Copay Puns

Mine does, yours should too

That is all

Local pharmacist here.

Please make sure you are aware of what your copays should be. I know multiple pharmacies in town that are adding dollars to your copays!

A new patient got some medications from my pharmacy and ask me why his copays were so much cheaper with us. In most cases, your copay is going to be the same wherever you go.

After digging into this we found that he was getting charged an alarming rate on some medications. One medication should of had a copay of $1.30 but instead he was told his copay was over $50! This pharmacy is billing insurances and then adding extra dollars disguised as a copay.

This patient filed a report with his insurance and with the state board of pharmacy and just got a check from that pharmacy for over $3,000!

So I am currently taking Gilenya for almost 3 years now and been with the same insurance now for the same amount of time. Today I got an email stating my copay increased from $75 to $1990. The Gilenya go program has also decided to decline to pay for it and now CVS Speciality won’t ship the Gilenya now. Anyone else experience this?

I filed for cardiac issues related to Gulf war service in November, and scheduled for an EKG at a civilian hospital on December 3rd. I never presented my insurance info, not was I ask for it. At one point I told the registration desk that this appt was scheduled by the VA, because they didn't understand why I didn't know the Dr. who ordered the test.

Today I got an explanation of benefits from my civilian insurance that says they paid $275 to the provider, and I owe a copay of $128.

Is this normal? I've had c & p exams before and don't recall getting billed for them. If it's not normal, who do I even contact about it?

I rely on my Ubrelvy to be an abortive if I get migraines. I am trying to get a new copay card for 2022. My current one expires 12/31/2021. Tried using the Ublrevy website to get a new one 2 days ago. After filling it out got the "this page is temp. out of order." Tried again just now and got the same message. Called the number on the website, and nobody is there to answer apparently.

Any tech savvy people on here know what to do? My deductible resets Jan. 1 and I do NOT have the funds to get a new thing of Ubrlevy at full cost and need this copay card.

I have been looking into this stuff for myself a lot lately and I need to share because I am very concerned that a bunch of people are going to reach April and find they have to stop their biologics all of a sudden. I’m gonna try to explain as best I can. Please feel free to ask any questions and I’ll do my best.

Starting January 2022 insurance companies can include drugs for which there is no generic alternative in their copay accumulator programs. This includes eczema drugs like Dupixent and Eucrisa. The argument until now has been that the insurers are trying to encourage selection of cheaper alternatives, which is why drugs without generics were excluded. Including them will, in many cases, make the choice into: “treatment or no treatment”, instead of “brand name, or generic”.

It’s important to understand how manufacturer assistance works, in order to see why this is a problem. Again, I’ll try to be clear, ask for clarification if needed. This example is made up and simplistic with the goal of clarity.

Let’s say my new drug Bloffimab costs $200 cash per dose and you need 5 doses a month for a total of $1000/month. Your insurance has a $2000 deductible, meaning that, until you have paid $2000, they aren’t covering any of your costs for prescriptions. Lucky for you Bloffimab has an assistance program that covers up to $2000/year. You sign up and for the first two months, we (the makers of Bloffimab) pay $1000 for your drug. It goes through the pharmacy and mostly back to us, so it’s kind of like you just get the drug for free for those months.

Now on month three, your deductible has been met, so the rest of the year, your insurance has to cover the full cost of the drug and that all goes to the manufacturer. So they gross $10000 for the rest of the year.

The way most copay accumulators work is that first part will still happen. Those first two months will still be covered by the assistance program. However, the insurance companies do no allow the manufacturer payments to contribute to your deductible. So, when you hit the Program’s $2000 limit, instead of your insurance footing the bill going forward, you now have to pay full price until you meet your deductible.

Different insurers do things differently. For example: I was informed by my insurance “provider” (Kaiser WA) that they will simply not permit the use of medication assistance programs until my full deductible has been met.

What does this mean for you? It depends. Some people may never

What can I do? Help. I’m insured through the marketplace.

Looking into an EPO plan. Specialist visits are $80. My baby needs to see a pediatric cardiologist every three months to do an EKG and echocardiogram. Will those be covered under the $80, or is it extra? And what would they fall under if so? Imaging?

She has be diagnosed with a congenital heart condition if that matters. Thanks!

Normally in the past when I would have my yearly check-up at my Cardiologist's office I was billed once for a copay. When I was on Medicaid I was only billed once and even when I was at my previous company (different insurance). I recently joined a new company back in May after months of unemployment due to COVID layoffs. In October I went for my yearly Cardiologist exams, which included a day for Echocardiogram and another day where I meet my doctor and get a EKG. A couple of months later I see I have been billed 3x my copay and when I call the hospital they say it is the insurance and when I called my insurance they say it is the hospital. They both say I was billed for the Echo, EKG, and Doctors visit.

What should I do? Should I just pay the copay amount or is one of the parties in the wrong? As I mentioned in the past I have never been billed 3x for the same exams, and even at other doctors' offices when I had exams/labs done they don't charge me 2x or 3x.

A while back I had a dentist appointment where I needed a crown and they made me sign a document which showed the cost of the crown. Recently, I had a dermatologist appointment where the doctor suggested I get a biopsy. I was never shown or told about an extra cost but was still sent a bill for $200 a few days ago. Can I fight this?

So, this may be long but I hope some of what I experienced may be helpful for others when they apply.

I have had eczema my whole life, sometimes better, sometimes worse. In college in Florida I went to see a dermatologist who, during our first appointment, looked me up and down and told me “you need to moisturizer every day” I never sought a follow up and I didn’t see another dermatologist for years.

In late 2019 I had a baby. After a few months I was having a bad flare. One day I touched a patch of skin on my stomach and it felt cold and wet. I headed for the bathroom mirror thinking “what fresh hell is this?“ in the mirror I could see that it was the only patch of healthy skin left on my torso, neck or arms. I finally went back to a dermatologist. She wanted to put me on Dupixent immediately but I was breast feeding my baby. Dupixent is contraindicated for breast feeding.

Two years, three dermatologists and multiple other treatments later, I have finally weaned my baby (listen, I’ve been home with her, there’s a pandemic) and am ready to finally give it a try. It’s early November, my prescription has been sent in and I get a call from the pharmacy asking how I want to pay. I tell them I’ve been planning to apply for the manufacturer’s assistance program. They let me know that the insurance I have is adding a copay accumulator starting January. I can use it till the end of December but after that they won’t accept the program until I’ve hit the deductible for the year. So basically, I have two months to give the drug a try and if it’s working for me I get to figure out a way to pay for it.

So, clock’s ticking. I start working on applying for the MyWay program. The errors that occurred were as follows:

-The first representative from MyWay stated he would fax the form we completed together to my doctor. He did not.

-On the second application: My doctor preferred I fill out one of the doctor’s sections and there was a lot of back and forth about getting it emailed, printed and then faxed back to them. In the end I drove to the office and filled it out in person. It was something they totally could have done.

-My doctor supplied the incorrect diagnosis code for my eczema when filling out their part of the form. “Eczema otherwise unspecified” is not indicated for Dupixent.

-The MyWay forms themselves changed to a new revision and had to be resubmitted by my doctor

-The revised new form needed me to resign then over the phone.

-The original form (f

I was told that CHAMPVA will pay as secondary to claims filed with your insurance from before you had CHAMPVA coverage as long as it was after your sponsor became 100% P&T. My husband became 100% P&T December 2020 and we didn't apply for CHAMPVA until just this month. When they approve us we would like to send in to have our copays reimbursed back to that eligibility date like we were told. Do we send in receipts or EOBs for this? I keep finding conflicting information and would love to hear from someone who has actually done it.

I hate that I have to post here but it's so dire.

I live alone and work full-time while trying to support myself through a cosmetology program. My back left molar has crumbled and I have to get a root canal that I've been putting off since August because my copay is so expensive.

I'm facing an appointment that I will have to again postpone if I can't come up with it. The pain is agonizing. I've been taking ibuprofen and Tylenol and antibiotics since November and nothing helps anymore.

Any help is appreciated

Cashtag : $lsoalchemy

Why YSK it's purely a waste of money to pay more than you have to for a prescription. MOST pharmacies in the US have in house discount cards that can save you a huge amount of money if you don't have insurance but you have to ASK the tech to apply it. GoodRX and WellRX provide the lowest cash price in your area but it's always worth it to see if they have an additional discount card you can use as well. For example, cash prices for my meds at Walmart is $36 and at HEB it is $18.65. After asking about the additional discount card, my total was $11.65. It would have been a waste of almost $25 for me to purchase them from WalMart and I saved an additional $7 off the list price at HEB just by asking a simple question.

Tl;dr, I'm seeking help and have 2 insurance policies (my family's Anthem and my UC ship Anthem card). I had to do a coordination of benefits earlier this year to get on the Acacia waitlist (which doesn't seem to be working out considering how long it is).

I was told to instead try Foresight since I've been waiting for long-term care for a while now. I gave my UC ship anthem plan card to Foresight and was wondering how much I'll be paying? I was told by CAPS that all I have to pay is a $10-$15 copay per session, but when I talk to the billing departments at the places I'm seeking help, no one seems to be able to confirm for me how this works/what I'll be paying out of pocket. I'm afraid of getting saddled with a $255 bill for one session when I can only afford to seek out weekly long-term help if it's just $10 - $15 per week.

If anyone can explain how this works to me and share their experiences, I'd highly appreciate it!

Also, if I give my UC ship plan over my family's plan, will my parents be able to find out about my appointments?

^ A lot questions, I know, but I appreciate the help! Sorry if some of them seem silly — this adulting stuff is hard, and I'm doing my best to figure it out.

Hi guys -

I get my Novolog insulin prescription filled from Express Scripts, the online pharmacy covered by my insurance (United Healthcare), and my 90 day supply costs $305.

Luckily the manufacturer, Novo Nordisk, offers a savings card and will reimburse me for about $230 of the prescription. The only problem is that the process is extremely slow - it takes about 6-8 weeks for them to issue a check which is around the time I need to order a new prescription so I'm basically consistently out of $300, which is a lot for me.

Does anyone have any recommendations or other options I might able to look into to help reduce my copay or anything??

I currently work at a pharmacy (a chain) and I often encounter people who either have high copays/deductibles or are uninsured. Most people have heard of GoodRx through commercials, but that is not always cheaper then the discount cards that pharmacies often have on hand. We get reps from these discount card companies that drop off cards every so often, and I would estimate we have at least 10 different ones.

My pharmacy will automatically run a discount card if the cost is high/no insurance, but I know that some of the busier stores don’t. You have to ask before they would run one.

Note: This will not make expensive brand name meds/insulin/inhalers dirt cheap. This mostly applies to generics. Also, these discount cards are in place of insurance, not in addition to.

Is it normal to get drug tested every visit to a behavioral health office? I recently started trying to go down the path of getting my ADHD treated. I've been to the doctor's office around 5 times and each time they make me do a piss test. I don't mind, but they won't allow refills on prescriptions without going to them once a month for like 15 minutes. Each time I go I have to pay around $130. So $130 a month including the cost of the prescriptions just seems unnecessary. Is this normal?

How can the plans offer zero dollar co pay and deductible and zero dollar premiums? as i see ads all the time says zero dollar copay deductible zero dollar premiums etc

and also how are they able to put money in a social security check?

Is that what it means, that copay doesn’t go towards deductible. What will I be paying for then to reach the deductible if most things have a copay?

Found this out today as a graduate student; also, the counseling center on campus can help you find an in-network provider based on your specific needs, as well as offer short-term therapy while you look.

I filed for cardiac issues related to Gulf war service in November, and scheduled for an EKG at a civilian hospital on December 3rd. I never presented my insurance info, not was I ask for it. At one point I told the registration desk that this appt was scheduled by the VA, because they didn't understand why I didn't know the Dr. who ordered the test.

Today I got an explanation of benefits from my civilian insurance that says they paid $275 to the provider, and I owe a copay of $128.

Is this normal? I've had c & p exams before and don't recall getting billed for them. If it's not normal, who do I even contact about it?