Known Johnson

April 3, 2008

United Healthcare blows goats – I have proof

Filed under: General — Tom @ 11:19 pm

You know, it just seems like insurance tries to get out of everything that they’re supposed to be responsible for. I had to fight with them to get my orthotics covered. I have flat feet, they have a lot of problems. There should be no question about this – I need orthotics. They fought it. I and my doctor fought back. We eventually won. Yay us. On the downside, I spent nearly a year fighting over my allergy shots, which they had told both me and my doctor would be fully covered, both the serum and the shots themselves, only to turn around and tell me that I owed $15 on every shot (twice a week for half the year, then once a week – this gets pretty expensive.) Just a couple weeks ago, I gave up – I can’t deal with the stress anymore, so I give in. They win.

I’m also on the generic version of Allegra – cheap, yes? Well, you’d think so, but not according to them. First off, it’s “tier two” in their program, meaning I don’t pay generic prices for it but the next level up, whatever that means, but it costs $25 rather than $10. But here’s the thing: they randomly decide that generics no longer fit into certain tiers and move them up. So, as I found out today, starting May 1, that generic Allegra is now going to cost $45. This is ridiculous. It’s a generic – the whole point of which is to cost less. Now it costs the same as the name brand. What is the point? I don’t get it. Am I missing something here?*

The best part is that in their letter, they “helpfully” suggest alternatives to fexofenadine (generic Allegra,) such as over the counter Claritin, stuff like that. Hello? If that worked, I’d be taking it! I tried it for months and didn’t really notice much of a difference. The first time I met with my allergy doctor he said “stop taking the Claritin, it won’t work for your problems.” This just proves that insurance companies are not out for your own good. Directing people, who have gone to doctors for specific help and gotten specific drugs, toward just any old OTC drug does not have the people’s best interest in mind. Hey, I realize they’re a business and they need to make money, but they need to realize that to keep making money, they need to keep providing me, customer, with services that actually suit my needs. The biggest need I have is covering my damned prescriptions at a reasonable rate.

*No, I’m not missing something here – I realize that there’s the possibility that they’re being “encouraged” by Sanofi-aventis, the drug’s maker, to nudge people toward the real-deal, since they may very likely begin offering all kinds of incentives to get people to switch. Watch and see – I’ll bet the market will flood with coupons from the manufacturer over the next few months. Either that or there’s a new product on the horizon that they’d rather us use because there’s a better profit margin there. Whatever it is, this move is designed solely to cushion their wallets, either by routing people to more expensive and profitable drugs, or to go to OTC drugs that don’t cost the insurance company anything (they make up for it in other ways, believe me.)

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8 Comments »

  1. Insurance companies piss me off. We pay them THOUSANDS of dollars a year and when we finally need them, they screw us over. Bastards. May they all rot in hell.

    I went through similar problems with my old insurance company (Aetna) when my doctor tried to put me on Allegra-D for my allergies (which at the time were awful). We had to right down a list of all the over-the-counter products I had tried that didn’t work, and my doctor had to fill out all this crap and then the insurance company had to present it to the board saying, “This is what she’s tried, do we approve of covering her Allegra-D?” Bastards! It took nearly four months to get approved for it. My doctor was awesome enough to give me free Allegra-D samples to hold me over, though.

    Luckily we have decent insurance now, Blue Cross, and haven’t yet *KNOCK ON WOOD* run across a “we won’t cover this” problem…

    Comment by bekah — April 4, 2008 @ 9:19 am | Reply

  2. *write down.

    Comment by bekah — April 4, 2008 @ 9:20 am | Reply

  3. That sounds very similar to United and my allergy shots (and my orthotics, until they finally did cover them.) It’s not enough that the doctor gives the prescription anymore, I guess. It’s just so tiring. I don’t feel like I should need to arm myself for combat when dealing with health issues.

    Comment by Tom — April 6, 2008 @ 9:42 pm | Reply

  4. I just got the same letter from UHC. They moved the medication to tier 3 which is the same tier as the prescription Allegra. So I’m going to request the brand name from my doctor. The generic cost about 60 dollars outright and I was paying 30 co pay. With the change in teir it will cost me 50 co pay on the same thing. Switching to Allegra, I’ll be paying 50 outright and the allegra cost about 130. Now the insurance company pays more for my prescriptions than it did before!

    Comment by Aaron — April 17, 2008 @ 11:41 am | Reply

  5. I just ran across this problem too, I have been taking allegra in the morning, zyrtec at night, and the allergy shots. I went to refill my prescription of allegra and the price went from 25 to 42 dollars (on the generic). So I called UHC, which directed me to Medco. And they said,” Allegra was pushed in a higher teir to encourage ppl to buy a new drug in a lower teir.” So I called my Dr., pharmarcy, and Medico (again) to ask what the new drug is and any alternatives. There is none. Any suggestions made to me were OTC, and is like taking water to cure/maintain my problems. Needless to say I’ll be looking into new programs come open enrollment.

    DISCOUNT: There is a way to save a buck. Instead of filling monthly prescriptions. Ask the Dr. to write a 3 month supply ( 90 pills). It was 20 cheaper then having 3 one month prescriptions.

    Comment by Mark — May 7, 2008 @ 4:35 pm | Reply

  6. Hi there,
    I am looking for advice on exactly what you sent to fight the NOT covering customer orthotics part with United Healthcare. I have cavus forefoot, sesamoiditis, very high arch and broken bones in my sesamoid bones which cause problems, cramps and tightness in the arches of my feet…for 10 yrs now.
    United blows…Blue Cross Blue Shield used to cover this, no problem, at least 1 or 2 paid a year. I regret switching jobs and getting United healthcare.
    — Cathy

    Comment by Cathy M — June 24, 2008 @ 9:29 am | Reply

  7. It was all down to my foot doctor – she provided them persuasive evidence over and over and simply kept sending it to different people until someone realized that it was a medical need. Keep at it – it will get taken care of eventually!

    Comment by Tom — June 24, 2008 @ 9:49 am | Reply

  8. My Employer just announced that we are switching from BCBS if Illinois to United H/C… everyone here at the Office is Upset! I looked up my Dr. and he is not in the Network… neither is the Clinic… neither is my backup wellness center.
    I tried to call the chicago office and got a recording that this is a non working number. I went to HR to express my sadness (not what I’m really feeling), and I was told that the whole HR depart was told by Mgmt. that if you don’t like it… there’s the door. We have 475 personnel here,and yesterday was a very somber day. Everyone loved BCBS… I’m very sad about this change. After 11 years, I may need to find another job, because I cannot afford to pay list price for an out of network Dr. visit. 😦

    Comment by Lisa Lisa — October 16, 2008 @ 8:00 am | Reply


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