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I was wondering if anyone knows how the pricing works for prescriptions when you have insurance. I had a PPO and until last year I had no problems. Then they decided Elmiron (which I have been taking for 20 years) now needed a pre authorization. Fine. My Dr. had no problem with that. Then they decided they were no longer going to cover Uribel and similar meds. For a plan that I was paying $1500/month for I don't think they should be reducing coverage. My PPO was going to jump from $1500/month to $2100/month. So much for the Affordable Care Act. So I switched to an HMO that is a little less than $1000/month. I don't qualify for a subsidy. January will be the first month of meds with my new insurance. Of the 6 I take for my bladder only 2 are Tier 1 = $4 generics. The rest are tier 2 so they pay 50%. Hopefully someone can explain the breakdown for me. This is for Hydroxyzine. A generic bladder med. Still under the old insurance.
Amount $19.28
You Pay $5.00 (my copay)
Ins Pays $14.28
U/C $19.28
So is the total $38.56 but the insurance company gets 1/2 off? Then we each pay our percentage of the remainder?? How is $19.28 uncollected if that is the total amount? And if with my new plan we each pay 50% is that the amount or the amount plus uncollected??? I consider myself a fairly smart person but I can't figure this out at all. Health insurance should not be this complicated.
Amount $19.28
You Pay $5.00 (my copay)
Ins Pays $14.28
U/C $19.28
So is the total $38.56 but the insurance company gets 1/2 off? Then we each pay our percentage of the remainder?? How is $19.28 uncollected if that is the total amount? And if with my new plan we each pay 50% is that the amount or the amount plus uncollected??? I consider myself a fairly smart person but I can't figure this out at all. Health insurance should not be this complicated.
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