Medical, scripts pharmacy, behavioral health insurance out of pocket, all on same page?

[twoweeled]

Is anyone else going through this? retirement deductibles are (per individual) $200 and $1000 out of pocket total between Medical, Pharmacy and behavioral health.
Every time I call pharmacy or medical, only medical has the correct numbers. Pharmacy claims not to be updated. I have met $200 deductible and the $1000 out of pocket. Medical is aware of it. Medical no longer charges me any co pays because I've met the $1,000 out of pocket. Pharmacy continues to charge. Pharmacy at one time claimed to show I had paid the $1000 out of pocket, but I still had to meet the $200 deductible!! I asked how that was possible, and was told that's what their screen shows. They said they'd put an inquiry and get updated. No update for over a month. finally after numerous calls, they claim they are updated. At that time, pharmacy showed $200 deductible met, and the $1000 out of pocket met. I asked about getting my $200 deductible back (I paid the $200 deductible again to pharmacy), as well as some of my copays back. Pharmacy told me, while I should not have paid the $200 deductible or some copays, they didn't know how to get the money back to me. That was about 5 weeks ago. I called to day, because they are still charging me copays.
NOW PHARMACY SAYS IT SHOWS I PAID $400 as an individual, but only $509 towards my out of pocket. So I still had to pay co pays!
They are going to initiate another inquiry for an update.

What a joke for retiree insurance. As anyone else met the $1000 out of pocket? I hope I'm the only one.

 

[olroadbeech]

Is anyone else going through this? retirement deductibles are (per individual) $200 and $1000 out of pocket total between Medical, Pharmacy and behavioral health.
Every time I call pharmacy or medical, only medical has the correct numbers. Pharmacy claims not to be updated. I have met $200 deductible and the $1000 out of pocket. Medical is aware of it. Medical no longer charges me any co pays because I've met the $1,000 out of pocket. Pharmacy continues to charge. Pharmacy at one time claimed to show I had paid the $1000 out of pocket, but I still had to meet the $200 deductible!! I asked how that was possible, and was told that's what their screen shows. They said they'd put an inquiry and get updated. No update for over a month. finally after numerous calls, they claim they are updated. At that time, pharmacy showed $200 deductible met, and the $1000 out of pocket met. I asked about getting my $200 deductible back (I paid the $200 deductible again to pharmacy), as well as some of my copays back. Pharmacy told me, while I should not have paid the $200 deductible or some copays, they didn't know how to get the money back to me. That was about 5 weeks ago. I called to day, because they are still charging me copays.
NOW PHARMACY SAYS IT SHOWS I PAID $400 as an individual, but only $509 towards my out of pocket. So I still had to pay co pays!
They are going to initiate another inquiry for an update.

What a joke for retiree insurance. As anyone else met the $1000 out of pocket? I hope I'm the only one.

is this in the western conference? I'll have to check our medical papers.

 

[twoweeled]

is this in the western conference? I'll have to check our medical papers.

yep! Western 177 outta AZ. I'm in California.

 

[twoweeled]

is this in the western conference? I'll have to check our medical papers.

As far as I can tell, no one is debating the deductibles or out of pocket figures I gave. Medical is already instituting them. I pay no co pays on medical. Pharmacy is another story. their figures change weekly (it seems) and have yet to ever waive a co pay. Pharmacy at one time, acknowledged I had over paid the $200 deductible, but just don't know how to go about paying my back. But they still charge copays, even though they have acknowledged in the past, I had paid the $1,000 out of pocket.

 

[olroadbeech]

we have no copays either. our prescriptions usually run 5 dollars unless there is no generic and then we pay 30%. our out of pocket is 30% but it usually much less because they write off some.

example . our responsibility on a $275 doctors visit was $29 .... only about 10% since they wrote off so much.

i'll have to dig up the retiree plan papers to see what our out of pocket is. we are in nor-cal and i'm sure it is probably different .

 

[Pismo Bill]

Is anyone else going through this? retirement deductibles are (per individual) $200 and $1000 out of pocket total between Medical, Pharmacy and behavioral health.
Every time I call pharmacy or medical, only medical has the correct numbers. Pharmacy claims not to be updated. I have met $200 deductible and the $1000 out of pocket. Medical is aware of it. Medical no longer charges me any co pays because I've met the $1,000 out of pocket. Pharmacy continues to charge. Pharmacy at one time claimed to show I had paid the $1000 out of pocket, but I still had to meet the $200 deductible!! I asked how that was possible, and was told that's what their screen shows. They said they'd put an inquiry and get updated. No update for over a month. finally after numerous calls, they claim they are updated. At that time, pharmacy showed $200 deductible met, and the $1000 out of pocket met. I asked about getting my $200 deductible back (I paid the $200 deductible again to pharmacy), as well as some of my copays back. Pharmacy told me, while I should not have paid the $200 deductible or some copays, they didn't know how to get the money back to me. That was about 5 weeks ago. I called to day, because they are still charging me copays.
NOW PHARMACY SAYS IT SHOWS I PAID $400 as an individual, but only $509 towards my out of pocket. So I still had to pay co pays!
They are going to initiate another inquiry for an update.

What a joke for retiree insurance. As anyone else met the $1000 out of pocket? I hope I'm the only one.

yes i have met the 1000 out of pocket this year and every thing has been paid 100 percent. express scripts did charge me twice but put a credit back on my account.

 

[Pismo Bill]

yes i have met the 1000 out of pocket this year and every thing has been paid 100 percent. express scripts did charge me twice but put a credit back on my account.

i am also in the west.

 

[twoweeled]

yes i have met the 1000 out of pocket this year and every thing has been paid 100 percent. express scripts did charge me twice but put a credit back on my account.

Mmm. It sounds like Express Scripts was lagging in your case too. My medical was up to date. Express scripts is just catching up after paying them another $200 deductible. Express Scripts tell me now, they may have overcharged me, but not sure how to get the money back to me.
I'm glad everything has worked itself out for you. Just trying to let people know what is/may happen and to prepare.