Hey so i am getting a headache from all of all this going back and fourth.ok let me start off by saying that Cigna my primary insurance has now got this thing that any maintenance medications meaning "everyday take" have to go through mail order.some new thing so they tell me today as im still figuring this whole pulmozyme stuff out which i just found out all i needed was an authorization when the pharmacy tells me i needed to apeal that was the ONLY thing i culd do but no that wasn the issue!but anyways..so ive got medicare as my secondary bearing in mind that i use my local pharmacy and it jus hit me today and i see that since may when i became eligible for medicare that they havent even been billing cigna first!so im like wow!!i havent said anything to them but it just hit me after being on the phone and putting two and two together.well when im talking to medicare they tell me that they do support mail order to but i have to decide as to who im going with as they dont bill two insurances so im like ok but im sure if i went with medicare id get in trouble right?..but i wouldnt go with them anyway as they tell me like only one of my meds would be coverd anyway?!?so i really have no choice but to go through cigna mail order..but what baffles me the most is apareantly medicare has been pickn up my costs and thats why its been so cheap at my local pharmacy so i almost just dont want to do anything ya know..but when i talked to medicare they said there showing no bills meaning that all my meds that have been going through the pharmacy well i know for a fact medicare has now been paying but yet medicare is telling me no they havent been paying a dime and cigna isnt paying coz id know all about it as its expensive copays!..so im not sure if i should go through cigna mail order pharmacy and if i do is there help with copays just based off of my income as i do live with my dad and hes work has over 100 employees he works for Texas Instruments. but i take care of myself so is there a program out there i can take advantage of?..or should i just stick with what im doing as know one knows anything as it seems ??need some answers please on whats a good thing to do or if someone has been in my shoes <img src="i/expressions/face-icon-small-smile.gif" border="0"> thanks carly!
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NEED SOME ADVICE REGARDING MY INSURANCE COMPANYS PLEASE
- Thread starter carly23
- Start date
Hey so i am getting a headache from all of all this going back and fourth.ok let me start off by saying that Cigna my primary insurance has now got this thing that any maintenance medications meaning "everyday take" have to go through mail order.some new thing so they tell me today as im still figuring this whole pulmozyme stuff out which i just found out all i needed was an authorization when the pharmacy tells me i needed to apeal that was the ONLY thing i culd do but no that wasn the issue!but anyways..so ive got medicare as my secondary bearing in mind that i use my local pharmacy and it jus hit me today and i see that since may when i became eligible for medicare that they havent even been billing cigna first!so im like wow!!i havent said anything to them but it just hit me after being on the phone and putting two and two together.well when im talking to medicare they tell me that they do support mail order to but i have to decide as to who im going with as they dont bill two insurances so im like ok but im sure if i went with medicare id get in trouble right?..but i wouldnt go with them anyway as they tell me like only one of my meds would be coverd anyway?!?so i really have no choice but to go through cigna mail order..but what baffles me the most is apareantly medicare has been pickn up my costs and thats why its been so cheap at my local pharmacy so i almost just dont want to do anything ya know..but when i talked to medicare they said there showing no bills meaning that all my meds that have been going through the pharmacy well i know for a fact medicare has now been paying but yet medicare is telling me no they havent been paying a dime and cigna isnt paying coz id know all about it as its expensive copays!..so im not sure if i should go through cigna mail order pharmacy and if i do is there help with copays just based off of my income as i do live with my dad and hes work has over 100 employees he works for Texas Instruments. but i take care of myself so is there a program out there i can take advantage of?..or should i just stick with what im doing as know one knows anything as it seems ??need some answers please on whats a good thing to do or if someone has been in my shoes <img src="i/expressions/face-icon-small-smile.gif" border="0"> thanks carly!
Hey so i am getting a headache from all of all this going back and fourth.ok let me start off by saying that Cigna my primary insurance has now got this thing that any maintenance medications meaning "everyday take" have to go through mail order.some new thing so they tell me today as im still figuring this whole pulmozyme stuff out which i just found out all i needed was an authorization when the pharmacy tells me i needed to apeal that was the ONLY thing i culd do but no that wasn the issue!but anyways..so ive got medicare as my secondary bearing in mind that i use my local pharmacy and it jus hit me today and i see that since may when i became eligible for medicare that they havent even been billing cigna first!so im like wow!!i havent said anything to them but it just hit me after being on the phone and putting two and two together.well when im talking to medicare they tell me that they do support mail order to but i have to decide as to who im going with as they dont bill two insurances so im like ok but im sure if i went with medicare id get in trouble right?..but i wouldnt go with them anyway as they tell me like only one of my meds would be coverd anyway?!?so i really have no choice but to go through cigna mail order..but what baffles me the most is apareantly medicare has been pickn up my costs and thats why its been so cheap at my local pharmacy so i almost just dont want to do anything ya know..but when i talked to medicare they said there showing no bills meaning that all my meds that have been going through the pharmacy well i know for a fact medicare has now been paying but yet medicare is telling me no they havent been paying a dime and cigna isnt paying coz id know all about it as its expensive copays!..so im not sure if i should go through cigna mail order pharmacy and if i do is there help with copays just based off of my income as i do live with my dad and hes work has over 100 employees he works for Texas Instruments. but i take care of myself so is there a program out there i can take advantage of?..or should i just stick with what im doing as know one knows anything as it seems ??need some answers please on whats a good thing to do or if someone has been in my shoes <img src="i/expressions/face-icon-small-smile.gif" border="0"> thanks carly!
A
Aspiemom
Guest
I read this, but haven't responded because I'm just confused. Maybe since it's all in one paragraph I'm missing a sentence when I'm reading or something.
Are you saying you discovered the meds were being payed, but no one owns up to paying?
Are you saying you don't know who to submit maintenance drugs prescriptions to? We used a maintenance mail-in program, but it's CVS Mailorder and I'm allowed to just go to CVS locally to get them filled and have the same copay. Sometimes it's $24 for 3mo and sometimes it's much more, depending on the drug and if it's name brand or generic.
I'm sorry I can't help. We're having insurance problems ourselves and no ones been able to answer my questions, either. I've had one response.
Are you saying you discovered the meds were being payed, but no one owns up to paying?
Are you saying you don't know who to submit maintenance drugs prescriptions to? We used a maintenance mail-in program, but it's CVS Mailorder and I'm allowed to just go to CVS locally to get them filled and have the same copay. Sometimes it's $24 for 3mo and sometimes it's much more, depending on the drug and if it's name brand or generic.
I'm sorry I can't help. We're having insurance problems ourselves and no ones been able to answer my questions, either. I've had one response.
A
Aspiemom
Guest
I read this, but haven't responded because I'm just confused. Maybe since it's all in one paragraph I'm missing a sentence when I'm reading or something.
Are you saying you discovered the meds were being payed, but no one owns up to paying?
Are you saying you don't know who to submit maintenance drugs prescriptions to? We used a maintenance mail-in program, but it's CVS Mailorder and I'm allowed to just go to CVS locally to get them filled and have the same copay. Sometimes it's $24 for 3mo and sometimes it's much more, depending on the drug and if it's name brand or generic.
I'm sorry I can't help. We're having insurance problems ourselves and no ones been able to answer my questions, either. I've had one response.
Are you saying you discovered the meds were being payed, but no one owns up to paying?
Are you saying you don't know who to submit maintenance drugs prescriptions to? We used a maintenance mail-in program, but it's CVS Mailorder and I'm allowed to just go to CVS locally to get them filled and have the same copay. Sometimes it's $24 for 3mo and sometimes it's much more, depending on the drug and if it's name brand or generic.
I'm sorry I can't help. We're having insurance problems ourselves and no ones been able to answer my questions, either. I've had one response.
A
Aspiemom
Guest
I read this, but haven't responded because I'm just confused. Maybe since it's all in one paragraph I'm missing a sentence when I'm reading or something.
<br />
<br />Are you saying you discovered the meds were being payed, but no one owns up to paying?
<br />
<br />Are you saying you don't know who to submit maintenance drugs prescriptions to? We used a maintenance mail-in program, but it's CVS Mailorder and I'm allowed to just go to CVS locally to get them filled and have the same copay. Sometimes it's $24 for 3mo and sometimes it's much more, depending on the drug and if it's name brand or generic.
<br />
<br />I'm sorry I can't help. We're having insurance problems ourselves and no ones been able to answer my questions, either. I've had one response.
<br />
<br />Are you saying you discovered the meds were being payed, but no one owns up to paying?
<br />
<br />Are you saying you don't know who to submit maintenance drugs prescriptions to? We used a maintenance mail-in program, but it's CVS Mailorder and I'm allowed to just go to CVS locally to get them filled and have the same copay. Sometimes it's $24 for 3mo and sometimes it's much more, depending on the drug and if it's name brand or generic.
<br />
<br />I'm sorry I can't help. We're having insurance problems ourselves and no ones been able to answer my questions, either. I've had one response.
blindhearted
New member
Ask Cigna who their Mail Order or Specialty Pharmacy is. You maybe able to go on their website to find out. That may help get you an answer. I had Cigna many years ago & I can't remember who their pharmacy was. Mail Ordering isn't really that hard. It's a little annoying having to wait for medicines but some companies require it, either for a lower co-pay for u or to cover the medicine at all. I think you have to have Medicare Pt D in order for it to cover prescription cost through a pharmacy. As far as order of payer. Cigna will be primary as long as your father's company has over 100 employees & he is currently working. If he was to retire, then Medicare would become primary.
As far as Ins vs Pharmacy as far as the Pulmozyme goes, if the insurance says you need Authorization (which probably means prior auth. then talk to your doctor & Cigna. Cigna should have a form for ur Dr to fill out. The should be able to send u one or tell u where to download it.) The pharmacy is probably talking about an appeal for the medicine that they have already fill and tried to get payment for. You need to find out what order they are talking about. Most insurance companies have a rule where you can get one fill on an authorized medicine but after that you can not get the medicine unless the auth. form is filed. Pulmozyme is known as a specialty medicine by most insurance companies because of it's cost & the group who it's prescribed to.
I hope that helps you. I did have trouble understand what you were asking since it is one huge paragraph but I will help u with what I can.
Oh, and stay on ur father's insurance for as long as humanly possible!! It may have expensive co-pays but it's so much cheaper than paying straight out for meds or trying to get our own health coverage.
As far as Ins vs Pharmacy as far as the Pulmozyme goes, if the insurance says you need Authorization (which probably means prior auth. then talk to your doctor & Cigna. Cigna should have a form for ur Dr to fill out. The should be able to send u one or tell u where to download it.) The pharmacy is probably talking about an appeal for the medicine that they have already fill and tried to get payment for. You need to find out what order they are talking about. Most insurance companies have a rule where you can get one fill on an authorized medicine but after that you can not get the medicine unless the auth. form is filed. Pulmozyme is known as a specialty medicine by most insurance companies because of it's cost & the group who it's prescribed to.
I hope that helps you. I did have trouble understand what you were asking since it is one huge paragraph but I will help u with what I can.
Oh, and stay on ur father's insurance for as long as humanly possible!! It may have expensive co-pays but it's so much cheaper than paying straight out for meds or trying to get our own health coverage.
blindhearted
New member
Ask Cigna who their Mail Order or Specialty Pharmacy is. You maybe able to go on their website to find out. That may help get you an answer. I had Cigna many years ago & I can't remember who their pharmacy was. Mail Ordering isn't really that hard. It's a little annoying having to wait for medicines but some companies require it, either for a lower co-pay for u or to cover the medicine at all. I think you have to have Medicare Pt D in order for it to cover prescription cost through a pharmacy. As far as order of payer. Cigna will be primary as long as your father's company has over 100 employees & he is currently working. If he was to retire, then Medicare would become primary.
As far as Ins vs Pharmacy as far as the Pulmozyme goes, if the insurance says you need Authorization (which probably means prior auth. then talk to your doctor & Cigna. Cigna should have a form for ur Dr to fill out. The should be able to send u one or tell u where to download it.) The pharmacy is probably talking about an appeal for the medicine that they have already fill and tried to get payment for. You need to find out what order they are talking about. Most insurance companies have a rule where you can get one fill on an authorized medicine but after that you can not get the medicine unless the auth. form is filed. Pulmozyme is known as a specialty medicine by most insurance companies because of it's cost & the group who it's prescribed to.
I hope that helps you. I did have trouble understand what you were asking since it is one huge paragraph but I will help u with what I can.
Oh, and stay on ur father's insurance for as long as humanly possible!! It may have expensive co-pays but it's so much cheaper than paying straight out for meds or trying to get our own health coverage.
As far as Ins vs Pharmacy as far as the Pulmozyme goes, if the insurance says you need Authorization (which probably means prior auth. then talk to your doctor & Cigna. Cigna should have a form for ur Dr to fill out. The should be able to send u one or tell u where to download it.) The pharmacy is probably talking about an appeal for the medicine that they have already fill and tried to get payment for. You need to find out what order they are talking about. Most insurance companies have a rule where you can get one fill on an authorized medicine but after that you can not get the medicine unless the auth. form is filed. Pulmozyme is known as a specialty medicine by most insurance companies because of it's cost & the group who it's prescribed to.
I hope that helps you. I did have trouble understand what you were asking since it is one huge paragraph but I will help u with what I can.
Oh, and stay on ur father's insurance for as long as humanly possible!! It may have expensive co-pays but it's so much cheaper than paying straight out for meds or trying to get our own health coverage.
blindhearted
New member
Ask Cigna who their Mail Order or Specialty Pharmacy is. You maybe able to go on their website to find out. That may help get you an answer. I had Cigna many years ago & I can't remember who their pharmacy was. Mail Ordering isn't really that hard. It's a little annoying having to wait for medicines but some companies require it, either for a lower co-pay for u or to cover the medicine at all. I think you have to have Medicare Pt D in order for it to cover prescription cost through a pharmacy. As far as order of payer. Cigna will be primary as long as your father's company has over 100 employees & he is currently working. If he was to retire, then Medicare would become primary.
<br />
<br />As far as Ins vs Pharmacy as far as the Pulmozyme goes, if the insurance says you need Authorization (which probably means prior auth. then talk to your doctor & Cigna. Cigna should have a form for ur Dr to fill out. The should be able to send u one or tell u where to download it.) The pharmacy is probably talking about an appeal for the medicine that they have already fill and tried to get payment for. You need to find out what order they are talking about. Most insurance companies have a rule where you can get one fill on an authorized medicine but after that you can not get the medicine unless the auth. form is filed. Pulmozyme is known as a specialty medicine by most insurance companies because of it's cost & the group who it's prescribed to.
<br />
<br />I hope that helps you. I did have trouble understand what you were asking since it is one huge paragraph but I will help u with what I can.
<br />
<br />Oh, and stay on ur father's insurance for as long as humanly possible!! It may have expensive co-pays but it's so much cheaper than paying straight out for meds or trying to get our own health coverage.
<br />
<br />As far as Ins vs Pharmacy as far as the Pulmozyme goes, if the insurance says you need Authorization (which probably means prior auth. then talk to your doctor & Cigna. Cigna should have a form for ur Dr to fill out. The should be able to send u one or tell u where to download it.) The pharmacy is probably talking about an appeal for the medicine that they have already fill and tried to get payment for. You need to find out what order they are talking about. Most insurance companies have a rule where you can get one fill on an authorized medicine but after that you can not get the medicine unless the auth. form is filed. Pulmozyme is known as a specialty medicine by most insurance companies because of it's cost & the group who it's prescribed to.
<br />
<br />I hope that helps you. I did have trouble understand what you were asking since it is one huge paragraph but I will help u with what I can.
<br />
<br />Oh, and stay on ur father's insurance for as long as humanly possible!! It may have expensive co-pays but it's so much cheaper than paying straight out for meds or trying to get our own health coverage.
lostindreamz
New member
believe me, Cigna will find out. My husband was able to use my insurance and I had Cigna. He also had medicare. Any time anyone submitted something to Medicare before Cigna, and then Cigna as second payer, we got a call from our caseworker and then I spent days on the phone trying to get it all straightened out. Believe me, you want Cigna on your side because in the long run, they will pay for more.
lostindreamz
New member
believe me, Cigna will find out. My husband was able to use my insurance and I had Cigna. He also had medicare. Any time anyone submitted something to Medicare before Cigna, and then Cigna as second payer, we got a call from our caseworker and then I spent days on the phone trying to get it all straightened out. Believe me, you want Cigna on your side because in the long run, they will pay for more.
lostindreamz
New member
believe me, Cigna will find out. My husband was able to use my insurance and I had Cigna. He also had medicare. Any time anyone submitted something to Medicare before Cigna, and then Cigna as second payer, we got a call from our caseworker and then I spent days on the phone trying to get it all straightened out. Believe me, you want Cigna on your side because in the long run, they will pay for more.