Insurance issue (Medco) Vent/Suggestions (long)

[Luv2Roam]

With all the Dis-ers in various fields and with vast experience, wondering what you suggest or have experienced.
We have had to use Medco for a year or so. Have not had many issues until recent.
I had my meds renewed at the doctor's office. Without even thinking I did not specifically request refills for 90 days each prescrip. (Pretty common meds from Flonase to cholesterol. And even generic meds used.)
Mailed in my new prescrip early this month. Waited, waited, waited. Nothing.
So called Medco. The meds were held up because they tried to contact my doctor's office to have the perscript changed to 1 90 prescript as opposed to 3 30 day prescription.
At that point I was getting low. I suggested to the Medco rep that I call my doctor and have them call in a prescrip to a local pharmacy. I also complained that I should have been told about the hold up and why. I would have called the doctor's office and asked they reply to Medco.
Ended up I had the current order that was on hold released and mailed. I got the impression it was going that day (Thursday).
I checked my order on line and flipped. It was mailed yesterday (Saturday) and I was charged full price (not deductibles) for each order for one month.
I called Medco again. My first thought was to refuse this order and get a regular prescrip filled locally.
I was told if I refused the order, I would not get any refund.
I complained I was not told anything on how I was going to be billed. (I never would have agreed to paying these amounts for 30 days.)
I am trying to remember how and who said what exactly on how these meds were going to be released. I was going to handle it through my doctor, and did not have a problem with this. So I am guessing the rep must have said something about releasing the order. Because I was under the impression they would not.
I called today and they acted like this is my fault I should have known. I said I should have been told or warned. No one ever said I would be paying full price for meds simply because it was a 30 day supply vs a 90 day.
And the rep would not let me speak to a supervisor until I actually rec'd the meds. I don't know what difference that will make between today and tomorrow, esp when I can see the invoice bill on line. I think it was just a stall hoping I would cool down and not bother them again. Couldn't get anyone's name of course.
I have their main address and will write a letter too.
But just wondering what to do, other than gripe up a storm.
Oh, I am sure in some booklet somewhere rec'd at some time there is all this wording.
Luckily I have never run into this before. What a live and learn experience. I think I can buy meds at a local pharmacy three times. I think I will see how I can work that to not use Medco again.
However I still think I should have been told at the time how I would be penalized as I was. And let's face it. It is not exactly a dastardly deed. My doctor wrote prescrip for 90 days, just individual months at a time, and apparently did not reply to Medco.
What really gets me is if I had done what I said last Thursday to the Medco rep this would not have happened. I wish I had just called the doctor's office and got some refills at a local pharmacy and asked them to reply to Medco. That's what I was going to do. Instead I did what the rep said. And I wish I recall exactly what she said for me not do that. I certainly was not expecting what I got.
I have Flex money. For me it's just as much the principle as the money.

 

[Pea-n-Me]

I would probably let the company you work for know you're having problems with them. These are big accounts that companies like Medco don't want to lose. They might be able to intervene with someone higher up, but also, if there are lots of complaints, maybe they'll look elsewhere next time their contract's up. At the very least, you shouldn't have been denied access to a supervisor by the rep, IMO. That's just wrong.

I called today and they acted like this is my fault I should have known.

I'd have to give this a little bit of merit, sorry. I myself never use the mail in option because they just make it too complicated. (Fortunately, we don't have a lot of meds).

For the time being, you'll probably want to re-read the instructions and follow them to the letter for future purchases. I don't know what recourse, if any, you have for your current problem. Maybe return them once you get them; don't accept delivery? I can't imagine it would be legal for them to not accept return of an unopened product. If they do, you could file a complaint with your credit card company, the BBB or your Attorney General's office. (That would get their attention, lol.)

 

[Luv2Roam]

Well, I was told I could refuse the shipment, and they would accept it back. But I would get no credit for the return. I suppose they can get by with it due to it being meds. But that will be good to know, if I can even find out from the state. If it was a cc I could dispute it But with being a flex card....
I plan to call the doctor's office tomorrow and have them put in big letters we must have 90 day supply prescriptions. And I plan to ask them if they got something from Medco and why they did not reply.
I think I will file a complaint with the state. If nothing else it's on file.
I even called Medco once I got the prescriptions because I wanted to see if I could fax them in. Was told I had to mail with a new form, which of course I did not have. I logged into their website and was able to print one.
I almost get the feeling I was not told so they could get some more $ out of me. The Medco rep certainly had the opportunity to tell me.
Believe me, part of me being mad is at myself. I just kick myself for not handling it the way I wanted. Never trust them again.
I am writing a letter to Medco. It may very well go into file 13. But with that I will cc the state too.

 

[Pea-n-Me]

But I would get no credit for the return.

I believe that would be disputable. They can't just do that - there are still consumer laws in this country. Don't accept delivery.

 

[DebbieB]

I don't see why you would file a complaint with the state. They were following the rules of your plan, they didn't write the plan, your provider did. My plan has mail order. It's $xx copay for up to a 90 day supply. It's the same copay if it's a 30 day prescription or a 90 day when you use mailorder. I'm surprised they even called the doctor to see if they really wanted a 90 day. It's not up to them to make sure you understand the terms of your plan. I would chalk it up to live and learn. By the way, I learned the exact same lesson the hard way too (they didn't even try to call the doctor, just sent it). I tried to send them back too but of course they could not accept it, they don't know if they were tampered with.

 

[my3sonsagn]

I would probably let the company you work for know you're having problems with them. These are big accounts that companies like Medco don't want to lose. They might be able to intervene with someone higher up, but also, if there are lots of complaints, maybe they'll look elsewhere next time their contract's up. At the very least, you shouldn't have been denied access to a supervisor by the rep, IMO. That's just wrong.

I second this. When I had my DVT/PE my discharge from the hospital included a Rx for an injectible med; when I tried to fill it at the pharmacy it was going to cost me close to $1k for a month's supply because, apparently, our prescription coverage requires that all "specialty injectibles" be ordered from a specific mail-order company (which was in no literature that I could find). We couldn't afford that, and my only other option was to be re-hospitalized; I called everyone I could think of including the insurance coordinator at human resources. She had it taken care of in no time flat - I could get a week's worth at the pharmacy and the mail order company promised to have the rest of that month's supply to me within that week. Companies (ie: people who decide who they buy insurance from) can get a lot done in these situations.

Good luck!

Jennifer

 

[Luv2Roam]

Well, co pay I could see. But I was charged what I believe is full price. One prescription alone is almost $100 (for one month of course). Even the Flonase is almost $42. For $42 I could buy a lot of OTC nasal spray.
Believe me, I would be happy with paying co pays. And that would be understandable.

 

[DebbieB]

Well, co pay I could see. But I was charged what I believe is full price. One prescription alone is almost $100 (for one month of course). Even the Flonase is almost $42. For $42 I could buy a lot of OTC nasal spray.
Believe me, I would be happy with paying co pays. And that would be understandable.

You may want to check with your plan provider. If you don't have copays, they can't charge you for a 90 day supply when they only provided 30.

 

[Luv2Roam]

Our main health care provider is Blue Cross Blue Shield. I thought they were still involved in all this.
Just so happened I called them Thursday morning as I was concerned about not getting the meds from Medco in time. The timely manner had come and gone already.
I thought I would call the doctor's office and have them phone in a prescription. But I wanted to find out from BC/BS if they would pay for it. I thought maybe they would not since a shipment was in process for the same meds.
BC/BS told me they have nothing to do with the prescriptions any more. Which I was not aware.
Probably part of all this is DH and I don't have medical issues really (thankfully), and usually just deal general doctor visits and meds. In the past I have remembered to ask for 90 day supplies. This one time slipped by me. And you can bet I will never forget it again!

 

[Nancy]

Our main health care provider is Blue Cross Blue Shield. I thought they were still involved in all this.
Just so happened I called them Thursday morning as I was concerned about not getting the meds from Medco in time. The timely manner had come and gone already.
I thought I would call the doctor's office and have them phone in a prescription. But I wanted to find out from BC/BS if they would pay for it. I thought maybe they would not since a shipment was in process for the same meds.
BC/BS told me they have nothing to do with the prescriptions any more. Which I was not aware.
Probably part of all this is DH and I don't have medical issues really (thankfully), and usually just deal general doctor visits and meds. In the past I have remembered to ask for 90 day supplies. This one time slipped by me. And you can bet I will never forget it again!

do you use the same card for both medical and prescriptions? If so then there is a good chance that BCBS could get involved at some point because the pharmacy is not carved out from your insurance plan.

If you have a deductible for RX you are paying the full contracted rate for the cost of the drugs until the deductible is satisfied. It will be cheaper if the script is written as 90 days. If they fill it at 30 days..even if done by mail order as a 3 month supply it will cost more.

I don't believe they can keep your money if you refuse the shipment or send it back. They can just reverse the claim. I could see if you used s few of them and then tried to return it, but unopened??? I would look into that one more. I know if you go to the store and refuse the drugs there they just back it out of the system..I would think mail order could do the same if the shipment is returned unused.


Oh yeah...no you can not fax in a prescription but the doctor can.

 

[golfgal]

Well, co pay I could see. But I was charged what I believe is full price. One prescription alone is almost $100 (for one month of course). Even the Flonase is almost $42. For $42 I could buy a lot of OTC nasal spray.
Believe me, I would be happy with paying co pays. And that would be understandable.

Are your meds on your formulary? If not or if they are name brand you could very well be paying the "co-pay" part of that med.

 

[Luv2Roam]

Well, normally, we buy meds, whether at the pharmacy or through Medeco and just pay a co pay.
Ours is not unusual. Generics cost less.
There have been cases where we need a one time med, and so just get that at Walgreen's or CVS.
We can have prescriptions filled at local pharmacies three times (per prescription) in a calendar year.
Say if I had a monthly med and I chose not to do this, I would pay a co pay three times. After that I would pay full price. That I understand. Don't like it. But what they hey. They do that in case of emergencies.
It was not until just a few weeks ago we rec'd our first Medco cards. We were surprised when we got them as we had not had any before. So could be something has changed.
And being so new in the year nether of us have had a need to use an insurance card at a pharmacy. So yes, guess I would show my Medco card at the pharmacy, rather than BC/BS. Hadn't thought that far. But I always carry my insurance cards anyway.
Our health insurance is through DH. And we do not live in the same state, nor does DH hear much (if anything) from the home office on benefits. I do not recall seeing or hearing anything different for health benefits. However if he got anything it was something just mailed in a packet. He probably got something. Now finding what and where is another thing....
We had Medco last year too. I think it is the same. The issue was my stupidity for not making sure it was a 90 day prescript. But who would have guessed there would be so much grief over 30 vs 90 day prescript? I never would have thought I would be charged the rates I was when it was not mentioned during a conversation with Medco, and when I have health insurance. I could even see a high expense if these were not such common meds. Thank goodness they are generic.
Had I been told of the costs I certainly would have done what I was going to do.
I think I may even see if any of these meds are the $4 ones at Walmart and just pay OOP from here on. One of my meds is very cheap anyway. So that will probably be the route I go on that.

 

[DebbieB]

I have BCBS. Our prescriptions are totally separate even though we only have 1 premium taken out of our pay. Right now my company uses Express Scripts, I have a separate card from them.

 

[wilderness01]

I'm sorry this happened. Call back and ask to speak to a supervisor. I have been there and done that with problems with Medco. If you get the right people involved, you can resolve your problems.

Medco is a nightmare to deal with, I know, and I'm sorry you are having trouble.

I called and complained to my insurance company as well and they put pressure on Medco to comply. It can happen, you just have to make sure you leave no stone unturned.

 

[Golf4food]

Our big company also uses Medco and many of us hate them as well. Complain, complain, complain, to your corporate HR department and hound Medco is all I can say. Many of us wish that the company would drop Medco like a load of bricks.

 

[ORMom2Four]

Oh wow, that is a huge hassle.

We just got Blue Cross insurance (switched from Providence) on Jan 1st, and my Dr. called in my first Rx to Medco on Friday. Blue Cross is very strict on how you get your meds. We didn't have that problem with Providence.

I read your post and got a bit nervous, so I called Medco. Sure enough, the way my Dr. wrote it, the Rx would only last me less than 2 months. I would be out of insulin (two different types) and would have to pay full price for all of my meds for month 3! Thankfully it was not too far along to cancel the order. Tomorrrow I have to get my Dr. to call it in the right way.

I have a feeling this is only the start of insurance hassles for all of us......

 

[Luv2Roam]

I am glad I saved someone some trouble.
Still no meds even yet today. But even when they finally show I do not plan on opening the packet anyway.
Remembered to call the doctor this morning, but did not want to first thing Monday am, as I am sure they have their hands full. Then got busy and forgot. So I need to call them for sure tomorrow. And I may need refills anyway as I have just a few days remaining as is.
I am going to guess the doctor's office is going to claim they never heard from Medco, whether they did or not.
If nothing else I would like to find out my rights from the state. For example can a shipment be refused (unopened) and they have to give full credit? It's not like they are meds that have special handling, like refrigeration.
I have a friend who found out she has MS. And our employer recently switched to Medco. (So either way I would be stuck with them.) I better give her a heads up as she has a lot of red tape it seems with her meds as it is.

Thanks everyone. It helps just to talk it out. And luckily this is nothing major. Except a major pain.

 

[ORMom2Four]

I did a quick Google search and there are tons of people who have had trouble with them. I even read one person with the same problem as you. They were told by Medco that, if they sent the meds back, they would be destroyed and the person would be charged for the meds anyway!

The nurse at my Dr. this morning said, "I know everyone's company picks Medco because they are cheap, but we have tons of problems with them"

It has been very frustrating dealing with them so far.

 

[Luv Bunnies]

I just started using Medco in September when we got new med. insurance. In just a few months, I've learned how to work with them to avoid any issues. Whenever you get a new prescription from a doctor, check to make sure it's written for a 90 day supply. I learned that 30 pills with 2 refills does not equal 90 days. It has to say 90 days. Ask the doctor to write it exactly like that and then mail it in yourself. If you need to order a refill, let Medco contact your doctor but be sure you contact them too. Ask to speak to the medical assistant who processes the faxes they get for refills and explain exactly what you need. Ask them to fax it back to Medco as soon as possible. Then keep checking your order status online with Medco to see if the prescription is being processed. If the status doesn't change after 2 or 3 days, call your doctor's office back and ask if they sent the fax yet. If they did, call Medco and ask them to look for it. They will send your doctor's office another request if they didn't receive the first one.

Above all, don't wait until the last minute to request refill. Make sure you have plenty of pills left in case the refill takes a couple of weeks.

I've learned that I need to drive the process to make sure it's done quickly and correctly. I can't leave it between my doctor's office and Medco since there always seems to be an issue. It's best if you push the process along to make sure you get your meds on time.

 

[Luv2Roam]

Never thought to google them. This gives me warm and fuzzy feelings...


April 26, 2004
Medco has agreed to pay $29.3 million to settle a case that accused the giant pharmacy benefits manager (PBM) of violating 20 states� consumer protection laws with its �drug-switching� practices.



Or how about this ---

Medco Settles Fraud, Kickback Charges for $155 Million

October 24, 2006

Medco Health Solutions has agreed to pay the United States $155 million plus interest to settle allegations that it defrauded the government.