CoPays and Insurance

[Guest guest]

OK, Here is what is happening. I just got of the phone with my

allergist who informed me that I am forced to go through my Pharmacy

(Caremart) to obtain the Xolair which will more than double my monthly

fee for Xolair or discontinue the injections. My allergist is doing

this because they are currently writing off more that they are actually

getting reimbursed to them from BCBS as payment for the medication.

Apparently, she does not like receiving partial reimbursement and

writing off the difference. She now wants full reimbursement or

discontinue the injections.

This is all fine and great for her but if I do it her way, I end up

paying $150.00 for each injection I receive which is one in each arm

twice a month with nothing going toward the copay limit of $1,000.00.

Even worse, I only get a portion of the vile in the second injection

and the rest of the Xolair is trashed.

You say, why not have the pharmacy send the medication to me and I give

myself the injection. This does not reduce the cost. In fact it will

inincrease the cost of each injection from $50.00 to $150.00. Anything

send by or billed through the pharmacy does not go toward the copay

limit and my payments will go on forever. If we are forced to do this

it will increase our monthly medical expenses to a level that exceeds a

little over a half of MY monthly salary, which I cannot afford and

continue providing what is needed for my family. This does not include

the medical expenses for my wife and two children which are less but

still add up.

The current process allows me to pay only $75.00 for each shot with the

payment going toward the maximum copay limit of $1,000.00. This good

because when all my copay expenses (meds, pills, exams, testing, etc. )

reach this limit everything else is paid in full. .

As a result of this change in financing, I need help locating a better

funding source. I have tried SPOC and it is useless. Caremart is not

willing to cooperate and the doctor is planning to discontinue

providing injections after August unless a better payment process can

be worked out.

Any and all suggestions are appreciated.