Sunday- God’s Day of Rest- Not mine or the Reps from the Insurance companies.
1-Have to call Humana which covers 3 of my 11 drugs according to another 4 hours on the plan finder. I have to ask which ones.
Still can’t compare drugs because they just say “no” to all drugs covered- not in formulary. Maybe I’ll just call them to be sure.
Got a nice helpful young woman, Ronnie, who was truly willing to help.
She went through everything (of course I had to give her each of my drugs by name, dosage etc. again in spite of the fact that I had entered them into the Medicare database which takes at least an hour) because the customer service or pre-enrollment reps say they can’t access the screen in which I entered all my drugs.
(Poor planning and time management on the part of whoever put together this whole healthcare deal)
But I did ask Ronnie about exceptions and though she couldn’t tell me the criteria because those criteria are judged on an individual basis, she did tell me they usually were accepted if written by the physician and sent to the plan board.
I asked her who made the decisions once my own doctor (who knows me) ordered it and it was an FDA approved drug– and she told me a group of doctors and pharmacists.
When I asked her if they were from an independent company or if they worked for the insurance company, she told me she believed each used a different group so she believed they worked for the insurance companies.
]This is sounding a lot like a crap shoot.
If you’ve got a group of doctors and pharmacists who work for a specific insurance company, for example, Brand X Health, let’s say, and they know they have certain deals with certain drug companies, doesn’t it put them in a conflict of interest situation?
Anyway, we kept going through my medications one at a time and found out that HOLD ONTO YOUR SEAT!
According to her plan info, 8 out of 12 of my medications were covered!
So far, it’s the most medications covered! Still I need four exceptions but two of mine are exclusions from the CMS, so I’ll have to call them and ask when both of my doctors have explained why I need them, how CMS can exclude them?
(Today the druggist told me that Fioricet was excluded because better headache drugs were available and Xanax was excluded because sometimes they were used as Rufi’s)
Now, does that make sense to you? Seniors can’t have drugs that act like rufi’s? It doesn’t to me. But she did tell me I could write to my Congressman about it. And I will. Texas or not!
Ronnie told me she could send an agent up to talk to me and explain how to get everything right.
I told her, “I don’t want an Advantage Plan because though they seem cheaper now, they have all the control over the doctors I choose, hospitals I choose and afterward everyone will be in an Advantage Plan and they can raise their rates and no one will be able to do anything about it.
Still, I accepted the agents appointment as long as she promised me he wouldn’t try to sell me anything I didn’t want. Let’s see if it works. Wednes. at 1:30. I can get back to you afterwards with the results.
A tiny bit of hope! Fingers crossed!