Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

Copay assistance with two insurances

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A quick update on the insurance coverage question.

Apparently the company "upgraded" the insurance coverage for this year and they classified the ART medications as "preventive" thus bypassing the deductibles.

This might sound good for everyone else but for people like us this is bad news.

Since the medications don't have deductible requirements, they only charge $30 per month's supply. That means I can no longer use the co-pay cards to pay for the deductibles. This in turns means that all my subsequent doctor visits will be hit with the deducible and essentially I will need to pay out of packet thousands of $ more than last year to fulfill the deductibles on my own dime instead of using the co-pay cards paying for them.

In summary: last year:

3-months supply: cost $11,000, where there is $3,000 deductible. Insurance pays only after I pay the $3,000 deductible, then co-pay of $30 for each month. Co-pay cards pay for $3,000 plus $30 copay each month. All my subsequent doctor visits is covered. I pay $0 out of pocket for the medication and very little for the doctor visits.

This year:

3-months supply, cost $11,000, insurance pays for all, only charge $30 each month (which co-pay card covers). $3,000 deductible left unpaid. Any subsequent doctor visit essentially I have to pay full amount out of pocket before deductibles are met.

Anyone has any similar experiences? How to handle this "upgraded" insurance coverage


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