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Oh, fuck me.
This is why I need the fucking meds in the first place. I have such a headache too.
Warning: waaaaaay too much text.
In which insurance is a pain in the ass.
I called my insurance company(s) today.
I lost my coverage (Horizon BCBS Direct Access, with prescription drug coverage "carved out" to Caremark) after my divorce in mid-December. COBRA extends back to the day you lost coverage no matter when you enroll, and it's pretty expensive, so it's usually a good idea to wait and see if you're going to actually use it before enrolling. That decision was made for me as soon as I picked up a refill of one of my medications and discovered that it's $346(!) out of pocket for a 30 day supply.
My ex's company uses a COBRA administrator called Ceridian. So I enrolled with them online, and once I started receiving bills, paid them directly. They in turn sent the enrollment and money on to Horizon. After a month or so (and another out of pocket payment for the same prescription), I called up to find out why I hadn't heard anything, and discovered that Horizon didn't have any record of me. After enough prodding at them and my ex's incompetent HR person, they figured out it was because they needed a physical enrollment form because they didn't have individual information about me like my birthdate. *facepalm* I filled out the form, and a couple of weeks later Horizon finally processed me onto their system, and in turn sent my enrollment over to Caremark. And I was at long last able to fill that prescription for just the copay, like a normal person! And able to fill all the others, which thankfully were on 90 day cycles and, with the help of samples from the doctor's office, were only just starting to run out.
I also went ahead and filled out the paperwork to get that $700 out of pocket cost refunded, which requires you to send in either the original receipts or what looks like a shitload of paperwork filled out by your pharmacist. Fortunately, I had known to keep the receipts, so that wasn't a problem.
Last weekend I (stupidly) ran out of that same troublesome prescription, which I knew was almost gone but I hadn't realized was also out of refills. I simultaneously received a letter of denial from Caremark for the refunds, due to something marked as "Plan Limitations Exceeded". I had my doctor call in a temporary refill a couple of days ago, which I was going to pick up today, and finally got enough past my annoyance to call Caremark this afternoon.
It turns out that "Plan Limitations Exceeded" means that, as of 1/1, they no longer allow a quantity of 60 for a 30 day supply, which has been my prescription since at least this time last year. When I questioned how this could be, since I had filled it under this insurance just last month, it turns out... well, it still doesn't make any mathematical or timing sense to me actually, but apparently the pharmacy had somehow gotten them covered as a couple of 15 day supplies or something. It apparently hadn't occurred to said pharmacy to mention the problem to me at the time so that I could fix it - perhaps because I had gotten other refills of this from them this year? IDEK.
After a lot of probing questions (to what was actually a very helpful Caremark customer service person), I found out that I need to get my doctor to get the prescription "preauthorized" as medically necessary. "Preauthorized" is in quotes because my doctor will need to very carefully specify that this is retroactive to the beginning of the year in order for me to get my refund. This authorization actually needs to happen via Horizon, who will then send it onto Caremark on their normal every-few-days electronic feed. Once this all goes through, I will be able to pick up my new prescription for this month without paying out of pocket again. Unfortunately, I will also need to resubmit the paperwork for the refunds from scratch. As I no longer have original receipts (since I sent them in before, remember), I will apparently also have to go through getting the pharmacist paperwork as my proof this time.
Interesting (or not) related notes:
- I called Horizon to double check the fax number and process, and their customer service rep tried to tell me that my doctor needs to do the preauthorization with Caremark instead. After some argument, he got off then phone for a few minutes, then came back to grudgingly admit to me that it really is through his company after all, and gave me the phone number my doctor needs to call instead of faxing.
- Apparently my doctor also needs to specify that it can either be 60 for 30 days or 180 for 90 days, since these don't count as the same thing to Caremark's systems. Again, IDEK.
- Please note that I've been paying $550 a month for my coverage all this time, which Ceridian has been quietly, correctly, and efficiently processing behind the scenes. I'm not sure if that means that Ceridian is that much better than the rest of them, or that people are always willing to take your money if you're willing to pay it.
- Ironically, I had already been planning to ask to lower my dose to what would be Caremark's acceptable amount when I saw the doctor next, which is now this coming Tuesday. But I still need this "preauthorization" to happen in order to get my money back. I apologized profusely to his assistant over the phone, though she seemed cool with it.
In which I am an asshole to my pets.
So a little later, and still a little irritated, I was making dinner when from out in the living room came a massive crash. I rushed out to find that one of my pets had managed to knock my laptop off of the table. Turning it back on, I was crushed to discover that it appeared to be basically functional, except that the screen stubbornly remained completely black.
That was actually my backup computer. A couple of months ago, my main computer suddenly stopped charging - I mean, REALLY stopped charging, to the point where having it plugged into the wall did nothing to keep it going on its own, never mind charge the battery. Over the course of the next couple of days, the power slowly crept down, until it finally shut irrecoverably down. I sent it into Alienware for repairs, only to get an email a few days later saying that, despite still being under warranty, they had decided that there was sufficient existing damage that I would need to pay for any repairs. I called to arrange to pay, only to be quoted a bill of some $450 bucks, covering among other things a new motherboard, a new sound card, and penalties(!?). I explained that I wouldn't have the money to cover that until 4/1, and would call back to pay then. I was told that they would ask the repair department if that was possible, but normal procedure was to give it 10 days, after which it would be shipped back to me unrepaired, and after that I would have to pay to ship it back and forth (possibly with other unspecified penalties attached).
Sure enough, several days later, a box appeared on my doorstep. Broke and annoyed, I brought it inside then ignored it, leaving it sitting next to my front door still in the box.
Back to tonight. When nothing I did brought the screen back to my backup, I grimly broke out the tiny screwdriver. I spent the next couple of hours disassembling it pretty much completely, cleaning and tightening and checking every connection I could get to. I reassembled, crossed my fingers, and turned it back on. Nothing.
I very calmly picked the laptop up, and hit it really, really, really hard against my coffee table. Unsurprisingly, this also failed to fix the problem.
While I was doing all of this, my pets were all busy quailing in fear. I am not in any sense an intimidating person, and this extends to my pets pretty much humoring my attempts to order them around just because they like me. So for them to be eagerly obeying my every command with alacrity is a pretty good sign of just how pissed I was at that point. When I hit the coffee table, the dogs all actually cringed. When one dared to ask to go out earlier, I yelled at him so meanly that he crept away. I felt a little bad, but I still made him wait another 45 minutes or so, until I finished getting out the dozens of little screws.
At this point, I had no idea what I was going to do. I don't know what to do with myself without a computer anymore, and that's completely aside from needing it for my job search. And my bank account is actually overdrawn until I get my unemployment check tomorrow. (Due to someone directly lying to me this morning when they assured me a particular debit wouldn't even be submitted until Monday, never mind processed. I fully intend to throw a shitfit until I get all of the overdraft fees back from that company next week.) I decide to finally unpack my main, in some distant, desperate hope that maybe some microchip got jostled enough in shipping that it would work in some crippled way.
And discovered a completely repaired computer.
In which I am an asshole to my mom.
Oh, by the way, did I mention that my mom is in the hospital? She was having a hard time breathing for a couple of days, so we yelled at her until she finally went to the hospital yesterday. Turns out that her blood oxygen level was at 63%! Last time I heard, the doctors were leaning towards a heart issue, which is not necessarily a surprise with someone who is unable to work due to deep vein thrombosis and yet still smokes. I don't know if she's gotten an actual diagnosis now, as the last thing she'd admit to us kids is bad news, if she can possibly avoid it.
I have a lot of problems with my mom, but I still love her. I called her twice at the hospital yesterday, and promised to call again today. I was secretly planning to actually go visit her, but I didn't mention it just in case anything happened to delay me. Such as my crappy day today.
Guess what? I was so angry at everything that I actually forgot to call her today.
I'm currently baking a cake. Maybe it will help balance my karma with the universe or something.
Warning: waaaaaay too much text.
In which insurance is a pain in the ass.
I called my insurance company(s) today.
I lost my coverage (Horizon BCBS Direct Access, with prescription drug coverage "carved out" to Caremark) after my divorce in mid-December. COBRA extends back to the day you lost coverage no matter when you enroll, and it's pretty expensive, so it's usually a good idea to wait and see if you're going to actually use it before enrolling. That decision was made for me as soon as I picked up a refill of one of my medications and discovered that it's $346(!) out of pocket for a 30 day supply.
My ex's company uses a COBRA administrator called Ceridian. So I enrolled with them online, and once I started receiving bills, paid them directly. They in turn sent the enrollment and money on to Horizon. After a month or so (and another out of pocket payment for the same prescription), I called up to find out why I hadn't heard anything, and discovered that Horizon didn't have any record of me. After enough prodding at them and my ex's incompetent HR person, they figured out it was because they needed a physical enrollment form because they didn't have individual information about me like my birthdate. *facepalm* I filled out the form, and a couple of weeks later Horizon finally processed me onto their system, and in turn sent my enrollment over to Caremark. And I was at long last able to fill that prescription for just the copay, like a normal person! And able to fill all the others, which thankfully were on 90 day cycles and, with the help of samples from the doctor's office, were only just starting to run out.
I also went ahead and filled out the paperwork to get that $700 out of pocket cost refunded, which requires you to send in either the original receipts or what looks like a shitload of paperwork filled out by your pharmacist. Fortunately, I had known to keep the receipts, so that wasn't a problem.
Last weekend I (stupidly) ran out of that same troublesome prescription, which I knew was almost gone but I hadn't realized was also out of refills. I simultaneously received a letter of denial from Caremark for the refunds, due to something marked as "Plan Limitations Exceeded". I had my doctor call in a temporary refill a couple of days ago, which I was going to pick up today, and finally got enough past my annoyance to call Caremark this afternoon.
It turns out that "Plan Limitations Exceeded" means that, as of 1/1, they no longer allow a quantity of 60 for a 30 day supply, which has been my prescription since at least this time last year. When I questioned how this could be, since I had filled it under this insurance just last month, it turns out... well, it still doesn't make any mathematical or timing sense to me actually, but apparently the pharmacy had somehow gotten them covered as a couple of 15 day supplies or something. It apparently hadn't occurred to said pharmacy to mention the problem to me at the time so that I could fix it - perhaps because I had gotten other refills of this from them this year? IDEK.
After a lot of probing questions (to what was actually a very helpful Caremark customer service person), I found out that I need to get my doctor to get the prescription "preauthorized" as medically necessary. "Preauthorized" is in quotes because my doctor will need to very carefully specify that this is retroactive to the beginning of the year in order for me to get my refund. This authorization actually needs to happen via Horizon, who will then send it onto Caremark on their normal every-few-days electronic feed. Once this all goes through, I will be able to pick up my new prescription for this month without paying out of pocket again. Unfortunately, I will also need to resubmit the paperwork for the refunds from scratch. As I no longer have original receipts (since I sent them in before, remember), I will apparently also have to go through getting the pharmacist paperwork as my proof this time.
Interesting (or not) related notes:
- I called Horizon to double check the fax number and process, and their customer service rep tried to tell me that my doctor needs to do the preauthorization with Caremark instead. After some argument, he got off then phone for a few minutes, then came back to grudgingly admit to me that it really is through his company after all, and gave me the phone number my doctor needs to call instead of faxing.
- Apparently my doctor also needs to specify that it can either be 60 for 30 days or 180 for 90 days, since these don't count as the same thing to Caremark's systems. Again, IDEK.
- Please note that I've been paying $550 a month for my coverage all this time, which Ceridian has been quietly, correctly, and efficiently processing behind the scenes. I'm not sure if that means that Ceridian is that much better than the rest of them, or that people are always willing to take your money if you're willing to pay it.
- Ironically, I had already been planning to ask to lower my dose to what would be Caremark's acceptable amount when I saw the doctor next, which is now this coming Tuesday. But I still need this "preauthorization" to happen in order to get my money back. I apologized profusely to his assistant over the phone, though she seemed cool with it.
In which I am an asshole to my pets.
So a little later, and still a little irritated, I was making dinner when from out in the living room came a massive crash. I rushed out to find that one of my pets had managed to knock my laptop off of the table. Turning it back on, I was crushed to discover that it appeared to be basically functional, except that the screen stubbornly remained completely black.
That was actually my backup computer. A couple of months ago, my main computer suddenly stopped charging - I mean, REALLY stopped charging, to the point where having it plugged into the wall did nothing to keep it going on its own, never mind charge the battery. Over the course of the next couple of days, the power slowly crept down, until it finally shut irrecoverably down. I sent it into Alienware for repairs, only to get an email a few days later saying that, despite still being under warranty, they had decided that there was sufficient existing damage that I would need to pay for any repairs. I called to arrange to pay, only to be quoted a bill of some $450 bucks, covering among other things a new motherboard, a new sound card, and penalties(!?). I explained that I wouldn't have the money to cover that until 4/1, and would call back to pay then. I was told that they would ask the repair department if that was possible, but normal procedure was to give it 10 days, after which it would be shipped back to me unrepaired, and after that I would have to pay to ship it back and forth (possibly with other unspecified penalties attached).
Sure enough, several days later, a box appeared on my doorstep. Broke and annoyed, I brought it inside then ignored it, leaving it sitting next to my front door still in the box.
Back to tonight. When nothing I did brought the screen back to my backup, I grimly broke out the tiny screwdriver. I spent the next couple of hours disassembling it pretty much completely, cleaning and tightening and checking every connection I could get to. I reassembled, crossed my fingers, and turned it back on. Nothing.
I very calmly picked the laptop up, and hit it really, really, really hard against my coffee table. Unsurprisingly, this also failed to fix the problem.
While I was doing all of this, my pets were all busy quailing in fear. I am not in any sense an intimidating person, and this extends to my pets pretty much humoring my attempts to order them around just because they like me. So for them to be eagerly obeying my every command with alacrity is a pretty good sign of just how pissed I was at that point. When I hit the coffee table, the dogs all actually cringed. When one dared to ask to go out earlier, I yelled at him so meanly that he crept away. I felt a little bad, but I still made him wait another 45 minutes or so, until I finished getting out the dozens of little screws.
At this point, I had no idea what I was going to do. I don't know what to do with myself without a computer anymore, and that's completely aside from needing it for my job search. And my bank account is actually overdrawn until I get my unemployment check tomorrow. (Due to someone directly lying to me this morning when they assured me a particular debit wouldn't even be submitted until Monday, never mind processed. I fully intend to throw a shitfit until I get all of the overdraft fees back from that company next week.) I decide to finally unpack my main, in some distant, desperate hope that maybe some microchip got jostled enough in shipping that it would work in some crippled way.
And discovered a completely repaired computer.
In which I am an asshole to my mom.
Oh, by the way, did I mention that my mom is in the hospital? She was having a hard time breathing for a couple of days, so we yelled at her until she finally went to the hospital yesterday. Turns out that her blood oxygen level was at 63%! Last time I heard, the doctors were leaning towards a heart issue, which is not necessarily a surprise with someone who is unable to work due to deep vein thrombosis and yet still smokes. I don't know if she's gotten an actual diagnosis now, as the last thing she'd admit to us kids is bad news, if she can possibly avoid it.
I have a lot of problems with my mom, but I still love her. I called her twice at the hospital yesterday, and promised to call again today. I was secretly planning to actually go visit her, but I didn't mention it just in case anything happened to delay me. Such as my crappy day today.
Guess what? I was so angry at everything that I actually forgot to call her today.
I'm currently baking a cake. Maybe it will help balance my karma with the universe or something.