Anyone else being screwed by their insurance?

notthisagain · Mar 22, 2015 at 05:22 PM

Up until January of this year, I had a coinsurance for my doctor and my therapist, and my prescriptions hven't cost as much as they do now. My coinsurance for my doctor was a little over $20 per visit and the one for my therapist was $18. Now they apply to a high deductible, so that I have no more co-insurance until I reach something like $2500. My doctor visits now are $83.00, my therapist is $89, and my psych visits are $75. My therapist offered to work with me outside of my insurance and charge me $70 per visit, which is still a lot more than what I was paying, but still cheaper than what I would pay had we gone through my insurance. I have also noticed the costs of my prescriptions going up dramatically.

Anyone else having a similar experience?

CANDC · Mar 22, 2015 at 05:46 PM

Quote:

Originally Posted by notthisagain

Up until January of this year, I had a coinsurance for my doctor and my therapist, and my prescriptions hven't cost as much as they do now. My coinsurance for my doctor was a little over $20 per visit and the one for my therapist was $18. Now they apply to a high deductible, so that I have no more co-insurance until I reach something like $2500. My doctor visits now are $83.00, my therapist is $89, and my psych visits are $75. My therapist offered to work with me outside of my insurance and charge me $70 per visit, which is still a lot more than what I was paying, but still cheaper than what I would pay had we gone through my insurance. I have also noticed the costs of my prescriptions going up dramatically.

Anyone else having a similar experience?

If you have recently changed insurance companies, this could be a different plan then you had.

If you have had this insurance company, then you either need to see when you can switch policies in this company or when you can get another company's policy.

The less expensive the insurance policy, the more you are likely to pay. Get a sheet of deductibles and copays and understand before buying.

Next year, and years following, you need to review this information carefully. Insurance policies coverage can change.

notthisagain · Mar 22, 2015 at 07:12 PM

I called both my insurance company and my prescription coverage company. During my open enrollment period, I made no changes, but somehow my deductible went up from $1100 to $2500 with an out of pocket maximum of $5000. I went to the websites of some of the pharmacies in my area, and they don't seem to have programs for the medications that I take.

I just read the sticky on this board about insurance and there was a link to xubex.com, so I figured that I would give that a try. It looks like they offer three of my prescriptions for a whole lot less than what my pharmacy charges. I have a pdoc appointment next week and I hope that what I read was accurate. I am going to ask him to go through that site instead of my local pharmacy. Keeping my fingers crossed.

Rose76 · Mar 25, 2015 at 05:38 PM

It sounds like you have a type of insurance that is there basically to kick in for catastrophic scenarios. Those types of insurance charge cheaper monthly premiums. So it's a case of pay more in premiums, or pay more for your care.

Is there an option where you could pay a somewhat higher monthly premium that would cover more of the costs of getting treatment?

The costs you are describing would, indeed, make it very hard for most people to afford the care you've been getting.

scatterbrained04 · Mar 27, 2015 at 01:31 PM

I get screwed sometimes at the pharmacy. I've had a couple times when my out-of-pocket on a prescription suddenly jumped up $40-50.

ringtailcat · Mar 27, 2015 at 06:19 PM

Xubex.com covers quite a few medications and the price listed is for a 90 day supply. Another option might be RxHope.com, they list many of the Branded medications. You type your medication in and it takes you to any programs for that drug, if available. Sometimes you can get coverage even if you have insurance if you meet the income requirements or can prove the cost of the medication is a hardship for you. Good luck!

raspberrytorte · Apr 17, 2015 at 09:23 PM

Quote:

Originally Posted by scatterbrained04

I get screwed sometimes at the pharmacy. I've had a couple times when my out-of-pocket on a prescription suddenly jumped up $40-50.

Oh my god, me too! I'm on all generics, so they should be seven dollars each. Went to pick up three prescriptions other day, and it was 32 dollars!! Wtf. For whatever reason my seroquel (generic) was 18 dollars. I don't know if it was the dose increase or what? My lamictal (also generic) is always around 22 dollars. Even my pharmacy doesn't know why this is. Sucky.

pinkflower17 · Apr 18, 2015 at 08:18 AM

Quote:

Originally Posted by notthisagain

Up until January of this year, I had a coinsurance for my doctor and my therapist, and my prescriptions hven't cost as much as they do now. My coinsurance for my doctor was a little over $20 per visit and the one for my therapist was $18. Now they apply to a high deductible, so that I have no more co-insurance until I reach something like $2500. My doctor visits now are $83.00, my therapist is $89, and my psych visits are $75. My therapist offered to work with me outside of my insurance and charge me $70 per visit, which is still a lot more than what I was paying, but still cheaper than what I would pay had we gone through my insurance. I have also noticed the costs of my prescriptions going up dramatically.

Anyone else having a similar experience?

This is normal. Most insurances start over with a new deductible at the beginning of the year. Once you hit your deductible, you should once again have lower co-pays etc. It may be costing you less now, but it may end up costing you more in the long run to work with your therapist outside of your insurance. When you do that, it doesn't apply to your deductible and therefore, your co-pay will take longer to drop back to the previous 18$. Play around with the numbers, but I think it would be cheaper in the long run to pay the higher number now. Your prescriptions also likely went up because you have a deductible for them as well. They also should go down once you hit it. It should say on your insurance card what your deductible is. This happens to me every year and the first couple months until I fit until I hit my deductible suck. A lot. Sorry our insurance world sucks. I don't really have any other good advice except to look for patient assistance programs, or try to change your meds to similar, cheaper generics. Good luck.

JoeS21 · Apr 23, 2015 at 11:21 AM

Is this categorized as a "high deductible" insurance plan? If so, you can probably start a medical savings account through most of the major banks. I think you can then pay with pre-tax money.

Menu

My Support Forums - Mental Health Support Groups

Get emotional support and friendship from others like you!

Anyone else being screwed by their insurance?

My Support Forums

scatterbrained04 Magnate Member Since Feb 2015 Location: Ohio Posts: 2,868 9	Mar 27, 2015 at 01:31 PM #5 I get screwed sometimes at the pharmacy. I've had a couple times when my out-of-pocket on a prescription suddenly jumped up $40-50.
	Reply With Quote

JoeS21 Member Member Since Jul 2014 Location: Boston Posts: 450 9 13 hugs given	Apr 23, 2015 at 11:21 AM #9 Is this categorized as a "high deductible" insurance plan? If so, you can probably start a medical savings account through most of the major banks. I think you can then pay with pre-tax money.
	Reply With Quote