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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



Gbcue
Premium
join:2001-09-30
Santa Rosa, CA
kudos:8
Reviews:
·AT&T U-Verse

1 recommendation

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.

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.



Gbcue
Premium
join:2001-09-30
Santa Rosa, CA
kudos:8

1 recommendation

IDK, you'd have to talk with your HR...


billydunwood

join:2008-04-23
united state
kudos:2
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.
--
No Victim=No Crime


DC DSL
There's a reason I'm Command.
Premium
join:2000-07-30
Washington, DC
kudos:2
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.
--
"Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."



DC DSL
There's a reason I'm Command.
Premium
join:2000-07-30
Washington, DC
kudos:2
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.
--
"Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."


DC DSL
There's a reason I'm Command.
Premium
join:2000-07-30
Washington, DC
kudos:2
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.
--
"Dance like the photo isn't being tagged; love like you've never been unfriended; and tweet like nobody is following."


swintec
Premium,VIP
join:2003-12-19
Alfred, ME
kudos:5
reply to Zoder

You could always buy your own plan outright with Cigna I suppose.


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.



dandelion
Premium,MVM
join:2003-04-29
Germantown, TN
kudos:5
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.



thegeek
Premium
join:2008-02-21
right here
kudos:2
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.


chamberc
Premium
join:2008-08-05
Irving, TX
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.


The Pig
I know you want to be me
Premium
join:2009-09-11
reply to Zoder

Cigna is the best!
I have it with NO deductibles!
I only pay $25 for doctor visits!



thegeek
Premium
join:2008-02-21
right here
kudos:2

Aetna is best. I have no deductible and pay $10 for doctor visits.



CKizer
Premium
join:2003-01-29
Tijeras, NM
kudos:2

1 recommendation

reply to Zoder

Welcome to healthcare coverage in the United States. Costs go up, services go down.



Omega
Displaced Ohioan
Premium
join:2002-07-30
Somerset, NJ
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.
--
What smells like blue?

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.



Hall
Premium,MVM
join:2000-04-28
Germantown, 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).


Hall
Premium,MVM
join:2000-04-28
Germantown, 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 !!!


cowboyro
Premium
join:2000-10-11
Shelton, CT
Reviews:
·AT&T U-Verse
reply to The Pig

said by The Pig:

Cigna is the best!
I have it with NO deductibles!
I only pay $25 for doctor visits!

The company doesn't matter, the plan does.
I have United, I pay 0. That is 0 for doctor visits, 0 for drugs... and my premium share is 0.
Actually the plan itself has a huge deductible (some 6000/family) which is covered by an HSA funded by the employer. But at the end of the day I still don't pay a single penny out of my pocket.


AVD
Respice, Adspice, Prospice
Premium
join:2003-02-06
Onion, NJ
kudos:1
reply to Hall

said by Hall:

Speaking of that (cash), ask your pharmacy how much the non-insurance rate is for it. It MIGHT be cheaper !!!

+1
--
--Standard disclaimers apply.--
The preceding posting is null and void in Arizona and any other jurisdiction where prohibited by law.

Zoder

join:2002-04-16
Miami, FL

It's about $50 more expensive without insurance. The brand name drug is several hundred more expensive.



DanHo
Premium
join:2002-05-20
Seattle, WA
reply to cowboyro

said by cowboyro:

The company doesn't matter, the plan does.

It most certainly does. Large employers have a greater ability to customize their plans than smaller companies. I guarantee that if the OP works for a larger company they selected the coverage limits/benefits all the way down to Rx (I work in the industry).


tower29
Premium
join:2002-02-12
Loveland, CO
reply to Zoder

I would be grateful that you company still provides health insurance. Our company dropped it a few years ago. Bummer for sure.



Hall
Premium,MVM
join:2000-04-28
Germantown, OH
kudos:2

1 recommendation

reply to DanHo

said by DanHo:

It most certainly does. Large employers have a greater ability to customize their plans than smaller companies. I guarantee that if the OP works for a larger company they selected the coverage limits/benefits all the way down to Rx (I work in the industry).

And to expand that further, the employer may be the insurance provider as well (or at least that's how I understood it with my previous employer). Aetna, Blue Cross/Blue Shield, UHC, etc was simply the "administrator".


DanHo
Premium
join:2002-05-20
Seattle, WA

Yes, it's called being "self-insured". Lots of large companies do this. The employer is on the hook for the risk, to a certain extent (re-insurance), but are able to use the rates for services that are negotiated by the insurance/administrating company. Usually the Aetnas/Cignas, etc charge a fee for administration, usually 2-5%.



Omega
Displaced Ohioan
Premium
join:2002-07-30
Somerset, NJ
reply to The Pig

said by The Pig:

Cigna is the best!
I have it with NO deductibles!
I only pay $25 for doctor visits!

Tri-care is better. $0 for everything.
--
What smells like blue?