Can't Get Cost on Upcoming Surgery

[JOHNNIE36]

W2R, sorry for the misunderstanding on my part. I guess when one is on Medicare for so long, you have a tendency to think everyone is. The form I'm talking about is "2012 Medicare Part D Formulary or Tier Exception".
I never heard about it until BCBS suggested I get my doctor to fill it out and fax it to them. The purpose is to have the doctor tell your drug insurance company that "patient must take this prescription drug and there are no others". I suppose the purpose is to tell your pharmacy that you deserve a break on the price because of the specific need. On the form it states that "this is a Medicare Part D form".

Interesting, but since it doesn't apply to your situation, maybe someone else can benefit from the post. I know it saved me a couple hundred bucks every three months. I never looked it up on the Medicare site because my insurance pharmacy led me through the process.

 

[Brat]

My mail-order house is Medco. Their drug prices are on line. What fascinated me is that if your pharma insurance is Medco and you fill a script locally at a participating pharmacy the $ is more and it is the same price at all the participating pharmacies. I checked Costco, Pharmaca and Walgreens recently for the same medication.

 

[JOHNNIE36]

My mail-order house is Medco. Their drug prices are on line. What fascinated me is that if your pharma insurance is Medco and you fill a script locally at a participating pharmacy the $ is more and it is the same price at all the participating pharmacies. I checked Costco, Pharmaca and Walgreens recently for the same medication.

I had Medco when I was covered by my company provided health care. I used Medco, Prescription Solutions for the last two years and now PrimeMail. Guess they are all about the same. However, I don't use them for anything except 90 day mail orders. All the local pharmacies are part of the plan but I only go there for immediate needs and short term prescriptions. They will only issue a 21 day supply max. Costco is still the cheapest; however, if it is an antibiotic, Publix will provide them free of charge.

 

[Buckeye]

No wonder this country is so screwed up on the subject of health care. I'm not saying the doctors. I'm talking about the health insurance companies, the hospitals, surgery centers, etc. DW is going to have rotator cuff surgery (same day surgery as outpatient). We have a Medicare Advantage insurance plan which has been a good way for us to go until this surgery. And, we are new to Blue Cross Blue Shield this year. Same surgeon is in this plan as in our last plan. No problem there.

Question I'm asking is what is our copay or deductible at the facility. Can't find out. Why? According to BCBS, copay at a freestanding sameday surgery center is $265; however, the surgery center this group of surgeons uses is not covered by BCBS. The surgeons in this group are not licensed to use the facility that IS covered by BCBS. So, we opt for a hospital that is in our plan. BCBS says an outpatient surgery is 20% of the allowable cost but they can't tell me what that cost is. Pretty cut and dried on an overnight stay. That price is also $265 but you can't just opt to stay overnight. The guidelines in the coverage manual state that the type surgery dictates whether or not it is considered "same day surgery". Your surgeon could write an order for you to stay overnight but you would still be billed for "same day surgery", the 20% deal.

I went to the hospital to try to find out about the price. They couldn't tell me. BCBS can't tell me. Still got a couple feelers out there but I'm losing faith in the system. No wonder people are pi**ed at our health care in this country. This is just a little problem. Wait till a big one comes along.

I thought they could send a pre-approval/"request for quote/pricing" to your insurance company to have the insurance company price it prior to the procedure. I can't remember the correct terminology. Each location/entity would probably have to do it for you to get a complete picture. Worth the effort? Will the answer make you change anything?

What a waste of effort to the universe.

 

[Moemg]

W2R, sorry for the misunderstanding on my part. I guess when one is on Medicare for so long, you have a tendency to think everyone is. The form I'm talking about is "2012 Medicare Part D Formulary or Tier Exception".
I never heard about it until BCBS suggested I get my doctor to fill it out and fax it to them. The purpose is to have the doctor tell your drug insurance company that "patient must take this prescription drug and there are no others". I suppose the purpose is to tell your pharmacy that you deserve a break on the price because of the specific need. On the form it states that "this is a Medicare Part D form".

Is your BC/BS a medicare advantage plan ? I just went on Medicare with regular BC/BS as my secondary so I wonder if it would apply in my case . I take several asthma inhalers that are not generic . I don't think they even make generic inhalers .