I live in Texas. I have UHC Navigate with Navitus as the prescription vendor. They recently changed the formulary for a medication that I was taking, changing it from not covered to covered.
The problem is that I use an Flexible Spending Account (FSA) and I will lose about $500 that was originally set aside for that medication. The FSA balance does not roll over, but there is a 3 month grace period. I won’t come close to reaching it now that the medication is covered.
I spoke with UHC, Navitus and my employer and they all said that there is nothing that they can do. Navitus said that they only send notifications when there is a negative change (dropping coverage), but not for when a drug is added as a covered item.
I found this statute: https://statutes.capitol.texas.gov/docs/in/htm/in.1369.htm, Sec. 1369.0541, subsection (3):
” (3) not later than the 60th day before the date the modification is effective, the issuer provides written notice of the modification to the commissioner, each affected group health benefit plan sponsor, each affected enrollee in an affected group health benefit plan, and each affected individual health benefit plan holder. “
What is my recourse here? Who is responsible, if anyone?
submitted by /u/tejaha7764
[link] [comments]I live in Texas. I have UHC Navigate with Navitus as the prescription vendor. They recently changed the formulary for a medication that I was taking, changing it from not covered to covered. The problem is that I use an Flexible Spending Account (FSA) and I will lose about $500 that was originally set aside for that medication. The FSA balance does not roll over, but there is a 3 month grace period. I won’t come close to reaching it now that the medication is covered. I spoke with UHC, Navitus and my employer and they all said that there is nothing that they can do. Navitus said that they only send notifications when there is a negative change (dropping coverage), but not for when a drug is added as a covered item. I found this statute: https://statutes.capitol.texas.gov/docs/in/htm/in.1369.htm, Sec. 1369.0541, subsection (3): ” (3) not later than the 60th day before the date the modification is effective, the issuer provides written notice of the modification to the commissioner, each affected group health benefit plan sponsor, each affected enrollee in an affected group health benefit plan, and each affected individual health benefit plan holder. ” What is my recourse here? Who is responsible, if anyone? submitted by /u/tejaha7764 [link] [comments]Read Morer/HealthInsurance