I’ve been enrolled in a United Healthcare group plan through my employer since January 2020. My employer offers a basic plan and a “plus” plan. I chose the plus plan because it had better coverage for my family (but a higher deductible). My employer renewed our plans for 2021 (and never gave the employees an opportunity to make changes, but that is a different story — smdh), and the new term started June 1st 2021. I’ve had a prescription since January 2021 that had a copay of $75 (I paid $30 with a coupon). When I went to refill the prescription on June 12, 2021, the pharmacy notified me that the copay was $300 (yes, three hundred)! I immediately called UHC to inquire and they said that the pharmacy was correct — my prescription now has a $300 copay because my drug benefits changed. I have not been able to pick this prescription up because I cannot afford to pay a $300 copay. When I went to work the next day, I spoke to HR, who said that no changes were made to the health coverage benefits. Long story as short as possible: I’ve spent hours on the phone with UHC, and with the brokerage who is the middleman between my employer and UHC, and still have NO ANSWERS. UHC is now claiming that I “switched plans”, although I did not. I never requested a switch, my employer did not request a switch, the broker claims they did not request a switch, and UHC has no actual paperwork proving that I requested a plan change. My new insurance card is identical to the one I had last year and all of the coverage information listed on my “myUHC” online account is consistent with what I initially signed up for EXCEPT for my prescription drug benefits. But the craziest part: I spoke to a couple of my coworkers who are enrolled in the exact same plan as me to see if they were having any issues. The three of us have compared and confirmed that we are in fact enrolled in the SAME PLAN, and yet, our drug coverages are not consistent (all of the over coverages, like deductible, etc. appear to be consistent). When I do a prescription drug price search in my online portal, the copay for this prescription comes up as $300. When coworker A does the same search on her portal for the exact same drug (same quantity, dosage, etc.), the search says that it’s “not covered” at all. Now person B happens to have the exact same prescription as me. She even refilled it on June 22, with no issues — her copay was still $75 ($30 with the same coupon I use). And yet, when she searches her online portal for the cost, it ALSO lists “not covered”……WHAT THE F**K IS GOING ON HERE The portal listing “not covered” when the drug IS clearly covered is an issue in itself, but the bigger issue I’m having is WHY I’m suddenly being charged $300, when my coworker enrolled in the same plan still has a $75 copay for the same prescription. (Please note: this is NOT an issue with the drug itself, nothing about the drug has changed and the manufacturer has not made any sort of changes that would affect the price). United Healthcare screwed something up here and refuses to admit it or fix it (the broker also screwed some things up with the renewal premium pricing, but that is a different story). Right now, this seems like it could be classified as DRUG BENEFIT DISCRIMINATION. What can I do here? Where should I report this? Am I going to need a lawyer to handle this? What are my rights in this situation? Is there a way to get some sort of compensation for damages, for my time and toll on my mental health (the prescription was a mental health prescription that I have now been without for an entire month)?? Does anyone have any other suggestions?
submitted by /u/PerpetualDemiurgic
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I’ve been enrolled in a United Healthcare group plan through my employer since January 2020. My employer offers a basic plan and a “plus” plan. I chose the plus plan because it had better coverage for my family (but a higher deductible). My employer renewed our plans for 2021 (and never gave the employees an opportunity to make changes, but that is a different story — smdh), and the new term started June 1st 2021. I’ve had a prescription since January 2021 that had a copay of $75 (I paid $30 with a coupon). When I went to refill the prescription on June 12, 2021, the pharmacy notified me that the copay was $300 (yes, three hundred)! I immediately called UHC to inquire and they said that the pharmacy was correct — my prescription now has a $300 copay because my drug benefits changed. I have not been able to pick this prescription up because I cannot afford to pay a $300 copay. When I went to work the next day, I spoke to HR, who said that no changes were made to the health coverage benefits. Long story as short as possible: I’ve spent hours on the phone with UHC, and with the brokerage who is the middleman between my employer and UHC, and still have NO ANSWERS. UHC is now claiming that I “switched plans”, although I did not. I never requested a switch, my employer did not request a switch, the broker claims they did not request a switch, and UHC has no actual paperwork proving that I requested a plan change. My new insurance card is identical to the one I had last year and all of the coverage information listed on my “myUHC” online account is consistent with what I initially signed up for EXCEPT for my prescription drug benefits. But the craziest part: I spoke to a couple of my coworkers who are enrolled in the exact same plan as me to see if they were having any issues. The three of us have compared and confirmed that we are in fact enrolled in the SAME PLAN, and yet, our drug coverages are not consistent (all of the over coverages, like deductible, etc. appear to be consistent). When I do a prescription drug price search in my online portal, the copay for this prescription comes up as $300. When coworker A does the same search on her portal for the exact same drug (same quantity, dosage, etc.), the search says that it’s “not covered” at all. Now person B happens to have the exact same prescription as me. She even refilled it on June 22, with no issues — her copay was still $75 ($30 with the same coupon I use). And yet, when she searches her online portal for the cost, it ALSO lists “not covered”……WHAT THE F**K IS GOING ON HERE The portal listing “not covered” when the drug IS clearly covered is an issue in itself, but the bigger issue I’m having is WHY I’m suddenly being charged $300, when my coworker enrolled in the same plan still has a $75 copay for the same prescription. (Please note: this is NOT an issue with the drug itself, nothing about the drug has changed and the manufacturer has not made any sort of changes that would affect the price). United Healthcare screwed something up here and refuses to admit it or fix it (the broker also screwed some things up with the renewal premium pricing, but that is a different story). Right now, this seems like it could be classified as DRUG BENEFIT DISCRIMINATION. What can I do here? Where should I report this? Am I going to need a lawyer to handle this? What are my rights in this situation? Is there a way to get some sort of compensation for damages, for my time and toll on my mental health (the prescription was a mental health prescription that I have now been without for an entire month)?? Does anyone have any other suggestions?
submitted by /u/PerpetualDemiurgic [link] [comments]Read Morer/HealthInsurance