After navigating the new website and our new benefits, there are a few "silver lining moments."
Looks like his generic "Singular" is completely free to us with the mail in order pharmacy. What would have cost us $37.67 for a 90 day supply was covered by our insurance.... Our doctors visit, not so much.
The quick visit (he brought in his old bottles so the doctor knew what he was taking before and just confirmed that he needed to stay on them) drafted a bill for $240.00.
His insurance will cover $78.98 since it was an "in-network" doctor and this is our "discount" for staying "in-network" but we are on the hook for $161.02.
It's moments like this where I miss his old insurance plan through Kaiser (the one that was deleted after the ACA went into effect). We got one free visit a year and had a standard cheap office co-payment for visits before a deductible.... and everything I needed I could find on their website, which isn't the case with our new insurance.
Now i'm stuck navigating through Blue Shield Blue Cross of Texas... yes, another state! His insurance comes through Texas because that's were his companies corporate office is and they buy insurance for all their other states through Texas apparently... and to be honest, I can't find a single packet that explains his plan online at all... the last bit of information I got said:
We pay 20% after a $1,000 deductible and had $30 office visits.Which, since we got a bill for $161 seems a little off to me. We also never received any new information when 2014 rolled in... just a slightly higher premium that was deducted from his paycheck.
I called customer service and after waiting 30 minutes on hold I was told that they don't have an explanation of benefits packet that they mail out, nor is one posted online. I was a little shocked and asked her how I was supposed to compare insurance policies without any information? You know, knowing what to expect to pay for an office visit before making an appointment would be kind of nice to know... especially since we are in a different state and therefore we don't have a Texas zip-code so their website doesn't help us at all.
I explained that we kind of just took a leap of faith with it when we purchased it back in November because SCB's old plan was cancelled under the ACA and it was the cheaper option with the information that we had... but now we are apparently paying $160 to go and just get a prescription renewed.
Eventually she gave me a phone number for SCB to call to at least get a Summary of Benefits and Coverage, but she told me even that wouldn't provide a lot of information.... but at least its a start. Guess i'll be having SCB make some phone calls this week. I also had him ask around the office. His boss told him today that the $30 office visits only kick in after we go through the $1k deductible... but then why did they cover almost $79 of our office visit (not that i'm complaining about them covering things-- I just want to know how the thing works)....
So far the only perk looks like free prescriptions... But we won't be using that for everything. SCB wants to be able to get his antidepressants at a moments notice, so he prefers we pay $10 for a 3 month supply from Walmart since there is one on every corner practically and worst case he had to walk around the store for a few minutes while they process them. (He tends to be forgetful and doesn't want to wait up to 2 weeks for them to be mailed to him.) I'm hoping this will also include his inhalers.