We are having issues with our health insurance for our 7 month old. She hasn't been ill aside from an ear infection but insurance hasn;t covered her wellness checks & I just paid $77 for generic ear medicine. Please let me know if you have a suggestion - thanks!
My son has a humana one plan. You can customize the plan to fit your needs. Thew do cover the wellness checks.
I would read your policy and see what it says. Then call the insurance co and see what they are claiming the denial on. My insurance company had the "wrong" policy attached to my name and was denying everything. It took a lot of screaming to get things squared away, if they are even squared away.
If they are just being jerks and you have stated in the written policy those are covered services, I'd file a complaint with the Texas Department of Insurance. Make sure each claim is a different complaint or they will deny it on that basis. You can start a complaint online, but they will need supporting info.
Good luck! Insurance companies can be criminal!!!!
BlueCross BlueShield of Texas
Get on the phone with the insurance company and find out what is going on. You might have a huge deductible that you didn't realize you have or maybe they don't have all of the necessary info from you to process the claim. There could be a number of things going on.
FYI - You can use the pharmacy at Sam's Club even if you do not have a Sam's card. Their prices are fractions of what Walgreen's, CVS, Kroger, etc. charge for prescriptions!
Best of luck to you!! =)
That sounds fishy. I'm wondering if the coverage changed, and they did little (if anything) to inform you of the change. Something similar happened to me and my family, and we found out that they changed our coverage from a typical co-pay to a high deductible HSA. There was little notification. We pretty much found out when we were expecting to pay much less for a prescription, like in your case. Unfortunately, a lot of companies are doing this to their employees. My husband's company used to have awesome insurance, with just $30 copays for doctor's visits, and prescriptions were never any thing like $77 - - until they changed to the high deductible HSA. I still wonder, though, why the well-child visits aren't covered. Even those are covered for "free" under the HSA plan my husband has through his work. Did they cancel your insurance all together, and not tell you properly? Hmm...
Contact your insurance company, and have your doctors office explain the lack of coverage. It could be a matter of terminology they are using.
If you are still not satisfied call the state Insurance Commissioners office. I did this several years ago in a different state but got my answers, resolved the issue.
you can also try CHIP. Children's Health Insurance Plan. That is usually government run, but can offset the expenses.
Good Luck.
Do you have health insurance? There is no reason that any generic should be that much! That is just insane! Is it through work or a private company? It is a private company you may want to look elsewhere. I don't know much about private insurance though. But definatly give them a call!
You definitely need to check with your insurance company to see what your coverages are. If you have an agent, call them - that's one of the reasons we're here. I've seen several people in the Orange area who have been sold an "insurance plan" by traveling salespeople at a great rate, only to find out when they need it that it is a discount plan that none of our doctors or hospital accept. (I'm not talking about the plan mentioned in an earlier post.) If you are on a group plan through an employer, the HR person there should be able to give you all of your coverage information. Good luck and call me at ###-###-#### if you have trouble finding answers.
D.,
Definitely call your insurance company & ask why the wellness checks weren't paid for & you also may want to review the coverages/exclusions of your policy. Sometimes a deductible has to be met before any copay's kick in...it just depends what type of plan you have. A generic for $77 sounds outrageous! I'd hate to see what the name brand costs if that's the case!
If you can't get a satisfactory explanation from the ins. company, then it's time to shop around for another, if that's an option for you. I have Scott & White, and I've been pleased with them so far. Blue Cross/Blue Shield is good also along with FirstCare.
if you are selecting your own insurance, i recommend Blue Cross Blue shield - but if your plan is company sponsored - you may not have a choice.
When your doctor prescribes anything, let them know that your coverage is minimal. Often doctors prescribe meds that a Drug Rep has told them about - but does not know which ones are higher costs or not covered by insurance. There are often cheaper drugs out there. Many pharmacies (Wal-mart, Kroger) have a $4.00 plan for some specific drugs - so be sure and check to see if what you need is on any of those programs (no insurance is required to get the $4.00 price). And always question your doctor about a prescription before you leave his office. good Luck!
about Me: a 54 yr old working mom of two grown kids. Married 31 years.
Hi D.,
First, Congratulations on the new baby.
I am an independent health insurance agent and I represent several well know companies like Aetna, Humana etc. You can contact me so I can help you with what you have. I am not sure what company you have or what type of plan but I would be happy to help you understand the policy you have and/or help you find one that will cover your baby. There is no obligation. My name is Connie ###-###-####. Take Care!
I only pay for catastrophic medical insurance for my children. I have been in the medical field for over ten years both on the clinical and administrative side. My personal opinion is that if you are a generally healthy person, insurance is a scam. This is why I only pay for catastrophic insurance. If the children get sick and I can not treat it at home I take them to rapid care to get a prescription. As far as well baby checks go they are not neccessary. I only took my baby's to the doctor if they were actually sick.
Good luck,
Lisa
I would defineatly check with the insurance to see why your meds were not covered especially if it was generic. For the meantime, I can get you a free rx card that will help you with a discount on generic and name brand meds.
You can go to this link and fill out the form. I am an independent rep for Ameriplan, and I like helping people. This rx card is good for one year. The discounts are available at major pharmacies like CVS, Walgreens, Walmart, etc.
https://secure.ameriplanusa.com/freeprescription/webFreeP...
Have you asked the insurance company why they haven't paid for the wellness checks or the medication? Is it something not covered? If it should be covered, then you need to submit an appeal.
C.
Independent Distributor of Mia Bella Candles
www.candlesarelove.com
you most certainly need to call your ins. company and see what your coverage is. Well baby check ups are usually covered and I have never heard of a generic medicine costing so much.
Cal your ins. company
I have unicare. Not the best, but all well baby is covered, you just pay co-pay (mine is 30). Other visits for the kiddos being sick are not covered though until the deductible is met. I have not had issues with generic medicine. I don't think I have paid over 15 dollars. Finding good insurance is hard. I have been on several but I found myself going back to unicare though because they are somewhat reasonably priced and I have had the fewest issues.
