The meds I use for scalp psoriasis have to come via mail from a "specialty pharmacy." No big deal. So do John's chemo meds.

So I ordered them a few weeks ago, paid the $70 copay the company billed me (which was $5 more than last year but hey, everything has gone up & I'm at least $1500 away from meeting my deductible so I've gotta pay for everything), and waited. I finally got a notice that it had been shipped today & should be here Thursday.

Great, right? Ha!!!!!!

Later I was on our insurance site, making sure there's nothing new for John posted since there are some claims from December that I'm 99.9% sure have not yet posted, and I noticed something strange: that $70 copay wasn't reflected in my deductible. The $9.79 one from WalMart a few days later was there but the big one was nowhere to be seen....

So, thinking maybe it hadn't been processed correctly or something, I called the pharmacy. 30 minutes of weeding thru a phone tree later, I get an actual person. "Oh, its NOT going to be applied towards your deductable because your insurance rejected it." WHAT???? "Your insurance refused to cover it because it's not included in their formulary." So I'm on the hook for the full charge which will not go towards my deductible??? "Yes, ma'am. But we applied a manufacturer's coupon that dropped it $8 so you only had to pay $70." Why wasn't I told that insurance had rejected it? Your bill to me called it a copay? "It's your responsibility to know what drugs are and are not covered under your plan."

AAAAAARRRRGGGGHHHHHHH!!!!!! It was frickin' covered 3 weeks ago...

Yeah, I know $70 every few months isn't that big of a deal but it's the principle that pisses me off. If I take a prescription in to WalMart or Kroger or anywhere local & it's rejected, they tell me up front and let me decide what to do about it which gives the option of either paying it myself or contacting the doctor to get a different prescription for something that IS covered.

These yahoos just billed me the full amount & I'd have never known if I wasn't watching our insurance like a hawk due to all of John's appointments.....