Wednesday, June 13, 2007

Co-Pay Roulette

Step right up folks, spin the wheel and win a new co-pay!
Disclaimer: This is purely a game of chance, no logic involved, and the house usually wins.
I am now on hubby's insurance, which is with United Healthcare (Medco for pharmacy). United (Medco) was also my previous insurance carrier, but this is a different plan/employer.
This all started when I went to the local pharmacy yesterday to pick up refills on my test strips and birth control pills. The test strips rang up with ZERO co-pay, which is a new but welcome phenomenon. The BC pills (same ones I have been taking for years), could not be filled because they needed "pre-authorization" from the doctor. Huh???? I wonder if the ins co would rather pay for a complex pregnancy for a Type 1 over 40 than BC pills.
So I decided to take the bull by the horns and call Medco. I'm convinced the first person I talked to was not really a person, but a trained parrot. When I asked why the BC pills required pre-authorization since the purpose was obvious, she just kept giving me the number for the doctor to call. Apparently they can answer who, what, when and where, but not why.
I then went through their automated system to get co-pays on Novolog, Cozmo Cartridges and Quick-Sets. The co-pay on Novolog was about $25 for 30 day supply locally -- OK, not too bad. And the co-pay on Cozmo Cartridges was ZERO for mail order from Medco -- GREAT, but really?? since I had been paying $125 before to for the same thing to Medco?
I couldn't get the automated system to recognize the Quick-Sets, so called back in for a live person. She confirmed that the Cartridges really are free, but that Medco no longer carries Quick-Sets and I will need to get those from my local pharmacy. Co-pay will be 30% of cost with a minimum of $20 and a max of $75. I didn't think local pharmacies carried infusion sets, and told the insurance rep that. She said that Wal-Mart, Walgreens, CVS, etc. do carry them. I thought "maybe something has changed since I tried that years ago", and called 3 local pharmacies. They don't carry them.
So I have left a message with the mail order diabetes supply house that I used previously (that is before Medco told me I had to order from Medco several years ago).
It's hard for me to trust a parrot, so a question for the OC....any of you getting Minimed Quicksets from Medco? I find it hard to believe they don't carry them anymore.
I wonder what the next spin of the wheel is going to yield. Oh well, so far I'm doing better than I did with the slot machines in Las Vegas.


Anonymous said...

After working at my current job for about 16 months, I discovered that I had been paying almost double the co-pays I should have been. Something about when insulin is filled, there is a list of other prescriptions that can be filled within 24 hours for no co-pay. I am not sure what else is on the list besides strips and lancets, but that might be what you are dealing with.
Here is a link to the post.
Good luck!

Major Bedhead said...

Can't you order supplies directly from Minimed? Would they help you out with this? Maybe you should try your rep or their customer service line to see if they can help you.

O's pump supplies are covered completely as durable medical equipment, but we have a different plan in a different state (I think).

Scott K. Johnson said...

How frustrating.

I just hate all of these extra hoops we are forced through much of the time.

Carol said...

Sara -- arghhh on the double co-pays!! Glad you figured it out though.

Major Bedhead -- that's a good idea. I acutally called the old supply house I used previously (before United insisted I use Medco and file under the pharmacy plan), and they called to verify coverage and found that I pay 15% and ins pays 85% under the durable med equip side. I use Cozmo cartridges and Minimed sets, so it would be nice to be able to get them from the same place. Maybe that will work.

Scott -- thanks for the sympathy! It helps to know others understand. I guess this stuff is so hard becuase it cab drift between prescription coverage and DME coverage.

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