Healthcare question
 

One of my kids has a prescription that they take every day. Been on it for a couple of years. It has been covered by United and costs $20 a month. Went to get it filled last month and pharmacist says United is no longer covering this medicine. New cost - $850.00. So this prescription just went from $240 per year to over $10,000!

United basically says they believe that another medication is better. Thing is, our doctor had previously tried that medicine with very poor results, bad side effects, etc. We have written an appeal to UHC. They responded telling us to go pound sand. Basically, that they know what's better for my kid than her doctor and parents.

Anybody have any experience with this? Are there any avenues of relief I can explore with either the company or DALPA?

Thanks

Yes, that's been happening with several other medications. You see, Delta chooses which prescription drugs they want to cover and which they don't want to cover if you choose one of the non-contractual health plans. You can always try an appeal but you're likely to be told to go pound more sand.

This is why i'm always surprised that your PWA has so little in it when it comes to health insurance plans. Most ramp agents at other airlines have more protections when it comes to their health insurance than Delta pilots.

Call Karen Brown Fleck at DALPA. 1800 USA ALPA. She has solved this same issue for several friends.

This is a dangerous and unacceptable precedent. DAL loves you.......

"If you like your plan...."

Will do, Thanks.

One thing to consider, just in case things don't go your way. What does YOUR research on the alternate medication tell you? What about other doctors, what do they say? How many patients have had adverse reactions, in numbers? Two, or twenty? Some doctors are well rewarded by pushing expensive medications, and it can influence their opinions. Would he pay 10K per year from his pocket for this prescription?

Maybe I didn't explain it well, but the alternate med, the one UHC wants us to use, is the one our pediatrician originally prescribed. We tried it, with poor results. The way I understand it, is if you are in this situation, you must try the med that UHC recommends for a certain amount of time, if it doesn't work, then you can appeal your case. We have already tried the one they want and I won't put my daughter through that again. We explained this to UHC in our appeal. They don't care.

That's what I'm thinking. Here's a nice way to keep a CBA cost neutral. Push costs back onto the employees through healthcare. Doesn't require negotiating a thing.

This appeal process is interesting, seems like there should be a third party. Basically, you're appealing to the company that told you to pound sand. You asked if you could stop pounding sand, they evaluated the situation and decided that it was in their best interest if you kept pounding sand. Not very fair.

This not only happens with prescriptions,but also with procedures.Had 3 different independent drs say I needed a certain procedure-uhc pencil pusher knows better and denies each time.

Exactly.

Left message with Karen Brown Fleck at DALPA today. I will update with any results.

Yep, have fought this battle as well. Don't get me started on the:

"Well, it was coded as procedure #704. It should have been coded as #703. Since it was coded incorrectly, we will not cover"

Nevermind that we are talking about the same damn thing.

So frustrating, I feel your pain brother. We had a somewhat similar problem and Karen was able to help us out, so there is hope.

Unfortunately it's not just UHC, it's the insurance industry in general. Cheaper to just deny 100% of all claims and then stall those who become the proverbial squeaky wheel than pay what they owe. Makes our management team look like Mother Theresa. Dealing with Blue Cross Blue Shield and Medicaid was another nightmare when my mother was injured in a car accident. The sheer maddening stupidity of these faceless organizations would be enough to drive anybody to the breaking point.