Tuesday, November 3, 2009

Dealing with insurance

Chef works for a small cafe and thus doesn't receive employer health care. I work for a nonprofit and due to turn over and cost they don't cover spouses or dependents. Back in June when we realized something might be wrong Chef applied for insurance through Blue Cross Blue Shield. It was difficult getting the plan set up and going but we managed to get it done. They were even able to back date it to the first of June. This was wonderful because he hadn't gotten everything in place before the first MRI. We had started the process but didn't technically have the coverage. Once Chef got his cards and set out to give the information to all the medical facilities he had visited in the last month. They were grateful and said they would now re bill the insurance. However we begin getting bills that said insurance had been billed but it clearly hadn't. I keep great records when it comes to medical stuff and we had never gotten anything from the insurance stating what would be covered and what wouldn't. Chef had never really had insurance before and was ready to pay whatever came our way and deal with the insurance after the fact (silly guy had no clue). I was able to talk him out of this and just wait it out and make more calls if need be. After multiple calls to insurance we got things straighted out. We have now long since passed his deductible. This brings me to meds!!!
Chef is going to have to start daily shot therapy. Actually he was to have started two weeks ago but insurance has been difficult. We had contacted them right after finding out about the need for shots, to make sure he had some sort of prescription coverage. Long story shot he has full pharmacy coverage as soon as his deductible was met. To get his meds we deal directly with the drug company we don't have a typical script that you take to the pharmacy. The neuro sends in a verification type slip to the drug company, they call you, they work things out with you insurance and then have your meds fed exed to you via your mail order pharmacy company. The drug company has been great their costumer service is outstanding (it should be since the drug runs $2500 a month!!!). The problem has been his insurance. They had put a block on his account according to the drug company. Then Chef had to contact his insurance to find out why this was occurring. The insurance couldn't say why it was there but by the end of the conversation they said they could process the medication. Chef called the drug company they recheck and he was cleared. Finally Chef SHOULD have his shots today.

2 comments:

Adam Jones said...

Talk about ripped from the headlines. I'm glad to hear that you guys got everything straightened out and that Chef is able to get the meds.

D-nice said...

We were so lucky. Now the challenge is to keep it!