# I pit Blue Cross and various pharmacies for not knowing their ass from a hole in the wall **URL:** \ **Category:** The BBQ Pit\ **Created:** [January 7, 2016, 1:06am UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376 "2016-01-07T01:06:26Z")\ **Posts on this page:** 17\ **Page:** 4
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [January 9, 2016, 4:48pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/61 "2016-01-09T16:48:37Z")
> [@davidm](#): > > I have it!!! šŸ˜ƒ Yay! šŸ˜ƒ ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 9, 2016, 6:22pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/62 "2016-01-09T18:22:03Z")
> [@davidm](#): > > I have it!!! šŸ˜ƒ YAY! Send some of that good mojo my way! šŸ˜ƒ ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [January 10, 2016, 3:27pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/63 "2016-01-10T15:27:11Z")
> [@davidm](#): > > [li]Thereā€™s been some change in the plan, possibly due to the new healthcare laws.[/li] Nope. These are all ridiculous guidelines set up by the insurance company and enforced by dog-fucking CVS Express Scripts. There is absolutely no reason that you could not get the medication from anyone who sells it; all of this bullshit youā€™ve had to go through is an attempt to control costs. These attempts always negatively impact the patients who are supposed to be treated by health insurance. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [January 10, 2016, 6:25pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/64 "2016-01-10T18:25:21Z")
> [@GrumpyBunny](#): > > Nope. These are all ridiculous guidelines set up by the insurance company and enforced by dog-fucking CVS Express Scripts. There is absolutely no reason that you could not get the medication from anyone who sells it; all of this bullshit youā€™ve had to go through is an attempt to control costs. These attempts always negatively impact the patients who are supposed to be treated by health insurance. Exactly. UHC stopped covering generic Vicodin out of the clear blue sky about a year ago and the first I heard of it was when I couldnā€™t get it at CVS. So I call, and the bot on the phone says yes, it isnā€™t covered anymore. Uh, pain medication? Finally she admits that I can get generic Norco, which is almost exactly the same thing, but apparently cheaper. So, jerking a person with chronic pain around to save a penny or two? Yeah, thatā€™s UnitedHealthcare, may they be nuked from space. ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [January 10, 2016, 9:34pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/65 "2016-01-10T21:34:17Z")
[quote=ā€œGrumpyBunny, post:63, topic:742376ā€] > [@davidm](#): > > [li]Thereā€™s been some change in the plan, possibly due to the new healthcare laws.[/li][/quote] > > Nope. These are all ridiculous guidelines set up by the insurance company and enforced by dog-fucking CVS Express Scripts. There is absolutely no reason that you could not get the medication from anyone who sells it; all of this bullshit youā€™ve had to go through is an attempt to control costs. These attempts always negatively impact the patients who are supposed to be treated by health insurance. I think youā€™re missing the context of what I said. I had mentioned that it was being covered 100% this time while in the past I had always had a 50% copay. So theyā€™re paying more now, which is hardly a cost saving measure. Hereā€™s the relevant context: > [@davidm](#): > > ā€¦ > One apparent silver lining in all of this. I usually have a copay of 50% on this expensive medicine. When the pharmacy thatā€™s shipping it called me, they said that itā€™s covered 100%. Since theyā€™re shipping three months worth, that will save me a lot of money. I see three possible explanations for this: > > [ul] > [li]Itā€™s a mistake and Iā€™ll be billed.[/li][li]The insurance company is doing that this one time because of the massive fuckup.[/li][li]Thereā€™s been some change in the plan, possibly due to the new healthcare laws.[/li][/ul] > Obviously Iā€™m hoping that itā€™s the last reason. That sort of makes sense because a new rule might go into effect at the beginning of a new year. Iā€™m not defending the insurance company for their overall behavior, just clarifying what I meant in that quote. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [January 10, 2016, 10:31pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/66 "2016-01-10T22:31:08Z")
Let me add another pet peeve. Since itā€™s the beginning of the year, I have about twenty notices from insurance companies that particular medications are not going to be covered. This requires me to do one of the following: See if an alternative is available, call the patient to see if they agree to it, have either the patient or my staff check to see if the alternative is on the new formulary, and if so prescribe it. Go through all of the patientā€™s old records to see what they have tried in the past and why it was stopped. File an appeal for coverage of the original medication with forms that are different for each company and remembering which ones require online appeals and which require a peer-to-peer telephone call (for which I usually have to have them call me back at their convenience) and hope for authorization. Try to get free medications from the manufacturer which requires the patient to fill out an extensive financial release form which they often either donā€™t want to do or have difficulty doing. Try to get samples from the manufacturer to give to the patient to cover the time until the above is worked out. If samples are not available, arrange an alternative treatment plan until the medications arrive and make sure the patient understands the new regimen. After all of this and getting a letter from the insurance saying that they have agreed to cover the nonformulary medication for a year get an irate call from the patient because although the medication is ā€œcoveredā€ that doesnā€™t mean the price is affordable and instead of paying $30 a month, the patient now owes $400 a month. Start over at step one. ---
**Author:** ![Tim\_T-Bonham.net](https://avatars.discourse-cdn.com/v4/letter/t/46a35a/32.png) [@Tim\_T-Bonham.net](https://boards.straightdope.com/u/Tim_T-Bonham.net)\ **Post date:** [January 10, 2016, 10:34pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/67 "2016-01-10T22:34:05Z")
> [@GrumpyBunny](#): > > These attempts always negatively impact the patients who are supposed to be treated by health insurance. NO!!! Health insurance companies do NOT treat anybody ā€“ Doctors, Nurses, etc. do that. Despite all their attempts to confuse the two, Insurance Companies do nothing to treat sick & injured people. They are just parasites on the health care system, ripping off a big share of the money for their so-called ā€˜servicesā€™. The health care system could function quite well without them ā€“ in fact, it already does so in many countries. ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [January 10, 2016, 10:59pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/68 "2016-01-10T22:59:12Z")
> [@psychobunny](#): > > Let me add another pet peeve. Since itā€™s the beginning of the year, I have about twenty notices from insurance companies that particular medications are not going to be covered. > ā€¦ This. My broker told me that notices had been sent to providers that Acro would no longer be shipping this medication and that an alternative provider would have to be used. But as you say, that office is probably swamped with such things at the beginning of the year. And anyway, shouldnā€™t I have also been notified? That way I could have started the whole bureaucratic process immediately rather than when I was ready for a refill. ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [January 10, 2016, 11:31pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/69 "2016-01-10T23:31:33Z")
> [@t-bonham@scc.net](#): > > NO!!! > Health insurance companies do NOT treat anybody ā€“ Doctors, Nurses, etc. do that. > > Despite all their attempts to confuse the two, Insurance Companies do nothing to treat sick & injured people. They are just parasites on the health care system, ripping off a big share of the money for their so-called ā€˜servicesā€™. The health care system could function quite well without them ā€“ in fact, it already does so in many countries. I know, right? Thereā€™s a health insurance scam operation that advertises on local tv here. ā€œHealth Care Reform is available NOWā€. Um, no. One canā€™t purchase health care reform. The whole campaign is idiotic. I wonder who their target market is, other than idiots? ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [January 15, 2016, 8:01am UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/70 "2016-01-15T08:01:34Z")
I received a letter from Blue Cross today stating that Iā€™m approved to receive the medicine from Walgreens Specialty Pharmacy for one year. Iā€™m not sure what the copay will be or if there even is one. Iā€™m going to contact my broker to see what she knows. Iā€™m kind of hoping that I can keep off the weight I lost, but since I started eating again Iā€™ve been ravenous. ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [April 2, 2016, 12:21am UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/71 "2016-04-02T00:21:16Z")
The saga continues. The 3 months are up so it was time for a refill. Since the medicine is prescribed to be used ā€œas neededā€ I havenā€™t actually used it all up but I figured that Iā€™ll refill it now. My thinking being that Iā€™d like to get as far ahead on it as I can (expiration dates allowing) so that the next time everything goes fubar Iā€™ll have a number of weeks backup while it gets straightened out. So I called for a refill and was told that I can get it now and that they could send me a monthā€™s worth with a copay. Thatā€™s not as generous as the last time (3 months with no copay) but I guess they did that to make up for screwing things up so badly and one month with a copay is the norm. One monthā€™s worth is 3 vials; 10 days per vial. The medicine arrived today - 15 vials of it. Thatā€™s 5 months worth. These people are idiots. The expiration dates are all 12/2016 and Iā€™ll use it eventually and it certainly gives me a feeling of security for now, but I just hope that theyā€™re not going to try to hit my checking account for a $900 copay all at once. Iā€™ll try calling them tomorrow but I probably wonā€™t be able to get anyone till Monday. ---
**Author:** ![Fat\_Chance](https://avatars.discourse-cdn.com/v4/letter/f/8baadc/32.png) [@Fat\_Chance](https://boards.straightdope.com/u/Fat_Chance)\ **Post date:** [April 2, 2016, 3:57am UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/72 "2016-04-02T03:57:46Z")
> [@GrumpyBunny](#): > > Nope. These are all ridiculous guidelines set up by the insurance company and enforced by dog-fucking CVS Express Scripts. There is absolutely no reason that you could not get the medication from anyone who sells it; all of this bullshit youā€™ve had to go through is an attempt to control costs. These attempts always negatively impact the patients who are supposed to be treated by health insurance. CVS and Express Scripts are 2 completely different companies. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [April 2, 2016, 6:25am UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/73 "2016-04-02T06:25:40Z")
Expiration dates are set at ā€œworst caseā€ scenarios: Left on a south-facing widow sill in the bathroom beside the shower. Above the radiator. In the Sahara. ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [April 2, 2016, 1:27pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/74 "2016-04-02T13:27:05Z")
> [@usedtobe](#): > > Expiration dates are set at ā€œworst caseā€ scenarios: > Left on a south-facing widow sill in the bathroom beside the shower. Above the radiator. In the Sahara. Iā€™m not concerned about the expiration date (although any extended time not refrigerated would destroy it much sooner). Iā€™ll likely use it all before December so thatā€™s not an issue. What Iā€™m not sure about is if I can keep an amount of prescription medicine that is obviously a mistake. When I ordered the refill they emphasized that it canā€™t be returned so if I did send it back theyā€™d likely just dispose of it. I think I sort of know what happened. The last time, they said that they were sending me 3 months worth and I correctly received 9 vials. However, the invoice showed a quantity of 45. I figured that, since each vial is 5 ml of liquid, and 5 \* 9 = 45, the quantity on the invoice was in milliliters. This time, the invoice shows a quantity of 15 which, if consistent with the previous order, means 15 ml or 3 vials which is what they said they were sending me. Iā€™m guessing that whoever packed the order saw the quantity of 15 and sent me 15 vials rather than 15 ml. ---
**Author:** ![watchwolf49](https://avatars.discourse-cdn.com/v4/letter/w/e9c0ed/32.png) [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)\ **Post date:** [April 2, 2016, 2:54pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/75 "2016-04-02T14:54:19Z")
> [@nearwildheaven](#): > > [snip] ā€¦ You have to get a LAWYER involved for your meds? :eek: :mad: First Iā€™ve ever heard of that. Maybe the day has come where we all need to bring a lawyer with us to the doctorā€™s office, for the amount we pay in medical costs, lawyerā€™s fees seem small ā€¦ ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [April 2, 2016, 2:57pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/76 "2016-04-02T14:57:18Z")
I should have started a new thread. Everyone is responding to old posts. :smack: ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [April 4, 2016, 3:22pm UTC](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376/77 "2016-04-04T15:22:01Z")
I just spoke to the pharmacy. It was an error on their part and I can keep all 5 monthsā€™ worth but I only have to pay the copay for the 1 monthsā€™ worth that they were supposed to ship. So I won the lottery on this and itā€™s their loss. [Previous page](https://boards.straightdope.com/t/i-pit-blue-cross-and-various-pharmacies-for-not-knowing-their-ass-from-a-hole-in-the-wall/742376.md?page=3)