I take two monthly prescriptions. I take Pentasa for my Crohn’s Disease. I take hormonal contraception via the Patch to prevent pregnancy AND to help with my periods/cramps.
Dan and I found out about a month ago that United Healthcare, the health insurance offered through his work, won’t cover the Patch. For the record, my prescription is for the generic. We’ve now paid for it twice out-of-pocket, $85 the first time (in Ohio) and $100 the second time (in Georgia). Dan has started the appeals process with them, but it’s a time-consuming affair that drags on.
Just so everyone is clear, it is ILLEGAL for United Healthcare not to cover at least one option of every type of contraception. And yet, they don’t cover any forms of the Patch.
Yesterday I called in a refill of my Pentasa at CVS. Dan and I went to pick it up after work.
The pharmacist told us that United Healthcare refused to cover it, claiming Pentasa is on their “exclusions” list. They won’t cover Pentasa. The out-of-pocket cost for 30 days?
Over $500.
Dan called them last night while I fixed dinner. The representative didn’t care that I’ve been on Pentasa since I was about 10 years old. The representative didn’t care that I have a pre-existing condition that is treated with Pentasa. The representative thought recommending other prescriptions that help some Crohn’s patients would be helpful.
Because a phone representative for a health insurance company can totally treat my incurable, lifelong disease.
So now we get to start a SECOND appeals process, just so that our health insurance will cover my prescriptions.
For the record, I’ve been with numerous insurance companies over the years, and this is the first time one has EVER denied coverage of Pentasa.
If you would like to join me online in calling out United Healthcare’s bullshit, their Twitter handle is @myUHC.
That’s ridiculous! Did they give excuse for why they wouldn’t cover it? (Ie, only want to cover a generic or something.)
For Pentasa, they cover other drugs similar to it, but not it itself. They basically won’t cover it unless I try the other 3 or 4 other drugs “similar” and suffer adverse effects. Which… sounds incredibly unethical. For my BC, they’re interpreting the law (incorrectly, like, it goes directly against what is clearly stated) as having to cover each formula of BC, not each method of BC. So they don’t cover any of the Patch versions, which is what I take, because each is available as the Pill. That is easier to appeal, since they’re breaking the law. I’m basically stuck trying other drugs before I have any way to get them to cover Pentasa.
Unbelievable! I hope the second appeals process gets you some results. I especially love how the phone rep tried to recommend other prescriptions. Ugh.
Yeah, we just found out they denied our initial appeal for the BC, so we have to go forward with the next round. I also have to try other prescriptions (and react poorly to them) before they will cover Pentasa. The only silver lining is that a) my gastroenterologist in SC thinks I might do well on one of them b) I have enough Pentasa to get me through a few weeks and c) I have an appointment with a local gastroenterologist this week, so I can get a second opinion on that particular drug before I switch to it.
oh. my. gosh. No words!!!
I know. The whole thing is absurd.
I HATE INSURANCE WITH A FIREY PASSION THAT BURNS FROM DEEP WITHIN! Sorry that was heated. 😉 When I worked in healthcare I had to call them all the time and pretty much no company liked helping us out. Let’s see… Not helping Dr offices AND not helping patients??? Doesn’t sound like a good situation to me! (PS. I’m SO sorry you’re going through this. That really sucks!)
I feel the exact same way about insurance. This is far from our first battle with health insurance, but the previous battles were with different providers. It’s like all of them are awful.
Health insurance is no fun to deal with. When Angel got a new job and moved to Michigan when we got married, the insurance wouldn’t cover the specific medicine he’d been taking for many years for a lifelong condition, they required him to try others and find out if another one worked (the same sort of deal that your insurance wants you to do)–the good thing is that one that he tried worked fine for him, and he takes that one till this day. Hopefully you’re able to get an insurance provider and a prescription that will work for you! Now, with living overseas, it’s gotten a bit more complicated to figure out what kind of insurance will cover this lifestyle and hopefully not cost $500 a month….
I understand my freakin insurance is refusing to pay for the medically nesscary asacol so my dr switched it and they are refusing to pay for the new one as well.
I feel your pain. They refused to fill my generic hormone patch and they require me to buy the name brand. What’s even worse, they picked the name brand out of thin air which is 122.00 and it’s not even working.
I had to go back to my GYN to get the name brand he originally prescribed me which has a discount card. It makes no sense that they will not cover a cheaper generic which works for me for the last two years.