Aaarrggh! Drug cost vent.

Discussion in 'General Parenting' started by gcvmom, Aug 4, 2009.

  1. gcvmom

    gcvmom Here we go again!

    We are in that "no-man's-land" period waiting for our COBRA insurance to kick in since husband is now unemployed. And while they have received our premium payment, and we are technically covered until the end of August retroactive to husband's termination date, it can take 30 to 60 days for our insurer to acknowledge this and get us back in their system. Sooooo, in the mean time, we have to pay cash/full retail for everything.

    difficult child 2 is just about out of his Seroquel XR. The psychiatrist phoned in a refill to our retail pharmacy this morning, since the mail order (and cheaper) pharmacy won't work with us until we're back in the system. The pharmacy tech called me very concerned today about the expense of this rx: $1,218.89 for a 30-day supply!!!!! :surprise:

    And to complicate things further, the psychiatrist's office closes tomorrow until the 16th for renovations... and there will not be any rx's available from them during that time. :anxious:

    So I've been on the phone with Astra Zeneca trying to find out if we can get help. But they need the doctor's office to fax the rx along with our application. Ugh. Not enough time to do that.

    But turns out they also have a Seroquel Savings Card program -- which I can live with, but the psychiatrist office is usually the one that gets the forms from their reps... so I'm trying to reach them today before they close to get them to fax the info to the pharmacy, who can then submit for the discount...

    And people wonder what I do all day, or why my house is always in such a state of chaos. I feel like I am always putting out fires like this! :mad:
    Last edited: Aug 8, 2009
  2. Star*

    Star* call 911

    GCV Chickey -

    Do you think it would be possible to (for the time being) get a Medicaid card and have an emergency application rushed? I'm sure you have thought of everything -

    If not dearest I send thee flame retardant slippers.....

    ps. If it's ANY consolation I did not wonder what you do all day - I KNOW.

    Hugs - RUB THE MAGIC ROOSTER FOR GOOD LUCK - seriously - ;)
  3. nvts

    nvts Active Member

    Continuing from what Star said - you should apply for medicaid either way. With husband out of work, you'll get a much better premium through Family Health Plus than you ever will with COBRA. It's ridiculous!

  4. gcvmom

    gcvmom Here we go again!

    Thank you, thank you, Star! :D

    I'm on hold right now with the COBRA administrator explaining our situation to see if they can expedite our paperwork to get the coverage reactivated quicker. She said she can send an inter-departmental email to put a rush on our application, so fingers crossed she comes back with really good news and maybe we'll be back in the saddle by next week.

    When I told her about husband's upcoming MRI next Monday, and the fact that difficult child 2 needs this medication for stability, she completely got the picture and offered to do this for us.

    I guess it pays to ask for help sometimes.... fingers crossed!
  5. gcvmom

    gcvmom Here we go again!

    Nvts, I don't know if we'd qualify because of our income level -- and even though there's technically no income right now, they look at how much he made last year, plus our assets, etc.

    I don't have time to hock everything I own to pay for stuff now.
  6. jal

    jal Member

    Have you contacted the pharmacy to see if they can get the generic form of Seroquel? I googled it to see if there was a generic (as my difficult child is on it too) and it is Quetiapine Fumarate.
  7. gcvmom

    gcvmom Here we go again!

    Well, they are pushing things through and difficult child 2's rx should be covered within 24 to 48 hours. husband's MRI should be covered in the next 2-3 days. And our overall coverage reactivation is being expedited so by next week it should all be covered!

    Whew! That is a HUGE load off my mind.
  8. AnnieO

    AnnieO Shooting from the Hip

    In our case medicaid does look at how much we made last year but then they look at current circumstances too. We don't qualify actually because I make too much by myself - it's by household income and number of people, and they do take child support into account. I make about $48 a year too much if you include that. $4 a month too much.

    However it's actually through BM. I won't go into that but I don't think she is reporting all income. Not that it matters. We can't afford insurance, and the buy-in through SCHIP starts at $4500 more a year than I make. The lowest level premium through this would be $1400 a month for two kids. I'd rather pay medical bills straight out, because they're never this high. I pay $207 a month for myself, and you may remember I am a smoker. So...

    Try for medicaid. It will be worth it - they will sometimes look at it as a stopgap to keep you all from the "system"... i.e., what will happen without the Seroquel...
  9. Wiped Out

    Wiped Out Well-Known Member Staff Member

    Glad to hear they are rushing it through!
  10. susiestar

    susiestar Roll With It

    I would at least check out the state medicaid for kids plan. Here we paid nothing while husband was in grad school and job hunting. They would have let us stay on the plan with no payments for another 3 months after his first check, but we went ahead and signed on with his employer.

    COBRA here tends to run about $800 per kid and $1200 per adult - monthly. We have never been able to use it.

    Here they look at your income for the months just prior to the one you are in.

    I am glad you got the insurance process on the fast track. You earned your warrior mom armor today, that is for sure!
  11. gcvmom

    gcvmom Here we go again!

    Okay, I will look into the Medicaid program. Obama passed that new COBRA legislation to offset the premiums we pay by 65% (I think). So our bill for most of July and all of August was just over $800 vs. $3,000. We were sorta hoping his state unemployment money would cover the COBRA premiums (if and when he ever gets that money). The discounted COBRA premiums are good for a few months, but if he's not employed after that, it will really start to hurt if we have to make those kinds of payments.

    Sigh. How did we get so lucky to have so many different medical issues in this house?

    Between difficult child 1's Crohn's medications, the Seroquel XR for difficult child 2, and husband's messed up brain, all the psychiatrist appointments, GI appointments, neurology appointments... ugh. Thank goodness easy child and I are relatively healthy people.

    I really shouldn't be complaining, though. Things could be sooooo much worse...
  12. ML

    ML Guest

    I'm relieved to hear that the O man was able to get those premiums down, they were truly cost prohibitive before. Hoping things turn out sweetie xo ML
  13. nvts

    nvts Active Member

    Make sure that medicaid is aware of all the health issues - difficult child might qualify for medicaid waiver even if the rest of the family did not. That part is based on income (even if unemployment is short) as well as disability.

    Check with the COBRA representative if the coverage kicks in as of the date that husband's coverage on the job related coverage ended. Continuity of coverage will settle all of the issues.

    Keep us posted!

  14. gcvmom

    gcvmom Here we go again!

    Thanks ML!

    Nvts, yes his COBRA coverage is retro to the day after his regular coverage ended -- I am thankful! So the dental services we both had last week, difficult child 2's lab work the week before, husband's new CPAP equipment and some prescriptions I paid cash for will all have to be submitted for reimbursement. Like I said, it could be a lot worse... I was just panicking at the thought of having to shell out several thousand more between the medications this week and the MRI on Monday...
  15. nvts

    nvts Active Member

    Aha! For the MRI, bring the old card, he'll have the MRI and then they'll call and say the insurance denied, you'll already have the new card...ok, underhanded maybe, but cheaper than a check!

    It would be one of those "what a knucklehead! He used the old card! I'll drop off the new one in the morning!" mooooohahaha!

    Glad you're feeling a little better!

  16. Star*

    Star* call 911

    I'm thinnin' I want YOU gals to handle MY insurance......WOW! :smug:

    I can TELL YOU where the Cobras are......~~~~~~~~~~~~:>-----<
  17. AnnieO

    AnnieO Shooting from the Hip

    Insurance is a hornet's nest. Yes, we need reform, but I don't know exactly what, so I'm going with the status quo.

    If BM drops the kids' medicaid I don't know what we're going to do. Hoover it up, I guess.

    Anyhoo, I am glad you've got something at the moment. And I'm thinking that medicaid may cover difficult child just because of the issues like nvts said.
  18. gcvmom

    gcvmom Here we go again!

    Step, I have my doubts about the Medicaid getting approval because of our income (or FORMER income). Maybe if he's out of work for longer, it won't be an issue... Blah. I don't want to think about THAT!
  19. AnnieO

    AnnieO Shooting from the Hip

    Yup, I know that feeling. But I think what nvts mentioned was that the issues difficult child has might qualify him even if no one else in your home. I think. I don't really know!!!!!
  20. gcvmom

    gcvmom Here we go again!

    I just wanted to update -- if you recall, I posted my rant on 8/4... just FOUR days ago. And I just checked online, and we are now BACK in our insurance carrier's system, as well as our mail order pharmacy!!!!! So now I've reordered difficult child 2's Seroquel XR and will be paying $150 for a 3-month supply, instead of over $1,200 for just 30 day's worth.

    It really, REALLY does pay to speak up and ask for help from these companies when you are absolutely stuck.

    :irock: :bigsmile:

    My warrior mom armor got a good workout that day!