Any of you in Florida experienced this?

[emeraldize]

This may have been posted previously, but I just saw it this evening. Client http://voxxi.com/2014/05/30/hiv-patients-paying-too-much-florida/

[Jeff G]

Thanks for posting this Em . The Affordable Care Act will eventually bring to light what insurance company's have been doing in the dark for ages now and it will be easier to expose them for the lousy inefficient healthcare model that they are and have always been .

For the life of me I can not understand how people gloss over the fact that there is a middle man in the middle of the pipeline sucking massive profits off the back of sick people at the end of the healthcare care pipeline . I think that in time the ACA will help educate people to who really is to blame for high cost of staying well .

[skeebo1969]

  Yup!  I like to think of it as the price you pay for all the sunshine.  Problem is though, I can't afford to get out and enjoy it.  Our healthcare cost has been raised about 300% since moving back home to Florida.  It's been tough.

[mecch]

For the life of me I can not understand how people gloss over the fact that there is a middle man in the middle of the pipeline sucking massive profits off the back of sick people at the end of the healthcare care pipeline .

I think it is partly explained by the rise of "blaming the disadvantaged". In a tight economy with so much precariousness, and a fair amount of downward mobility, people too easily lash out and blame the "takers".
All it takes is media commentators/pundits, and elected officials, displacing the focus from structural issues.

Why do I get the impression that this is always increasing:

its the poors' fault they are poor
its the unemployed' fault they are unemployed
disable people are likely fraudsters and fakers
sexual degenerates with the AIDS brought it upon themselves - its their fault, not society's responsibility...
the sick can go to the emergency room thats enough, otherwise get a job with benefits, moocher

I hope this is just my shaded distorted vision from abroad and the spirit of equality is alive and well for a good chunk of Americans (who managed to elect Obama 2x and get the ACA to begin with, so theres hope!)

[mitch777]

Thanks for posting this Em . The Affordable Care Act will eventually bring to light what insurance company's have been doing in the dark for ages now and it will be easier to expose them for the lousy inefficient healthcare model that they are and have always been .

For the life of me I can not understand how people gloss over the fact that there is a middle man in the middle of the pipeline sucking massive profits off the back of sick people at the end of the healthcare care pipeline . I think that in time the ACA will help educate people to who really is to blame for high cost of staying well .

this^.

[initforlife]

This is going on in Missouri too. I had CoventryOne insurance and my complera was still almost 1500 co pay which is what the RW program paid for me I thought that was crazy when I saw it. also I had to get approval before they would even give me my meds once again Rw stepped up and paid for them until Coventry one decided to pay it .. Coventry one is the insurance Rw has you sign up for here in mo and they  help you with the cost. I no longer have this now as I got approved for Medicaid .

[skyeblue]

I live in Arkansas and I am going through the same thing. My medical (cigna), and my prescription (CVS Caremark). I have a $2500 out of pocket before my insurance pays anything, after that I have to order my meds by mail order 3 months at a time with a $1500 deductible. RW has sent them 2 checks, but they say that they have not received either of them. I have been trying to get my Atripla for 6 weeks now and they are still saying I need to remit payment first. I even had one rep tell me the payment had been posted and them removed from my account. My Dr gave me two weeks worth of samples and I am down to one week of meds left. The insurance rep suggest that I ask my Dr for more samples. I do not know what to do now.
 Is anyone else having this issue?

[emeraldize]

That is serious!

I hope others here have some advice for you.

Payments can be proven as having been received or not.
Two payments not received ?

Something is off on one or both ends.

If I had Atripla, I'd PM you, get your address and mail you a couple to help tide you over.  That is not my regimen.

The more I think about this, the more outrageous I think this is. Can you enlist your ID doc to advocate for you ?

[skyeblue]

Thank you Emeraldize,
 Most people I try to talk to about this seem to think I am reading to much into it.
I am beginning to think my insurance is just trying not to send my meds because they are so expensive.
The guy from the Ryan White Program said he has trouble with CVS Caremark all of the time. I am tempted to contact an attorney and see what they can do to help me. But that cost money too.

[skyeblue]

Oh, I forgot to mention, I do contracted work for the affordable care act. And this is the insurance I am provided that covers everything required by the Government.

[emeraldize]

Have you thought about calling CVS Caremark yourself? Like tomorrow morning? Ask for someone as high up the management chain as possible and make your inquiry as well as give them a deadline for receiving your medication and information. Document everything you do. And, send a follow-up letter that captures everything he or she says to you. It would not be a bad idea to include someone suggested you seek an attorney, but you decided to call CVS Caremark direct first.

With express or overnight mail there's no excuse for them not getting your medications to you within 24 hours. Any smart manager knows that. But, if that's not acknowledged in the course of the phone call then make sure you add that, too. You might even consider saying "you are threatening my health--both physical and mental."  Nothing beats the truth!

[Peteskier]

Yes I am dealing with this with Cigna.  All HIV medicine is tier 5 the most costly copay.  Cigna now requires a Medication Prior Authorization Form to be filled out by the doctor and faxed back.   In order to get medicine from Cigna I have to go through the Cigna Specialty Pharmacy.  They kicked back the RX because my date of birth was not on the RX. I am taking Atripla and they kicked it back a second time stating that there was no description  on how to take the medication.   (The medicine is only taken one way) Then they tried to process the payment under an old cancelled policy I had with them last year and closed the order.  Finally after getting them to process it on the active plan they have on their system and after all those hurdles were crossed they would not process through the Florida ADAP copay assistance program and said it would be 338.00 a month.  I have been trying to solve the problem since July 26 and it is now August 7 with no luck.  Cigna is trying to make it as difficult as possible for people with HIV that are just trying to survive. 

[skyeblue]

Call 1-888-281-8981 and sign up for Atripla copay card, I did and it paid my whole copay/coinsurance. It pays a total of $6800.00 a calender year and automatically renews in January. No set limit per month anymore.

Good Luck

[cr8tivemind]

I just recently acquired Humana as my insurance provider thru my employer, (Aug 2014) and based on their drug calculator tool, Atripla (which I am currently taking) falls in their Specialty Drugs, which would cost me $720/month for a 30 day supply.

My employer used to have Aetna, which I was only paying $75/month and was under the Tier 3, but due to issues with our previous broker, we switched to Humana.

I can't afford to pay $720/month on medications, so I am hoping the Ryan White Foundation/ADAP services here in Florida can help supplement/off set costs even though I have insurance.

[cr8tivemind]

I'm not familiar with insurance as much, so if you could, could you clarify what the Atripla Copay Card would do? Did you have a monthly/90 days cost to pay for your medication?

Thanks!

Call 1-888-281-8981 and sign up for Atripla copay card, I did and it paid my whole copay/coinsurance. It pays a total of $6800.00 a calender year and automatically renews in January. No set limit per month anymore.

Good Luck

[skyeblue]

cr8tivemind, I just called the toll free number and signed up. They gave me all of the numbers I would need to give my insurance company and it covered the whole copay for a 3 month supply of Atripla. It will cover a total of $6800 a year. The card automatically renews every January.
Atripla copay
1-888-281-8981

Give them a call and just tell them you need to sign up

[beach99]

Just my 2 cents, I got the Atripla co-pay as well as my insurance out of pocket is 50%, The card does indeed pay for the out of pocket up to 6,800 annually with no monthly cap. Good luck to you and FYI you may know already, but you don't even need the card at the Pharmacy until it arrives, just the numbers.

[OneTampa]

I just recently acquired Humana as my insurance provider thru my employer, (Aug 2014) and based on their drug calculator tool, Atripla (which I am currently taking) falls in their Specialty Drugs, which would cost me $720/month for a 30 day supply.

My employer used to have Aetna, which I was only paying $75/month and was under the Tier 3, but due to issues with our previous broker, we switched to Humana.

I can't afford to pay $720/month on medications, so I am hoping the Ryan White Foundation/ADAP services here in Florida can help supplement/off set costs even though I have insurance.

Thanks for posting this information as it is helpful to me as I am coming up on a similar situation with Humana. I am confirming my coverage and out of pocket expenses.

[Almost2late]

I'm also in Florida but not having any issues with insurance as of yet but I know all to well that if these creepy insurance companies get away with what they're doing, the others will just follow and do the same shit.. So its my problem too.. Wondering if a petition on this has been started with Change.org, hmmm