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Insurance issues - Blue Cross - watch out!


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#1 Happycat

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Posted 02 January 2014 - 04:42 PM

Hi, all, I hope the New Year is going well for you! 

I ran into a little snag with my pharmacy benefits this morning, and thought it might be a good idea to warn others.  I have Blue Cross Blue Shield in Massachusetts.  I don't know how this will affect BCBS plans in other states, but thought it best to let you all know.

Anyway, I tried to get some prescriptions filled today at a local pharmacy, but the system kept saying I wasn't insured for pharmacy benefits.  Blue Cross MA contracts their pharmacy benefits with Express Scripts.  For the BCBS plan I have, there's only one card for both medical and pharmacy benefits.  I do not have a separate prescription benefit card from Express Scripts.  Anyway, BCBS had a deal with ES that allowed BCBS members to use their BCBS member number for their pharmacy benefits, not an ES number/card. 

Well, apparently, ES decided to change that for 2014, but somehow neglected to inform BCBS.  So I actually needed a separate "temporary account number" in order to get my pharmacy benefits paid via ES.  I still don't know as of yet if I will receive a pharmacy benefits card from ES or if BCBS and ES will reach some sort of new deal on the single card covering both. 

Then, to make it even more fun, ES somehow dropped our pharmacy coverage completely.  BCBS still doesn't know how it happened, but they were able to get it turned back on with ES in a couple of hours.  Luckily, we had a few days of pills left, and it was mainly for drugs that we could easily skip a few days if needed.  I'm very glad I wasn't trying to fill my Gleevec prescription!  I get it at the hospital pharmacy, not my local one.  I figure they will have the insurance all figured out by the time I need that refilled, but just in case, I will call it in as early as possible this month.  And follow up on it, too!

If you are using Blue Cross in MA, definitely check into your pharmacy coverage.  If you use BC in another state, you might not be affected, but don't be surprised if you run into a problem.

Cheers,

Traci



#2 Tex

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Posted 03 January 2014 - 01:02 PM

Glad you pointed that out.  I've had BCBS for several years now and we had MedCo which was bought out by Express Scripts.  I've always had separate cards for medical and prescription but I don't know if I'd know that otherwise.  They really aren't the best at keeping their clients informed.



#3 Cliffee

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Posted 03 January 2014 - 07:07 PM

Same exact thing happened to me. Pharmacy called Blue Cross and issue was resolved. Something with the new year rollover.

Thankfully no biggee!



#4 SunNsand

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Posted 04 January 2014 - 08:16 AM

We have Blue Cross and Express Scripts also. The problem we recently ran into was them denying to cover a script of mine and one of my husband's. My 86 yr. old mother-in-law had her insurance do the same thing last week, so be prepared for that to happen more often. I'm now working on an appeal to get my med covered (not a TKI). 



#5 Tex

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Posted 04 January 2014 - 01:50 PM

Best of luck to you.



#6 Antilogical

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Posted 04 January 2014 - 02:07 PM

I have Coventry/HealthAmerica, and I must use the Medco/Express Scripts mailorder service for my Gleevec Rx.  Coventry was recently acquired by Aetna Insurance, so naturally they are switching all remaining "specialty drug" refills to the Aetna Specialty Pharmacy.  I looked it up, and it was ranked pretty low in a survey of customer satisfaction.  I foresee headaches in my near future....


Dx: Sudden severe anemia detected 07/2011, followed by WBC spike. CML Dx 02/2012.

Rx: 03/2012-Gleevec400.  Reduced 02/2013 to Gleevec300 due to side effects (low blood counts).

Response: PCR-Und within 7 mo. on G400. Maintained MMR4-MMR4.5 on G300. PCR-Und since 02/2016.


#7 Tex

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Posted 04 January 2014 - 02:42 PM

Many, many years ago I used to sell health insurance.  I would expect Aetna to be better than BCBS overall, though ExpressScripts appears to be its own organization and has done very well up 'til now.  I hope the switchover winds up being better for you.



#8 Susan61

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Posted 04 January 2014 - 10:09 PM

Hi:  I have Aetna insurance, and Express Scripts Accredo Pharmacy for specialty drugs like my Gleevec.  I have had no problem with the Specialty Dept for my Gleevec, but they drive me crazy with the other drugs at times.  The price on all our medications have gone up.  I do not know what is going to happen when we go on Medicare, because from what I have heard that is a nightmare in itself.  My husband is still working so we can maintain our benefits with Aetna.

I think we are all drowning in expenses with these drug companies, but we have no choice.

Susan



#9 Tex

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Posted 05 January 2014 - 12:22 PM

Just goes to show.  I had to use Acredo for my HGH a few years back.  They drove me nuts with calls, verifications and all kinds of assorted nonsense.  I've really never had any issues getting my regular meds.

As Mom used to say, what the hell, let's all get in the back seat and sing!



#10 GD1010

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Posted 05 January 2014 - 03:56 PM

Thanks for the head's up on that! My wife is just switching from Gleevec to Tasigna this week and the last thing we need is one more speed bump.






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