I am still trying to work out Maggie's medications with Anthem Blue Cross. This has been going on for weeks. They now require certain medications to go through their "specialty pharmacy" but that pharmacy will not work with medi-cal and the cost to Maggie is $150/month for two different medications. Maggie does not have $300 month and if she is not in this program the cost to her is zero. We like zero better.
I gathered all my patience and made the call to once again try to get this resolved. The woman was reasonable and informative and had me re fax the forms directly to her and confirmed they were received!! I asked her if a written explanation would help as Maggie's situation does not fit into any form every created. She said if I wanted to fax that I could.
Why yes, thank you, I believe I will.
I'm sure you don't want to see the entire letter, so I will just give you some excerpts.
I have been trying for several weeks to get assistance regarding an exemption from the Specialty Pharmacy Program for my daughter Mary Margaret McDonald. I have had several conversations with Blue Cross, who would refer me to Curascript, and countless conversations with Curascript all without resolution. (In addition, I was receiving at least 6 or 7 Curascript robo calls every day asking for more information but receiving no assistance.) Finally, I was advised by “Mr. X” at Anthem that there is a method of seeking exemption. I followed instructions, obtained the proper forms, went to the doctor to have them completed , forward (faxed) the completed forms signed by Mary Margaret's doctor to exempt her from the program, but never received any response. I followed up this morning. I was instructed to fax the forms to a different number than is printed on the form (!), and did so. This morning’s conversation with Ms. X seemed to (finally) break some ground. She confirmed receipt of the form
Mary Margaret receives medi-cal, California State program for the disabled or indigent, to help defray her extraordinary medical costs. Medi-cal picks up the co-pays and provides coverage for some things that are not covered by private insurance. This includes the co pays on medications, which in Mary Margaret’s case can total thousands of dollars each month. I have explained this to Curascript and to Anthem in the past, but I cannot make anyone understand the complexity of the situation. They have suggested that Mary Margaret pay the out of pocket co pay of $150 per medication and seek reimbursement from medi-cal. First of all, Mary Margaret does not have $150 a month to pay and, in any event, Medi-cal does not work like that. There will never be a reimbursement.
I recognize her situation is very different from the typical insured. Most people on medi-cal do not have private insurance, but she does. However, the existence of private insurance should be a help, not a hindrance, to getting her the medication and services she needs.
I think that last line is my favorite. I should receive a decision in two to three weeks, which is great, since I've been trying to get one for seven weeks already.