I normally get IV infusions every 6 weeks. The cost for this is a specialist visit co-pay of $50. The medication for the infusion costs a lot. The doc estimates between 25 - 30K per year for this medicine.
So back in April, I needed to move up my infusion due to an out of town trip. The doc couldn’t source the meds the normal way, so called upon CIGNA’s Tel-Drug program. They happily sent along the drug, and I got my infusion, and a bill for $50.
A bit later, I got another bill, from Tel-Drug. It seems I have a $75 co-pay for non-formulary brand name drugs dispensed in doses over 30 days. So, I contacted them and explained the situation, how I normally receive the drug, etc etc. Nope, they don’t want to hear it, I owe $75.
I escalated it through HR as well. Nope, the claim was processed correctly, you owe $75.
Now, I understand having cost differentials in place when services seem similar but offer widely different cost structures, such as a different co-pay for ER visits vs PCP visits. I get similar service (“Take 2 aspirin and call me in the morning”) but the cost structures are widely varying because of the expense of operating an ER vs a PCP office. In this case, however, the insurance company is being asked to pay for medicine. It is HIGHLY likely that CIGNA has a better negotiated price for Remicade than my doctor does, so it’s probably even cheaper for them to dispense it through their pharmacy. I realize that the contract says you can screw me this way, and that you feel obligated to your shareholders to screw me this way, but I look at it this way: $75 is a tiny percentage of the medicine’s overall cost to you. Maybe 1 or 2% However, to me, this represents an increase of 150% to my typical costs, for ZERO net benefit to me.
On my billing notice, it says that I should not delay payment because that may affect future services from CIGNA Tel-Drug pharmacy. Rest assured Tel-Drug pharmacy, I will not ever be utilizing your services again, and have no intention of paying for your stupid convoluted rules this time, either.