Exchange plan buyers beware…

Recently, I had the pleasure of meeting and with a Merk rep, Gina. I always get plenty of reps during my time @ Dr. Celina John’s Office. The visit is usually involves the doctor and the rep. However this time both her and I struck a coversation about medication coverage and pharmacies.

Although, I personally do not have this problem with pharmacies I found out from Gina that she was a victim of a pharmacy charging her a $120 copay for a medication (generic)?!

She, just like many other thousands of people has an exchange medical plan and until recently she thought that she would have no problem of using her local pharmacy for her medications. But to her suprise, she paid a whoping $120 copay for a medication that she thought had no copay at all. Why this happened? Well, it’s because that particular pharmacy was OON (out of network) with the particular exhange medical plan that she acquiered. What?! I personally do not know any doctor office that takes a copy of your pharmacy card. I always ask the patient for their pharmacy information-for escripts purposes.

In the end the moral of the story is that anyone that has an exchange medical plan please call the pharmacy number on your card and find out if a particular pharmacy you are going to use is INN (in network/ participates) with your plan. This way you will avoid those costly $120 copays, like Gina had to pay, and obtain your medication for low or no copay.

The exchange health benefit dilemma …..

So, you got medical Insurance, YAY! And now the doctor you wanted to see is not in network with the plan?! But why?

Unfortunately, with the creation of the exchange plan a lot of providers find themselves out of network and members find themselves trying to find providers that will accept their insurance or lose their current provider.

So….. please check the availability of the provider for the plan BEFORE you purchase it! ****For every plan there is a plan description page and a link to its provider search.***

Hope this helps!

P.S. if you have any questions please feel free to contact me via email KR2medicalbilling@gmail.com (I will answer you within 24 hours)