Friday, January 22, 2010

Insurance Help!

I'd love any advice with this...

Since FD started working full-time, we'll lose our state-funded supplemental insurance. Froggy has medical insurance through Blue Cross, but her policy (that I purchased before knowing she had CF) does not cover brand-name drugs. As you all know, basically ALL CF medications are brand-name. And either there isn't a generic, or the generic is so awful, CF docs won't even write prescriptions for them.

Has anyone been through this? Where do we begin? Our social worker at the hospital gave me a number to call a service that works with women and children. I left a message with them, but would like to get the word out that we need some advice.

I called Blue Cross and we can apply for a different policy, but the rep. basically said there is "no way" they would approve a new policy. Lovely. Okay world, send me the answer!


Anonymous said...

In terms of the formulary/non-forulary issue, you can file an exception. Forms SHOULD be available on their website. Basically your doctor has to explain why that medication is necessary. They should also have a list of medications that they consider to be covered, noncovered, formulary on their website.

We recently had an issue with one of Max's meds in which suddenly after 6 years we had to pay 50% plus a $15 copay. Apparently they considered it to be a nonformulary. There is no substitution because he doesn't weigh enough to take the dosage -- a 300 mg capsule. So he gets a suspension.

I never would've known about the exception as the customer service rep at BCBS wasn't very helpful -- my husband's cousin, a social worker for a senior center told me about it.

I'm sure you've already done so, but I believe the CFF has also set up an assistance program. I glanced at it; however, our income is too high. Ratatosk

ferfischer said...

Appeal, appeal, appeal! It's a pain, but with enough evidence, it can work!

The DutchMac Tribe said...

I wish I had advice, but all I can send you is lots and lots of positive mojo this works itself out for you guys. Stories like these are what make me terrified to move back to the States, back to a place that does NOT have nationalized healthcare!

Don't get me wrong, no system is perfect by any means, but Froggy's crazy predicament with meds just wouldn't happen here.

We're all sending you tons of warm fuzzies and are looking forward to the day you say 'It's all taken care of!'


Froggymama said...

thanks everyone. Liza, thanks so much for letting me know about this. I don't understand why our social workers at our clinic don't know this stuff! Gripe number 635. :)

Danielle said...

I'm on the MRMIP program - Major Risk Medical Insurance Program. My monthly premium is nearly 300 bucks, but EEEEVERYTHING I need is at least partially covered. All meds are covered with a co-pay of just 35 for name brand and 10 for generics. And then my DME (mostly just insulin supplies for me) I only pay 20% of full cost. I think the website is

Mieke said...

I am so relieved to know that our health care system is the best in the world and that it doesn't need to be fixed and that the government should just stay out of the private well-oiled and fair system.

Thank God that Republican got elected in Mass. it is a huge relief that his election will put a stop to health care reform! It is clearly working perfectly. Praise God!

Mimi said...

if you doctor puts on the the med...DAW....(despence as written) then blue cross will have to cover we had the same thing with our child and the doctor didn't want hin on the un name brand....good luck