Saturday, August 13, 2016

Filling and topping up maintenance RX's while I can

Image: https://www.ummchealth.com/uploadedImages/UMHC/home_rxrefill.jpg

As mentioned, we have just a few weeks left on this year's health insurance plan before the new year starts and we have met both of our deductibles to date, so everything, as long as we use in plan providers, is $0 OOP.

I recently returned to my Dermatologist for what I strongly suspected was Psoriasis. He stated that it's either Eczyma  (I already was diagnosed with this years ago, mostly on my hands, feet, undeside of the upper arms)or Psoriasis-the treatment would be the same.

My Dad was plagued with Psoriasis, I actually was the one who would put his salve on, which was needed on 90% of his body. He had it so bad, he was told that he could retire under disability. Due to his work ethic/mind set, that was not an option. What I have developed on my elbows is not eczyma, I am very familiar with plaque Psoriasis, that is what I have. MD prescribed a RX cortizone, which he gave me a sample for, as well as a sample for an expensive OTC urea moisturizer cream, which he also gave to me as samples. I left the MD's office with him telling me to use the creams for 7-10 days, it'll clear right up. I actually used it 14 days, and while it helped, it is not cleared up. Again, not a surprise when dealing with Psoriasis.

I called the MD's office after the 14 days and spoke with a nurse. Per my conversation during the appointment, I was to call in for a RX, should I need more that the samples provided. I had the nurse call in a RX for the topical cortizone. They filled a generic. OOP cost to me was $0, normally I would pay $5/$25/$40 for a one month supply at the retail pharmacy. If I had ordered something thru mail order pharmacy, I'd save 1/2 a month's worth of co-pay charges, if my deductible had not yet been met, this was an incentive to use the mail order service. I can see that the RX cleared my insurance. Cost for the generic ointment: $278! Egads! So glad that I got it now.

Effective Sept 1, we  pay 100% of everything   (MD's, RX, test, etc) until we hit the first $4000 deductible for a combinatin of RX and medical expenses. Then, a second deductible comes in to play, with us paying 10% of Rx or medical costs if in plan  and 30% if out of plan  until we hit the $6000 total OOP deductible, then the insurance will cover everything at 100%.  We always aim to use in plan services.

Meanwhile, I am topping up whatever RX's I can, advising the kids to do the same. Ditto any medical appointments. DD is addressing some gastro issues and will need a gastro MRI but it's only done at the local hospital (none of the ancillary MRI places do it), limiting her ability to attend to it before the new plan year. She has a date for Sept, but was told to call daily for a cancellation. I anticipate it being very costly, to the tune of over $1000. Even a $100 medical bill is hard for her to handle, as she works retail while paying off college loans. Luckily, she just finished paying off the bank of Mom for her car, increasing her disposable cash to $200 a month.



6 comments:

Ms. Sandie said...

I feel your pain about meeting new year deductibles. I hit ours this year (haven't done that since 2007) and the new meds for my Crohn's is almost 700 a month. Since I hit the deductible my co-pay is $25 for this one med. I currently take two other daily prescriptions and DH takes one. I am going to be contacting the pharmaceutical company that makes it to inquire about assistance programs.

meme said...

This might be a dumb question...but did you daughter inform the hospital schedule person of the insurance issue? I have my fingers crossed that she can get in earlier than the September date....and sending along my thoughts and prayers that everything turns out okay for her.

CTMOM said...

Meme, yes, they are aware. Issue is that there is only the hospital where this test can be done. She was told to call daily for a cancellation

CTMOM said...

Sandie-have you asked your MD's office for any discount vouchers or samples?

Marcia in rural WNY said...

My daughter recently was approved for a medication that would have cost her $300 a month co pay. She is good through the end of this year and then will have to re-apply.

My Dad had psoriasis as well--it's terrible. At one time he was taking methotrexate for it, which I believe is a cancer drug! Sun bathing was encouraged at the time to clear his, and it did help to some extent. Maybe you can have a medicinal sit in the sun occasionally!

Are you finished with teaching or do you go back in September for another semester? I know I read it but I have lost track already.

Linda said...

The hospital for your daughter is not the only one. There are others, maybe far away. Compare the cost of travel to the cost of the MRI. You might want her to travel a bit to get this. Well, unless you live 500 miles from another hospital.
Ask the hospital where the nearest place to have the MRI is since they cannot do it before Sept. Did the doctor do a referral or are you trying to get the appt on your own? I hope you can get this done before sept.