Sometimes I feel like I don’t even have time to spend with dad because I am so overwhelmed with the weight of all the tasks to be done. About two years ago, mom started having difficulty paying bills due to vision and hearing problems so I agreed to write out the checks and make telephone calls as necessary to help her. After mom passed away, one of the first things dad said was that I would have to pay the bills because mom always did that. I told him I was already doing that since they moved to the first Assisted Living Facility (ALF1). Dad is well aware that he is not able to handle his own financial affairs though we never talk about the fact that he has dementia or Alzheimer’s disease. I am his health care surrogate and Power of Attorney as I was for mom so this should make it possible for me to discuss his affairs with insurance, etc. In fact though, I have had many problems with each company and this could be a topic for another post!
At ALF1 residents were required obtain all prescriptions from a specific pharmacy which packaged all pills in individual blister packs. If we insisted on getting the prescriptions from Medco, they would charge us an additional $60 per month PER Prescription to repackage them into blister packs! So, we did not use Medco directly with 90-day supplies, we allowed ALF1 to obtain all prescriptions for both mom and dad (while mom was alive) and for dad afterwards for the time they were there.
Early in 2011, when I realized that dad’s insurance was not paying anything for his prescriptions, I called to find out why. I was told that Medco was the insurer for pharmacy products and Blue Cross directly handled everything else. That is confusing enough but the “deductible” and “out of pocket” expenses are combined and must total $1500 before insurance pays for most things. The difference between “deductible” and “out of pocket” expenses are obscure and seem to differ each time I ask. However, usually little or nothing will be paid by insurance until the $1500 limit is reached.
When I first called Medco, in March, I was told that he had not paid his deductible yet, and that put me off for awhile. A few months later, it looked like his deductible must have been met by now and I called again. This time I was told that they never received those pharmacy bills and that was why they had not paid. They sent me forms to complete – one for each medication – and I completed and returned them. Then a few weeks later they phoned me again to say that they had made a mistake. They did in fact have those bills; however they could not pay them because he had used a “local” pharmacy instead of Medco for those medications. This time they wanted to send me “appeal forms” to fill out to ask that since dad is required to get the blister packs, they should pay for his medications as an exception to the local pharmacy rule.
So I spent a good part of a day last week completing these “appeal forms” for the same medications that I had filled out forms just a few weeks before. I noticed by this time that Medco never sent me a response in writing – they always called to say that they could not pay because – yada yada yada – a reason that changed each time they responded to my letters! I made copies of my letter, and of each form, and mailed it all by certified mail to track their response. I also requested that they respond IN WRITING rather than by telephone. We shall see what happens with that!
In addition, that same day, I called Blue Cross to find out why they had not paid anything on some of my father’s bills from his recent hospitalization. Again, I was told that he had not met the “out of pocket” minimum of $1500. I said if they counted the money he spent on unreimbursed prescriptions as the “local pharmacy” they would see he had already spent well over $2000. However, that was a decision Medco had to make so the letter I wrote that morning would maybe take care of that. Or maybe not. I am not hopeful as I have gotten the run-around from Medco many times over the past 2 years. I suspect most other family caregivers have stories very similar to mine.