9 replies to this topic

[gianfranko]

Currently my wife, who has CML, is covered under my insurance plan (Aetna) which pays for her gleevec at a copay of $20 a month.  She has been offered a job at a company who has their own plan from BCBS-FL.

The BCBS-FL plan is an HSA-compatible plan that has a high deductible ($2,500 to be exact).  I was wondering if she were to get the new job could and be covered under both plans, could we fill a gleevec prescription using the BCBS-FL, then send the explanations of benefits to Aetna for reimbursement of $2480 (the BCBS-FL deductible minus the $20 copay)?  Or can the pharmacies do this directly and bill one insurance and then bill the next?  Anyone have any experience using two insurances?

[Tex]

Pretty much she should only be covered under one policy.  Insurance companies tend to frown on clients who have two or more insurers, there's a fraud potential.

I've never been a big fan of BCBS (I sold insurance half a lifetime ago) but have been insured by them for about eight years.  They're just slow to pay.  I know nothing about Aetna's quality, though, but you two have experienced it, ay least.

If either of you would have to participate in your paying for your insurance, you could probably save a few bucks by letting the company you work for insure you.  But double check the quality of the insurance.

Of course, you could talk to your HR person to double-check about dual coverage if you're just looking to pay for her medication.  There might be something work out there but I doubt it.

[gianfranko]

Well, it not like I wanted her to have two insurance plans.  But, the situation is that she is now covered under my insurance and if she accepts the job offer she will get insurance from that company.  I cannot remove her from my plan until open enrollment (november).  And chances are that I will be loosing my job this year and COBRA is extremely expensive (you can see my previous posts regarding this situation).  Thus, I am inclined to tell her to accept the offer and enroll in BCBS-FL plan (which, by the way, costs nothing a month).

I was reading online that there is a way to make the two insurance situation work.  Companies have something called Coordination of Benefits (COB) that allows for having more than one insurance.  The thing is that I am unsure how it works.  From what I've read her new insurance would become her primary insurance and my insurance would become secondary (or the last payer).  Thus, in the first fill of gleevec she will have to pay the full deductible amount ($2500).  I was just wondering if then I go and take Explanation of Benefits from BCBS-FL and file a claim with Aetna or would the pharmacy take care of that for us directly?

[Tex]

There's a fundamental concept in insurance called "subrogation" which prevents a person from receiving benefits from multiple insurers.  That's where I was coming from in my reply.

If your job's in question, it's certainly a good idea to have another option to swing to so you don't get slammed with COBRA.  I would suspect your wife will be able to enroll you in BCBS along with her should that become necessary, 

Since your primary concern seems to be paying for the Gleevec (ridiculous cost), I'd just go talk with your pharmacist.  S/He would be able to tell you if your idea is possible and how it would work out for you and will even know how things would go trying make this work out using BCBS and Aetna.

Sorry I can't give you a more definitive answer.  But I used to need malpractice insurance just for moments like this.   This is really a technical question that needs to be answered by somebody who is in the industry and familiar with its intricacies.  I really don't think you can rely on any other answer.

Blessings

[hannibellemo]

As I see it, there are two issues here. If either or both of you are covered under a drug plan (separate from major medical) then only one drug plan will pay. I don't have a drug plan, everything goes through major medical. My husband does have a drug plan and they don't pick up any of my Rx costs. I don't know what would happen if both policies paid for drugs under major medical, but I assume both would pay something.

I consider myself lucky not to have a drug plan. Once my deductible and out of pocket is met (in January) my major medical picks up 100% of the expense for my TKI.

However, you can be covered under two major medical plans and one becomes your primary pay and the other becomes your secondary pay. You have to deal with coordination at that point and make sure that everything is set up properly. If it is you can be lucky enough to not have to pay much of anything for labs, doctor visits, etc. It just depends on your individual policies.

Probably not going to help you much for your drugs, though. Those are the answers I got from our insurerers when I asked. You need to check with yours.

Pat

[chriskuo]

More and more companies are eliminating or penalizing spousal coverage when the spouse is eligible for his/her own employer coverage.

Refer to the major press coverage UPS received when it dropped coverage for employed spouses last year.

My former employer charged a significant penalty if a spouse was covered under its plan when direct employer was available.

[Frogiegirl]

I have BCBS with an HSA and a high deductible,(4000) for in network. and my hubs covers me on selecthealth as my secondary. I found out by accident this year, if you fill your prescription first thing before any doctors appointments my deductible is reached without me even paying 4000 because the prescription plan has a max of 50 dollars for any prescription name brand or generic, and the remainder is paid by my prescription plan and makes it so I have reached my deductible(my percriptions and medical go toward my deductble). weird I know, but it has been a big stress reducer! Personally I love the HSA plan I have. My employer contributes 800 for not smoking and matches the first 500 you put in. Plus the dollars contributed are pre-tax so thats good too. You can use the HSA for just about anything medical, my employer even allows massages and gym memberships to be paid for out of your HSA. I'm a little confused about the fraud thing Trey mentioned as both insurance companies know about eachother because you have to coordinate benefits when you have two insurances. which is a simple phone call to both giving them the other insurance info. Oh and also my employer charges 300 dollars a month if your spouse has insurance available to them and doesn't take it. You also have to think of some benefits that come from her having a job, getting out of the house socializing and feeling like a contributing part of society is huge. I only work part time but I feel better when I do just for those reasons. Sometimes my CML makes me tired but working part time I know I can come home and re-coop the next day. Oh and also at the end of last year I got a print out of all the perscriptions that had been filled through 2013 from my pharmacy and sent that in to my secondary and was partially refunded for some of them. Most pharmacies will only bill one insurance, its up to you to bill the other insurance. its a pretty simple process. all of this can be overwhelming, and this is just my experiences with it

[mariebow]

Frogiegirl, what is HSA

[Frogiegirl]

Hi mariebow! an HSA account stands for a Health Savings Account. its not to be confused with a flexible spending account, those are use or lose. and a HSA rolls over every year and the funds go with you if you quit your job or leave the company the funds are yours to keep They give you card usually a visa that you run like credit that deducts from that account. The front of the card say HSA on it. hope that helps

[mariebow]

Yes it did Thanks