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Employer changed insurance company-higher co-pay.

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bocin

Junior Member
What is the name of your state? Kentucky
I am in week 40 of a 48 week hep c treatment plan. My employer changed insurance companies at the end of week 39. my co-pay prior to the change over was $40.00 a month. After the change the co-pay asked by the new insurance company will exceed $800.00 a month. We were told by our employer the change over would be seamless and the coverage would be the same if not a little better. This was not the fact.
The outcome of my treatment hinges on a complete 48 week regimen of pegasys interferion and ribavirin. I can no longer afford the co-pay asked of me. Neither my employer of the insurance company cares to address this issue. My employers human resource director even denies stating the new co-pay would be the same or better.
What recourse do i have? I've applied for help from the drug manufacturer but this will take time and surely interrupt my treatment.
This whole thing has really worried me.
Thanks for any replies.
 


cbg

I'm a Northern Girl
Frankly, you don't. The copay is what the copay is. Neither your employer nor the insurance carrier is required to exempt you from the terms of the plan.
 

Experts

Junior Member
I agree with CBG. So you have about $1600 left in the treatment, will the provider be willing to set a payment plan for this?
-Experts
 
Last edited by a moderator:

jezziebelle

Junior Member
Another suggestion. Contact the insurer, ask if they have a medical professional that can review your case. Ask if such medical professional is allowed to make an exception or recommendation that prescriptions be covered under major medical. This can be a valuable arguement if any increased cost issues might result from non-compliance with the recommended treatment plan as a result of the cost prohibitive co-pay. Also study for yourself any "cost containment" provisions of your health plan document. But, don't be deliberate in any attempt to deceive the insurer. If cost containment exceptions are sought on that basis, be prepared to prove it just as you will when seeking relief from the pharmaceutical manufacturer.
 

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