Well, today reinforced my belief that insurance companies are a freakin' rip off. I DESPISE with a passion our current health insurance company. First DH had to wait 6 months after being hired to even qualify for benefits. Ok, I read every piece of information the company sent regarding our new health insurance, I thought I understood it... apparently I was wrong! Not only did I have to wait an additional 3 months after our insurance went into effect in order to see my doctor, I find out our deductible is $3000 EACH. Not what the info said, but oooh kay.

So, 3 months ago I finally got to go back to my doctor, I was thrilled beyond belief because this meant I could finally get back on my Enbrel. Dr. Cohen's office also hooked me up with an Enbrel Easy Step card which helps to pay insurance deductibles! How great is that? So, I go home & call my pharmacy. They call me back and tell me that my primary insurance won't pay anything toward my prescription. What? How can that be? I call the insurance company. They tell me that lovely little deductible must be met first, then they will pay 70% of the prescription until I've paid an additional $2250, which at that point they pay 100% of my prescription. Ok, this is a slight problem, but not horrendous because I have that Easy Step card!

Pharmacy processes my prescription through Easy Step card, which leaves just enough money on it to cover the next 2 months of prescriptions since my insurance will pick up 70% now. In the meantime, I spend numerous hours on the phone with various customer service people at Regence Blue Cross Blue Shield trying to find out why it's not showing that my deductible has been met (they also told me to change my pharmacy to one that they use regularly). Oooooh... I have to FILE THE CLAIM MYSELF? Hmmm... didn't see that in any of the original info. So, I fill out a form, I fax it to them, I'm assured that it's going to be expedited. Yeah, 2 months it takes for them to post the deductible to my account. :::sigh:::

In the meantime, it's now been 2 months with me NOT getting my medicine. So I call the new pharmacy and am told that they have filled my prescription and want to set up delivery (specialty pharmacy mail order thing). First I blasted them for filling the prescription without my calling them. Then they tell me they are sorry for the confusion, but that's their policy, they get it from the doctor & fill it immediately. Since I'd called them and had them retrieve my prescription from my old trusted specialty pharmacy and told them at that point that I would call them when I was ready, this just didn't sit well with me. All that aside, the gentleman I spoke to told me the prescription was ready and would I like to pay my co-pay with Visa, MC or other, then proceeds to inform me that I owe $954!!!! WTF??? How in the hell have I gone from paying $50 to nearly a thousand? Oh, well, they charged the amount to my Easy Step card and that's the balance that was left. OMGOMGOMG

Finally, today, seeing as the call mentioned above was over a week ago now, I call the pharmacy again to see if they have gotten my insurance straightened out so that I can pay my $50 and get my damn meds. They now tell me that my primary insurance is showing that they won't pay anything for this prescription. Now, another call to Regence. I'm informed by the CSR that we have a REIMBURSEMENT plan! OMGOMGOMG again!!! Once again, nowhere in the benefits package does it tell me that I have to pay not only $3000 to cover my (keep in mind that's just for me)annual deductible, then also have to pay $2250 before they will pay 100% of my claims. So, this means that out of pocket each year, regardless of what they claim, $10,050.00! PER PERSON!

So, now I realize, my dreams of having my Enbrel back were pipe dreams. I never should have started taking it again. When I first found out back in April that we had to met the deductible first, I debated about even taking the first shot. Seriously, this is unbelievably depressing. The CSR's that I talked to at Regence in April, May & June, not once did they ever tell me that we have to pay EVERYTHING then submit it to them for reimbursement. Had they been kind enough to do that, I would have called my doctor & asked for something else. Yes, there are programs available to help me, but it takes 6-8 weeks to get into them to begin with, then they have limits of $4800 (max for most) per year, there is a ton of paperwork that has to be filled out and you can only be in one program at a time. For instance, with my Easy Step card, I have $1800 left on it now, but I can't even apply anywhere else until I use all of those funds. Then I have to get a letter or something from them to pass on to the next assistance program.

The super ironic thing about it all... Amgen Wyeth actually has a program for Enbrel patients that provides FREE medication... if you don't have any insurance that is. The reason my husband works where he does is so that we will have decent insurance. Little did we know when he accepted this job over the others that he could have taken, that the insurance this company offers is a freaking joke! I would have been better off had he just gone to some small company that didn't offer health insurance!

I am soooo sorry for my verbal abuse to the CS lady that answered my call to Regence today, I truly am, I know it's not her fault, so I guess I shot the messenger when I shouldn't have... but what the hell do we pay nearly $400 a month for to this damn insurance company when it does us no good?

For all of you out there that read this and have similar insurance, and are quite happy with it, keep in mind, my husband brings home less than $4000 a month after insurance, taxes, etc. My Enbrel right now costs nearly $3000 per month. We have a mortgage, we have 4 children and only the one income. Why don't I work? Because I can no longer work in the fields I've been trained for, I'm disabled to a point, but SS says I'm too young and too white to be disabled. Actually, I do have a job and it's a damn hard one, I'm a stay at home mom. I take care of my children, I clean, I cook, I do laundry and I haul them all to their various extracurricular activities. I'm the first one up & the last to go to bed even when I'm running a fever of 105 and can barely move. That's my job, I just don't get paid for it and seldom do I ever hear the words "thanks mom" just because.

Regence Blue Cross Blue Shield SUCKS - Cigna ROCKS! My husband has been informed that when he changes jobs he is to immediately ask who the company has health benefits through, if it's not Cigna, he must end the interview and go on to the next one. I could just strangle the man anyway for leaving his previous job!