I am a lady that is living with cancer. After I was diagnosed andreached the point when I could no longer work my former employer filed incorrect termination dates with COBRA which led to a 5 month battle to get that problem corrected. During this 5 months I had no prescription coverage. All medication cost was paid out of pocket. When my insurance problem was straightened out I had to pay the monthly premium cost (6 months X monthly premium). I was told to submit receipts and pharmacy printouts to MEDCO for reimbursement. This is what happened and I promise it will show you how much these companies fight there customers.
With insurance you pay 1 copay for a monthly supply. It is normally a round figure like $ 10. With no insurance I had to buy 3 to 5 pills at a time. The cost is very high. Here is how they calculated there responsibility. This is an actual example.
I paid $38.59 for 3 pills (the copay for 30 pills is $40)
MEDCO replied saying the approved amount for this claim is $29.02. Copay amount is $29.02. Total payable by MEDCO is $ 0.00.
It goes on page after page. 95% of the specific claims have the approved amount as equal to copay amount. Leaving MEDCO owing nothing. Copay amounts are on a sliding scale. And this is the truth - the copay amount for 5 pills is more than the copay for 30, if you pay $50 dollars out of pocket or $ 5 the copay amount adjust magically to MEDCO 's approved amount, in the rare case that they agree to pay on a claim then the amount they say a drug should cost is applied and not what a national chain like CVS would charge!
Out of $2000 of prescription cost MEDCO with their in house formula agreed to pay (drumroll)
ONLY (2000 X 0.07) of the cost, thats right %7. Has anyone else experienced this type of problem? Has legal action ever taken place for this?
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