So today I had a battle with Anthem Blue Cross Blue Shield of Maine. We have been getting the run-around regarding Erica’s Remicade infusion. She was getting the infusion every 6 weeks in Boston; however, they stopped approving it. Erica’s Rheumatologist fought with the insurance company and had to have a zoom conference for her to convince the insurance company to approve the meds. Now that we got it approved today was a nightmare. We had to call the insurance company as we were told it would cost us 1400 dollars to get the medication. Finally after being transferred around multiple customer service reps we figured it out. Erica has already met her deductible, so she now must pay co-insurance which is 10% of the cost. Due to our medical plan is split into which means prescription drug coverage is covered under another plan/provider. Now that provider refused/denied refused the meds so now the medication is covered under our medical insurance… It is very complicated in my mind.. Anyways with the Prescription Help Plan from the drug manufacturer we will end up paying around 5 dollars instead of 1400 a month.
I cannot imagine if you did not have case management experience having to navigate this horrible system.