Sorry this is a long post. I hope someone might have some ideas for recourse as I don’t have weeks to sit around waiting for BCBS to maybe fix their issues. So to start this and express why this is such a bad time for this to happen, the last 10 days have been challenging. I’ve had to do more breathing treatments than at a point I can remember for a long time. 5 nebs per day (more than I should be) plus additional rescue inhalers in between. It’s been a struggle (especially at night).
Yesterday I went to the pharmacy to pick up my nebulizer treatments as I’d used the last one that afternoon. I also needed to pick up a new Advair script to hopefully help settle my lungs. When the tech brought them out, instead of getting my low copay amount, she said I owed $1,120. I laughed and said she forgot to use my insurance, she went back and said, “I’m sorry, but on June 20 Blue Cross kicked you off their prescription plan”. Aghast I said it has to be a mistake. That’s crazy. It’s impossible! I asked if there was anything she could do. She said no but you can pay for them yourself. The pharmacist saw what was going on and came over to tell me this has been happening a lot with BCBS and they refuse or are too incompetent to fix the issue properly as it keeps hitting big swaths of plans. So I went home with no medications. Ended up with coughing spasms til 6:00 am when exhaustion finally pushed me to sleep.
Today I called BCBS and they said, “there’s a systems issue and someone will try to attend to it”. I asked for an ETA and they refused to give one. When we asked what I’m supposed to do, she said pay for it all up front and send in receipts for reimbursement.
I went back to Wal-Greens today and my favorite pharmacist was there. He’s amazing and has been taking care of me for 20 years now. What he told me was shocking. This isn’t something new. BCBS has been doing this to people/companies all year. He’s part of a network of pharmacists from across Michigan/U.S. and said this has been a continuing and repeated nightmare. He believes people are getting hurt being forced to go without their medications because they don’t have the money to pay for meds up front while BCBS sorts out their problems. Diabetics suddenly forced to go without their insulin, cardiac patients suddenly without their heart medicine. Pulmonary patients suddenly having to go without breathing meds. Thankfully because he knows me so well, he gave me an advance on my neb treatments to get by for a bit. When I told him what the BCBS rep told me, his words were:
“UNDER NO CIRCUMSTANCES SHOULD YOU PAY FOR YOUR PRESCRIPTIONS UP FRONT. There is a good chance you will NEVER see that money again. He said BCBS has been denying reimbursement when people have been inadvertently kicked off their policies, and often when they do pay, it takes 6 weeks to 6 MONTHS to get your reimbursement.”
I’m floored. I’ve never had a single problem with BCBS before, they’ve been fantastic. I had no idea part of their company was such a mess. Here’s a not fun part that has me concerned. I have to get my Trikafta next week from a special order pharmacy. It’s the most important medication I have for my lungs. It costs $22,000. Even if I felt confident I’d have no problem getting reimbursed, I don’t have that kind of money in the bank. And I can’t help but think… “I” have the capacity to try and fight to fix this before something bad happens, but what about the elderly who are on their own who don’t have a support base or don’t have resources. Or the patient who’s critically sick in bed, and doesn’t have the strength or mind to try and work through red tape? It makes me incredibly upset knowing how awful this could be for some people who just need this system to work. So how does a peon like me get through to someone at BCBS who can actually make a difference and fix this faster? Obviously the first point of contact has no power, and half the time hates their job.
For my final note of something I find odd. I can’t find a single comment/article on this problem anywhere on the Internet. My pharmacist(s) have made no bones about what a damaging, widespread, nightmare this is and they can’t believe a regulatory agency hasn’t become involved. So why isn’t anyone else complaining about this on the Internet? I posted some info on my local reddit sub as I thought it was an issue in just my city and got responses verifying what the pharmacists had stated.