It's amazing how completely un-helpful your insurance company can be.
Scenario: I send in rx's to new mail order supply place.(for cartridges + Cleo infusion sets). The cartridges, they mail me back 20 (partial box) and charge me $35. Ugh. Should have gotten the doc to write it 3 boxes for a 3 month supply.Another thing about Medco, they grill you about how many you actually use in a 3 month period.(really none of their business, if the doc writes the rx for that number)
The Cleos, they say it isn't covered under the mail order portion of my plan and send back the RX. Now the new mail order supply place is Medco, switched from Caremark on Jan.1. But the retail pharmacy portion is still processed through Caremark. I call BCBS to see about getting appeal forms, Medco has informed me that the only infusion set covered under the MO portion is a MM set.(NOT luer lock, and not compatible with my pump) How much sense does it make to cover the pump cartridge and not the infusion set?? BCBS rep practically immeadiently hands me off to the Medco rep again.(not interested in answering my questions about the appropriate forms at all) Medco rep suggests going to a durable medical supply company and trying to get them there, processing it through the retail portion. I call all of the durable medical supply places around here, and none of them have insulin pump supplies.(I don't know if any do..) Medco rep also gives me the phone numbers to BCBS appeal places(she was more helpful then the BCBS rep!) Medco can't give me the info for retail, that has to come from Caremark.Register for the Caremark website, and call Caremark to see if any infusion sets are covered under retail. They say they don't have access to that information,refer me to a covered benefits PDF(no mention of any pump supplies), and switch me right back to the Medco rep. Hang up, this isn't going anywhere.
(very productive day,and its now 5 pm)
On the Caremark website, there's an option to check drug coverage(and several infusion sets listed) but all of them spit out the following:
"We're sorry; this drug is NOT COVERED by your benefit plan OR may NOT BE THE APPROPRIATE REGIMEN as defined by your plan. For more information, please refer to your benefit materials or contact your benefit administrator (Error Code 70)."
Looks like I will have to appeal(once I get the info to do that). They don't even make that easy, BCBS rep wouldn't tell me how and there are no forms on the website.
I'll have to call that number the Medco rep gave me. I also want to get the ball rolling for sensor coverage + that will take a long time.(if ever)
I'm really not sure I like this insurance, certain parts are good but the rest is a nightmare..We could switch every year,my husband has alot of options and I thought I'd picked out a winner(D-cost-wise) but apparently not. My former BCBS plan was much easier to deal with. And, I have about 5 infusion sets left so unless they last a month each,I'm going to have to go back on shots.