So, I have Florida Blue MyBlue, and Ive had the same plan for months. Its a zero deductible plan and we pay quite a bit every month for it. I went in to pick up my Novolog today and was charged $66.00 for my copay. I had to pay that for my sons last month, and it was for 5 vials so I was like ehh, ok its not a big deal for 5 vials. Well, today, I paid $66.00 and was given 1 vial. I found out when I got home there was only the one. I called, they said it was showing I have a deductible and if I came back in, he would refund me and try to run it for more vials. I was like, “I dont have a deductible…” he said it was showing on their end that I do. I went back and he printed a sheet that showed I have a multi-thousand dollar deductible that I never had before, ever. He called the weekend number and the lady I talked to wasnt helpful. I started bawling in the store and just ran out. I couldnt even control the stress or fear or any of it in that moment.
I went home and looked at my plan benefits and it says this plan has a 0.00 deductible.
I cant call and talk to anyone right now because they’re closed until tomorrow. But I cant stop crying because Im thinking of all the what if’s.
Do you guys think theres a mess up in their system? Has this happened to any of you? What do I do?
Truly freaking out. Diabetes is incredibly expensive as it is. My insurance plan is expensive. I dont know how Im supposed to now pay into a deductible, on top of it all.
Hi @HisWifeTheirMama there are so many plans and rules it’s impossible to know for sure. What I have experienced is I call the insurance and the service person tells me that this medication is covered and that one is not. I call another service person at the same insurance company ant THEY say that no no that medicine IS covered but this one is not. Strategy? Keep calling and escalate to the highest service person at the company before you give up. Good luck.
I am more surprised when a trip to a retail pharmacy is trouble free. The people behind the counter are overworked, underpaid and using systems that needed to be updated 20 years ago. Two things that help me survive is knowing my insurance plan and not taking anything someone behind the pharmacy counter says, except the pharmacist, seriously.
Did you keep the sheet the kid at the pharmacy showed you? If so is the insurance company and plan name correct? Or call the phone number on your insurance card and ask the rep to verify you are still on the plan you’ve paid for because ACA Plans Are Being Switched Without Enrollees’ OK - KFF Health News Ask about deductibles and maximums the plan will pay for pharmacy benefits because these can be different than the rest of the plan.
When you go back to the pharmacy to get the rest of your insulin take your insurance card and if you have one your pharmacy benefits card. Ask them to correct their mistake and dispense the amount of insulin your doctor prescribed. They could be looking up the wrong person, you could have multiple records in their system, they may be using an old insurance or there might be even news on Monday about another heathcare technology company being hacked.
It’s odd that they have you one vial due to your supposed deductible - if your Rx was for 5 that’s what they should have given you.
Not to doubt you but I’m wondering what your insurance card says? I think the deductible and copay are usually printed on it.
I have a very different experience from @spdif: thankfully my pharmacy has always been extremely helpful when there has been a glitch with my insurance. From time to time my plan switches their preferred formulary so the one I took before is no longer covered - or at least not at the same rate. Recently I had an issue because my doctor wrote the scrip for tablets rather than pills for one of my meds - running the wrong formulation is a possibility as well. Or it could be that insurance requires special authorization from the doctor. I don’t know if the $0.00 deductible does not apply in such cases but it might be worth looking into.
My pharmacy is generally great at taking the necessary steps and giving me specifics about what’s going on so I can follow up myself if I feel the need.
A couple of side notes:
Hopefully your meltdown was not because you are so low on insulin that you don’t have a cushion - if that’s the case ask your doctor to write an rx that will give you some breathing room: if your average is say 30 units/day, they should allow for more in case of unexpected highs or illness.
And finally: if you use a pump ask your doctor for pens as backup. Assuming they prescribe the same kind you use in your pump, you can use those to fill until you get your bottle. Just make sure you don’t use the basal insulin to fill.
