February 15, 2015...
« Reply #5 on: February 18, 2015, 11:15:58 PM »
Hello poz family. I need some help. My son went to his local pharmacy for his meds. The plan he has says 160.00 for specialty.....yet they are charging much more as it is not through optimum Rx that charges only 40$. Why are the charges so much higher??? He called member services of course they are closed. He set up an online acct and it gives the same ridiculous prices if you go through local. This is mind boggling as he says..Not to mention Market exchange enrollment was a night mare . 2x they gave UHC the wrong plan something about glitches in the system. He said he will call to opt out. Just curious if the prices for his meds will be that big high.???? Through local pharmacy after he opts out.
Loving Life through the Ups & Downs.

K

Offline Kmg1947

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  • Posts: 36
Re: Insurance Open Enrollment Deadline February 15, 2015...
« Reply #6 on: February 19, 2015, 11:19:45 AM »
Hello to all.

My son called United Health Care this morning and he said the lady was so nice and explained to him that specialty drugs are 160.00 however since his is under their tier 2 formulatory it will only be 40.00$ for each of the 3 meds he needs. He calls Kroger and of course give them his plan info and he noticed on his medical insurance card the RX info is OPTUM RX, so of course his local Kroger Market/Pharmacy could not fill them and referred us to the Optums phone#. My son said I don't know why the United H C rep didn't just say that. He calls Optum and they asked his reason for using local instead of them and he told them and they said that would be a valid reason to opt out and did some paperwork across the phone with him as well as gave him a confirmation and said a letter explaining that the 3 drugs he takes will be able to be obtained through his local pharmacy/pharmacist. He said the lady could even see where he tried to use his card to fill the meds so she was able to over ride them on her end and said she would call the pharmacy to give the info on the over ride for the scripts. She told him to wait about 45mins or so before picking up. My son said he is going to call again to make sure. He said the people at united health care are very quick to get you off the phone even though they were nice, and that some of the people are really not knowledgeable on all the plans and changes and programs etc but never the less my son is a friendly guy, so he said that he just figured some of the changes that come about the employees are not necessarily trained on nor aware right away since changes can happen dealing with insurances. He has the right attitude I was starting to get mad until I seen how calm he was about it. He said he will update me when he gets his meds at the local pharmacy we use......Just an fyi for anyone using UHC through market exchange with subsidy please confirm your deductibles and out of pocket expense. My son said the UHC rep said the market exchange employees are sending over incorrect plans before deducting the tax credit from applicants that qualified for the subsidize insurance and the reps from UHC than have to go back in and match the deductible with the correct plan to match the pricing. For example. You may have asked for Silver Compass 2000 but with the tax/subsidize pricing it would be Silver Compass 400. My son said this was a MAJOR issue so both insurance companies and market health exchange people are probably going home drinking a 5th after all the mental torment of processing these policies correctly...Total bug in the A nightmare for the consumer though.

I hope all of you are having a lovely day. I will update you guys soon and let you know of any other dilemma.

Blessings to you guys
Kmg
Loving Life through the Ups & Downs.

K

 


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