- Report: #149202
Complaint Review: Blue Cross Of California - Los Angeles California
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Blue Cross Of California
bluecrossca.com Los Angeles, 90060 California, U.S.A.
Phone:
800-333-0912
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Blue Cross Of California removed expensive med, no available substitute, generic, from formulary, then lied saying it was never on formulary, now can't afford! Ripoff Los Angeles California
I am self-employed and have had Blue Cross of California's Individual PPO Share 2,500 plan for about 6 years. Up to now, I haven't experienced any major problems, although copayments for certain medical tests are rather steep.
I was diagnosed with narcolepsy/cataplexy 2 years ago, and as a result I take 2 medications regularly to control the condition. Cataplexy is the same muscle paralysis that everyone experiences when they're in REM sleep so they don't act out their dreams. But some of us narcolepsy sufferers experience this while awake, which can result in falls, broken bones, etc.
My doctor prescribed a new drug that was developed to treat cataplexy, the first one ever. It was like a miracle, and has changed my life!! Blue Cross said it was on their formulary, so I would pay the usual copay of $30/month for it. I was thrilled!
Well, after a couple of months, they decided to take it off of the fomulary. I suddenly received an astronomical bill for that month's supply. When I called Wellpoint, their pharmacy benefits provider, they informed me that indeed the drug was removed from the formulary. I asked how this could be, since there was no generic and no substitute drug available, and they couldn't answer the question.
My doctor was appalled and says they had no right to do that. I filed a grievance with Blue Cross, and their response was that it was never on the formulary!! They lied, and said that I shouldn't expect to pay a small copayment for a nonformulary drug. I followed through with a complaint to the California State Department of Managed Health Care. Upon completing their investigation, they sided with Blue Cross, apparently believing their lie that it was never on the fomulary.
I am in the process of filing yet another grievance, this time including the proof that I was paying the formulary copayment for this drug (well, twice because that lasted all of two months), but in the meantime I don't think I'll be able to afford to continue the drug. What liars they are! And every year, my monthly premium goes up about $94.
Liz
Sacramento, California
U.S.A.
I was diagnosed with narcolepsy/cataplexy 2 years ago, and as a result I take 2 medications regularly to control the condition. Cataplexy is the same muscle paralysis that everyone experiences when they're in REM sleep so they don't act out their dreams. But some of us narcolepsy sufferers experience this while awake, which can result in falls, broken bones, etc.
My doctor prescribed a new drug that was developed to treat cataplexy, the first one ever. It was like a miracle, and has changed my life!! Blue Cross said it was on their formulary, so I would pay the usual copay of $30/month for it. I was thrilled!
Well, after a couple of months, they decided to take it off of the fomulary. I suddenly received an astronomical bill for that month's supply. When I called Wellpoint, their pharmacy benefits provider, they informed me that indeed the drug was removed from the formulary. I asked how this could be, since there was no generic and no substitute drug available, and they couldn't answer the question.
My doctor was appalled and says they had no right to do that. I filed a grievance with Blue Cross, and their response was that it was never on the formulary!! They lied, and said that I shouldn't expect to pay a small copayment for a nonformulary drug. I followed through with a complaint to the California State Department of Managed Health Care. Upon completing their investigation, they sided with Blue Cross, apparently believing their lie that it was never on the fomulary.
I am in the process of filing yet another grievance, this time including the proof that I was paying the formulary copayment for this drug (well, twice because that lasted all of two months), but in the meantime I don't think I'll be able to afford to continue the drug. What liars they are! And every year, my monthly premium goes up about $94.
Liz
Sacramento, California
U.S.A.
1 Updates & Rebuttals
Dan
Sacramento,California,
U.S.A.
A FIX
#2UPDATE Employee
Fri, February 09, 2007
Liz, I am in Sacramento, an independent agent, and sell Blue Cross of California. Your situation is an extremely eazy fix (honestly). I know the reason you picked the plan---I am self-employed as well and understand business. You were happy with the plan, and understood it when you got it. Their plans are widely available on the internet, by phone, through all brokers, or regular mail, so it's not like you didn't know what you were getting before you bought it---it is in simple English (unlike others mentioned here...) I provide all the major carriers in California, and I am not Blue Cross's cheerleader;however, they are the largest, most organized, most powerful carrier in California---even their website is the most organized. The real deal is that you got unhappy when you started needing the prescriptions. People get really unhappy when they pick a plan based on financial risk and price, and then suddenly their health changes and causes then to start experiencing the deductible, or the non-formulary list (the financial risk.) You, however, can fix your situation very easily, even with your pre-existing situation. Look me up--you do not have to buy from me, even though I charge nothing anyway (buy from anyone you wish, or do it yourself), but I can tell you how to fix your situation---I do it everyday.---Dan Stuart Sacramento PS Call any independent agent in Sacramento---they will know how to fix your situation.
