Navigating the overly-complicated world of Health Insurance

Recently I have discovered that insurance companies now offer up to 6 tiers of prescription coverage as well special dreaded disease programs.  They also offer some medicines on their program as covered medicines only to carry the hefty $200 price tag.  I have also discovered that there are some tricks you can use to get better co-pays on medications and office visits.

Use goodrx.com or rxcut.com will shop co-pays for generics at your local pharmacies.  It is best not to stick to one specific pharmacy.  If you start needing to take medicine daily, then shop around.  Generics tend to be where the pharmacies make their money so it helps to use these websites to shop around.   Also if you have insurance, check into their mail order system.  Many times a 90-day supply from your mail order will cost the same as one month supply from a walk-in pharmacy.

If generics are not working for the medications you need, the try the PA or Prior Authorization.  The down-side is it is an option that requires an awful lot of paperwork from your doctors office.  This is a way to have name brand products covered somewhat by your insurance.  Once approved, these medicines are typically covered at moderate co-pay for up to one year if the need is for long-term.  Now if this is a better co-pay but still very high, then you may ask to petition of a cheaper tier.  If your doctor determines the generics are less effective, or if the side-effects of generics are uncomfortable to you, ask if you can do a petition for tier change.

Another option to explore if you have health insurance, is the dreaded disease program.  Check to see if there is any special programs for your medical condition that rewards regular follow-up and routine visits, as well as progress towards healthy goals.  Blue-cross Blue-shield offers this program for diabetics.  They will cover office co-pays as well as 80% of insulin co-pays if you follow all the paper work of this program.  It is worth calling to ask if they offer any rewards system for taking care of your health when you have a chronic illness.

The world of health care is constantly changing.  It is terrible difficult to keep informed of all the programs.  please ask your provider any tips and info that they have learned.  Ask about coupons and do not be afraid to ask about assistance programs.  We are all in this together and can help each other navigate the changes.

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