Happy New Year! I waited until after the first of the year to start dealing with the insurance company for my Xeljanz.
Yesterday I spent two hours on the phone trying to get a straight answer about my meds and figure out how we would be able to afford them.
Two hours of frustration, the run around, no answers, some tears and then I got April on the line.
She was a God send. Several conference calls later including one to Pfizer, the drug manufacturer, we came to the best possible answer.
Believe me I have a sheet of paper with names, times and comments to fall back on.
It started with the prescription provider for our plan saying they need preauthorization from my doctor. I get that. My doctor knows it’s medically necessary so no problem there. What the plan rep couldn’t tell me was after the preauthorization was received exactly what my costs would be. She said it would be $3,882.67 for the 30 day supply.
I asked what would happen when I met the $4,000 deductible. She didn’t know. She said to call Cigna the insurance company.
April was very caring and went above and beyond to get answers. She went over everything and said she believed that our individual out of pocket maximum would kick in and help a lot.
She conferenced us back with the prescription plan provider and we walked through it all again. They believed that we would have the 80/20 split after the deductible. Which would be $776.53 for 30 days.
April dug deeper in the plan details. After the $5,000 individual out of pocket maximum is met she said we would not have to pay anything for the meds. They’d be covered 100%.
So we still have to have the $5,000 to pay out of pocket. We talked about the Xeljanz copay assist card I had already gotten. She conferenced us in with a rep from the Xeljanz patient assistance division. They confirmed that the card I have can be used to pay for the initial prescriptions until the out of pocket maximum was met.
So it seems we will be taken care of completely. Thank you April for your persistence and compassion!
Always be persistent. Ask questions. Keep digging!
Don’t take your health for granted. Love on each other.