Zoder
join:2002-04-16
Miami, FL | [Rant] United Healthcare My group plan was switched this month from Cigna to UHC. I've been taking a drug that has been generic for a number of years now. Cigna's formulary has always treated the generic version of this drug as a tier 1 medication. UHC treats it as tier 3.
That's a 6x increase in my costs  |
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 GbcueP.E.Premium
join:2001-09-30
Santa Rosa, CA
kudos:8 | said by Zoder:My group plan was switched this month from Cigna to UHC. I've been taking a drug that has been generic for a number of years now. Cigna's formulary has always treated the generic version of this drug as a tier 1 medication. UHC treats it as tier 3.
That's a 6x increase in my costs
Blame your employer. |
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Zoder
join:2002-04-16
Miami, FL
1 edit | I know. But in this case it's UHC's universal 2012 formulary for all plans not employer specific. I did some checking after the post and last year it was a tier one with UHC.
Btw, what happens when employers switch providers mid-year? Do all the employees lose the deductable they've already paid towards for the year and have to start over? If that's so, that really sucks. I haven't needed to use mine so I don't know. |
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GbcueP.E.Premium
join:2001-09-30
Santa Rosa, CA
kudos:8 | IDK, you'd have to talk with your HR... |
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| reply to Zoder
said by Zoder:I know. But in this case it's UHC's universal 2012 formulary for all plans not employer specific. I did some checking after the post and last year it was a tier one with UHC.
Btw, what happens when employers switch providers mid-year? Do all the employees lose the deductable they've already paid towards for the year and have to start over? If that's so, that really sucks. I haven't needed to use mine so I don't know.
Yes, you lose the deductible you paid. The deductible is not a year thing. It is a CALENDAR year. For instance, our healthcare is renewed May 1st. So from May 1st to December 31st of the same year is our deductible. January 1st starts a new deductible. We have Blue Shield, which isn't bad, except when you have a $3k per person deductible for the hospital.
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No Victim=No Crime |
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 DC DSLThere's a reason I'm Command.Premium
join:2000-07-30
Washington, DC
kudos:2
 ·Covad Communicat..
·Verizon Online DSL
| reply to Zoder
First, talk to your coworkers and employer. You may not be the only person in this situation. Get together and see what pressure the employer can apply. If your group is large enough, the provider might budge.
If that doesn't work, you could try writing UHC an old fashioned letter asking that they reconsider classification of the medication, underscoring the point that it is a generic. You should have paperwork from your old prescriptions that show the "regular" price of the medication and what you paid. Include a copy of that. And, do some nosing around the Internet and see if you can find out what other plans have it in their formulary as.
You should also have received a "Member Rights" document with your plan packet. It is required by law. In it should be a section that describes how to file a challenge/dispute of a decision. If you receive a negative response to your letter (or none at all) then you should try the dispute channel.
And, lastly, contact your state's health insurance administrator and see if they can make anything happen.
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"Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following." |
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DC DSLThere's a reason I'm Command.Premium
join:2000-07-30
Washington, DC
kudos:2 Reviews:
·Covad Communicat..
·Verizon Online DSL
| reply to Zoder
said by Zoder:Btw, what happens when employers switch providers mid-year? Do all the employees lose the deductable they've already paid towards for the year and have to start over? If that's so, that really sucks. I haven't needed to use mine so I don't know.
The deductible is with the plan provider, not your employer. It's like your auto insurance: If you are with Company A, have an accident, paid the deductible, then switch to Company B you have a whole new deductible. That is just how insurance works. You aren't entitled to any refund.
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"Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following." |
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DC DSLThere's a reason I'm Command.Premium
join:2000-07-30
Washington, DC
kudos:2 Reviews:
·Covad Communicat..
·Verizon Online DSL
| reply to billydunwood
said by billydunwood:The deductible is not a year thing. It is a CALENDAR year. For instance, our healthcare is renewed May 1st. So from May 1st to December 31st of the same year is our deductible. January 1st starts a new deductible.
It depends on the provider. Mine uses a Plan Year of March 1 for deductible reset, even though the renewal is January 1.
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"Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following." |
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 swintecPremium,VIP
join:2003-12-19
Alfred, ME
kudos:4 | reply to Zoder
You could always buy your own plan outright with Cigna I suppose. |
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Zoder
join:2002-04-16
Miami, FL | reply to Zoder
Thanks for all of the responses.
Our group is way to small for our employer to have enough leverage on this.
Per DC DSL's suggestion I checked Aetna, Humana, and BLBS of Florida. They all list it as a tier 1 drug too. So my only option seems to be to fire off a letter to UHC. It probably won't have an effect, but it couldn't hurt. |
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 dandelionPremium,MVM
join:2003-04-29
Germantown, TN
kudos:4 | reply to Zoder
Good luck, not having personal experience with Cigna, but using Blue Cross some and having the misfortune to have UHC once, I think would pick any insurance BUT UHC from now on. |
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 thegeekPremium
join:2008-02-21
right here
kudos:2
 ·Suddenlink
| reply to Zoder
said by Zoder:My group plan was switched this month from Cigna to UHC. I've been taking a drug that has been generic for a number of years now. Cigna's formulary has always treated the generic version of this drug as a tier 1 medication. UHC treats it as tier 3.
That's a 6x increase in my costs
That happens sometimes. Contact the manufacturer of the drug. They typically have plans to help low income folks with the costs of medications. If you don't qualify for the manufacturer's low income plan then check Wal-Mart. Maybe the drug is one that they have for cheap without insurance. Last option, deal with it. Cut spending on non-necessities like cable/internet/beer/smokes/dining out/etc. |
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 chambercPremium
join:2008-08-05
Irving, TX
·Time Warner Cable
| reply to Gbcue
said by Gbcue:said by Zoder:My group plan was switched this month from Cigna to UHC. I've been taking a drug that has been generic for a number of years now. Cigna's formulary has always treated the generic version of this drug as a tier 1 medication. UHC treats it as tier 3.
That's a 6x increase in my costs
Blame your employer. Or, you could thank your employer for providing you such a valuable benefit. It's sad we live in a nation that private corporations are forced to provide certain benefits contrary to market forces. |
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 The PigI know you want to be mePremium
join:2009-09-11 | reply to Zoder
Cigna is the best!
I have it with NO deductibles!
I only pay $25 for doctor visits! |
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thegeekPremium
join:2008-02-21
right here
kudos:2 | Aetna is best. I have no deductible and pay $10 for doctor visits. |
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 CKizerAd eundum quo nemo ante iitPremium
join:2003-01-29
Tijeras, NM
kudos:2 | reply to Zoder
Welcome to healthcare coverage in the United States. Costs go up, services go down. |
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 OmegaDisplaced OhioanPremium
join:2002-07-30
Cheyenne, WY | reply to chamberc
said by chamberc:said by Gbcue:said by Zoder:My group plan was switched this month from Cigna to UHC. I've been taking a drug that has been generic for a number of years now. Cigna's formulary has always treated the generic version of this drug as a tier 1 medication. UHC treats it as tier 3.
That's a 6x increase in my costs
Blame your employer. Or, you could thank your employer for providing you such a valuable benefit. It's sad we live in a nation that private corporations are forced to provide certain benefits contrary to market forces. I think it sad that some people think affordable healthcare is not in the best interest of this country.
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What smells like blue? |
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Zoder
join:2002-04-16
Miami, FL | reply to CKizer
In reality it's your plans that are great. You can have a crappy plan with Cigna or Aetna. For example my mother had UHC with her school plan before the economy tanked in 08 and those benefits were great. The current plan they offer is with Cigna and it's not close to being as good.
It just seems odd that UHC's team that decides the drug formulary would differ so greatly from the other big insurance companies on how this one drug is classified. |
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 HallPremium,MVM
join:2000-04-28
Dayton, OH
kudos:2 | reply to thegeek
said by The Pig: Cigna is the best! I have it with NO deductibles! I only pay $25 for doctor visits! said by thegeek:Aetna is best. I have no deductible and pay $10 for doctor visits. Ha ! Don't praise the insurance carrier, you have to praise your employer. They are the ones who determine co-pay amounts, deductible amounts, and so on.
No experience with Cigna, but we had Aetna up until last year and certainly had deductibles ! Office visits were $25 or $35. It does depend on what plan you pick, of course, but there was NO "no deductible" option and $25-35 office visit co-pays was the lowest option (in fact, it was the same across the board for all plans). |
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HallPremium,MVM
join:2000-04-28
Dayton, OH
kudos:2 | reply to Zoder
said by Zoder: I've been taking a drug that has been generic for a number of years now. Cigna's formulary has always treated the generic version of this drug as a tier 1 medication. UHC treats it as tier 3. To Cigna, does "Tier 1" automatically mean "generic" or are there are brand drugs also in Tier 1 ? Reason I'm asking is, if it's truly available in generic form, it should be available to all insurance or even cash !
Speaking of that (cash), ask your pharmacy how much the non-insurance rate is for it. It MIGHT be cheaper !!! |
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