FUDiabetes

Anyone else had billing/order issues with CVS?

insurance
cvs

#1

It never fails…we show up to pick up prescriptions for Liam and we’re hit with huge bills. This time, the bill was almost $600. It’s always because they have billed things incorrectly and listed things as requiring co-pays when they should not be.

So, we usually have to spend 3 or 4 hours on the phone every 90 days with our Insurance and CVS (corporate), who has to work with our local CVS to figure things out.

The way our Insurance works is as follows:

We “bundle” all diabetes supply on a single prescription for 90-days (the 90-day part is required). We have written into our prescription the following items: Test strips, glucose tabs, alcohol wipes, glucogon, lancets, syringes, insulin (both vials and the pens…the vials is carried over from a previous prescription that hasn’t expired yet, and the pens is the “new” method we are using so we are getting Lantus and Novolog pen cartridges as well as the applicable pens for these insulins.)

With our bundle agreement with our Insurance, we’re required to pay for the most expensive item, then everything in the bundle is free. In our case, the Insulin is the most expensive part. So everything else should have been free…but inevitably, each 90-days, they attempt to charge us more than they should by applying co-pays to items that they shouldn’t be applying co-pay charges for.

So after 3 - 4 hours on the phone with various departments to get things figured out.

The beginning “cost” for the day was $565. After spending the 3 hours on the phone, it went down to $189. After utilizing the Novolog “discount card” we will spend about $100 out of pocket. That’s not bad at all for a 90-day supply of Insulin supplies (this doesn’t include the sensors/transmitters…different company and full cost will be required for these until we meet our annual family out-of-pocket requirement.)

Anyway, so they did “manual overrides” for us on the phone to fix things…but I just wish they would FIX IT so that next time we come to get our prescriptions filled, we don’t have to spend hours on the phone with them getting it worked out.

Anyone else use CVS and has had similar issues of them never getting things written up/submitted correctly to insurance?


#2

Your prescription coverage is a CVS / Caremark plan? Or does cvs just happen to be your local pharmacy and they’re trying to wrestle with some other pbm’s coverage and policy ?


#3

Yes, CVS is the pharmacy we fill our prescriptions through. Anthem BCBS is our Insurance.

We are required to order all supplies at the same time through something called “Maintenance Choice®”, where we receive 90-day supplies of long-term medications by picking them up at a CVS/pharmacy or having them mailed to your home at no cost to you. We refuse to do any “mail order” prescription order filling because they have yet to get our order/billing correct.

yes. Caremark is our prescriptions plan.


#4

If it’s a Caremark plan it’d seem there’s no excuse for them to be screwing it up since it’s their own plan… if they are just playing he role of a local pharmacy and billing a different PBM then I’d see more potential for screw ups


#5

Just gets old to go through the dance every 90-days where they charge us for this or that when they shouldn’t be charged for. Maybe there’s something behind the scenes going on that I’m just not aware of that would cause this…all I know is that EVENTUALLY, it gets fixed, so it’s definitely a screw up on someone’s part (repeatidly)


#6

This is a really uniquely structured policy. I haven’t seen a plan with that kind of deal before. Lucky you!!! That’s a pretty sweet deal.

I’m sorry things don’t seem to be lining up though. It’s strange that you have to jump through these hoops every 90 days, but it might be because your policy is so unique. Seems like they should still be able to figure it out…


#7

My company is awesome and offers great benefits…I love Northrop Grumman.

Just today they released a memo outlining a brand new benefit…all “parents” are now entitled 2 weeks of paid leave. This is “Parental Leave” so applies to both the mother and the father (moms also get a lot of paid time off in addition to this.)

This came just in time as we’re just about to pop with our 6th and final son, so instead of taking 2 weeks of XVC (vacation) off, I’ll be taking a month off.


#8

Glad you’ll be able to spend some quality time with the new little one! Though, if you’re off work that means you’ll have to wake up in the middle of the night too! :wink:

Boy or Girl?!


#9

lol. I’m already up all hours of the night with Liam. Nothing new here.

But a lot of Erin’s usual “duties” will fall on me over the weeks she’s in recovery. Picking up/dropping off 3 kids at schools = 3 hours per day. I’ll pick up all the other duties she usually does so I’m sure I’ll be busy as hell. lol. I’ve always said…my job is easy compared to hers. i have the utmost respect for any “stay at home” parent, be it the mom or the dad…the work they do is invaluable. I wish they were compensated for their work!

This will be our 6th and final son. We have so many sons because I had hoped to give her at least one girl because she’s always wanted one. But after 6, and one with Diabetes, we’ve decided it’s just not in the cards.

I already have a grown daughter from my previous marriage (she’s 23) and the running joke with my wife is that "My x-wife stole my only X chromosome.) lol


#10

lol. The Ex always gets blamed for everything!

6 boys is a lot though. I’m sure they’ll be a handful! I’m glad you’ll have some time off right after the birth. Congrats!


#11

@ClaudnDaye They are handsomely compensated for their work when the kids grow up to be responsible adults.
My wife was a stay at home mom and I could not be more proud of our two sons.


#12

I used to have a similar option with Caremark/CVS. They called it diabetic kit, and had to mail order because CVS could not handle billing side. Most of the time CaRemark got it wrong, and I spent hours getting it billed right. I was given many excuses, such as the pharmacist needs to process items in certain order, or enter codes at time of filling order. I liked the low copay cost, hated the hassle. Bonus was that dexcom sensors were included in the kit for the first year until they excluded them from the kit but covered with separate copay.

I had to get my HR team involved once, to get me a refund, and things went a bit smoother after that. Is there someone you could engage from HR ?


#13

We are with Caremark, but we do not have this sweet deal of yours!

Surprisingly, we have never had a billing problem. Every time we think we do, it turns out we are in error because we did not understand the subtleties of the plan that result in higher billing for us…


#14

Im with a member funded plan managed by Caremark. At retail pharmacies it’s a total guessing game and there seems to be no discernible pattern whatsoever to my copays. When I use their mail order the copay is capped at $75 per item per 90 day supply. Mail order might be something to look into if your plan offers incentives…


#15

We can use mail order with our existing plan we just don’t want too because they have yet to get our order or bill correct. Maybe one day… We have many years ahead of us to cross our fingers and hope they get it right eventually.


#16

With CVS Caremark, mail-order doesn’t have to go out automatically. When I call to get my supply order, I ask what my total co-pay would be before the order is shipped. I do not authorize automatic refills because I want to make sure that I’m charged the right amount each time and that I don’t end up with supplies I don’t want/need. I’ve never had problems with them charging the wrong amount, but my co-pays are pretty simple. Most people probably get automatic refills, but I guess I’m just paranoid!

Your unique plan design may work better with mail-order because they mostly work with 90-day prescriptions. I don’t really know though. I guess the only way to know is to try it out.

Let us know if you ever do!


#17

Wow, great day for meds pick up…after getting the billing worked out, ends up we paid ZERO this 3 month period. We’ll take it. We got a sh*t ton of supplies also. I guess we won’t mind the long phone calls to straighten out billing/order issues as long as the price is right in the end.


#18

Wow! This has not happened to us since… diagnosis :slight_smile:


#19

I’m so sorry you’ve been through this hassle. So frequently. So very frustrating.

We’ve basically given up on the mail order aspects of the diabetes management. The stuff wouldn’t show up, or it would show up late, or they would send it to the wrong house – the one we hadn’t lived in for years. It was such hassle and a nightmare. And it was somehow never their fault and always ours. Eric swore never again.

We haven’t used CVS in years either. I’ve never heard of the bundle. Seems cool. But it sounds like what I’ve been saying for years: managing diabetes is a full time job. Arguing with insurance companies becomes second nature.

Persevere my friend. Saving that money is probably worth it.


#20

I can’t believe just how much these medicines actually cost…my mind is blown. Because we had to pay ZERO this time…which isn’t typical, usually we have at least $100 in cost every 90 days for these supplies, I thought I’d go out to the BCBS website and see what these medicines actually cost for Liam.

The figure I came up with just blew my socks off. $4,079.03. Just…wow. Most of that cost was associated with the Insulins.