Saturday, January 23, 2010

A little panicky

We are probably going to lose CCS (California Children's Services) because our income increased with FD's new job.

I'm very worried because of past experiences with Blue Cross.

For years, we were trying to get Froggy's compounded Prevacid covered. CCS said they would pay for it, only if our insurance 'denied' it. Blue Cross refused to deny it. They said, "It's a covered medication, but you have 100% copay." When I asked, "How the hell is it covered if I'm paying for the entire bill," they replied, "It's on our list of approved medications, but with your plan anything compounded or brand name is 100% copay."

I'm terrified that they are going to do this with all of Froggy's meds. Tobi, Pulmozyme, Pancrecarb - all brand name, all thousands of dollars each month. Even if the medication is on their list of covered-meds, if it's a brand name, it's 100% copay.

Is this legal? How can this be legal? They get around it by saying it's covered, so they won't 'deny' it, but won't pay for it either?

I've contacted an agency, our social worker and nurse care manager, as well as the CF forums. I'm hoping someone has the answer.


Jessx0x0 said...

Not sure if this helps you but did you try the attorney services for the cystic fibrosis foundation. They might have some insight for you. I hope it works out for you.

holly said...

I'd call and ask them what you will be charged for each medication. Also, what is your out of pocket maximum? There is also something called GHPP. You qualify once you are denied by CCS and they may be able to charge you an annual premium depending on your income but it is never more than $1,000 per year. They should be able to help you. We'll talk more on Friday.:)

Cara said...

This is seriously the craziest thing I've ever heard! I don't have any advice since I don't have civilian insurance, but you guys are always in my prayers! :)