Posted by MK (66.139.221.198) on November 01, 2002 at 22:23:43:
In Reply to: Re: CIGNA : Prescriptions, Pre-auth, and out of pocket Exp. !!!!! posted by Ken Young on November 01, 2002 at 21:19:32:
To:KEN
From: MK
We signed up for the HMO two-tier policy, I called the 1-800 # the day we recieved our cards and ask how to go about filling certain prescriptions that have been prescribed to me for the past 2yrs - b/c I knew they were harder to get since one is an anti-depressant and the other is a C2 ( Narcotic ) for ADD. I went to my PCP - he gave me both prescriptions and so i went to the Pharmacy - they denied to pay. They said that I needed a pre-authorization for these
meds in order to qualify for the copay $15 gen & $30 brand - I called the Dr's office - they called in the pre-authorization - Denied. On the anti-dep that is listed as covered by Cigna - I even called customer service and verified both drugs - I was told no problem - still denied
when I tried to fill them for the 2nd time - I called and called and got the run around - so I filled them private pay b/c there can not be a lapse in these meds without dire consequences. On one of the prescriptions the reason for rejection was based on that my one month supply was not accepted b/c I have to take a pill and a half and they would only give me one a day - the other was rejected without reason. So I keep filling private pay - 277.63 / month. I have called them , talked to the pharmacy , talked to my dr.'s office ( they are still telling me that it will go through - denied denied denied followed by more excuses and one more new step i have to do - blah blah blah. So I had my pharmacists print out all the info they require for a pharmacy claim, called customer service to double check - now I'm here wondering if they will sit somewhere and gather dust and prove to be a waste of a stamp!!!! I am cancelling CIGNA
tomorrow - and i have already started a new plan with United Healthcare - effective nov 3,a PPO plan with the works - I went back to my old Dr. knowing they take United - they are cancelling this month w/United b/c they said they don't pay.
I called United and went through the same process - looked up my meds - got them approved and got all the details to go about filling them. I talked to a cust service operator today with United told her everything I had to go through with Cigna and she was not to eager to to give me positive news - although in my policy - in writing - it says all is good to go. I told her I can handle private pay - I don't even care if they do give the run around to not have to pay - just let me know now so I can get on with my life - and make sure I have these meds on time. I know that was alot of information all at once but I feel like i followed the rules and got shoved around. Am I to expect this from United, is Cigna really going to reimburse - or should I just write off my loss and call it a day??????
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: TO: M.K.
: FROM: KEN YOUNG
: I will attempt to help you but since is your first insurance experience so you say, are you sure you understand you contract correctly?
: You say you have to fill out a group of forms to be reimbursed for medication?
: Didn't your program give you a indentification card for medication and all you had to do was present it to the pharmacy, they would call your insurer's 1-800 number and verify coverage and all you had to do was pay the co-pay which is usually $5.00 on generic and $20.00 on named brand medication as long as you presented the doctor's prescription with it?
: Ken Young
: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
: : I have to fill out some forms for Pharmacy
: : reimbursements and I have the claim forms, but I'm just so- so - so hesitant because I don't know if I'm just getting the run around. This is our ( husband + myself )first go at Insurance and I have had the worst Luck. I followed the rules but they ran me into the ground with Dr.'s Pre-Auth {which I had } and so on and so on. I would greatly appreciate any information anyone has on CIGNA - as a whole - even the tiniest bit of info. would be wonderful.
: : Thanks, Mk
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