Boiling Point

What started as minutes on the phone has quickly turned into hours, between United Healthcare, Wallgreens Specialty Pharmacy, and Nike Human Resources.  I have reached the boiling point.

All I want is my crizotinib.  I’ve been on this drug for over 2-years.  I understand that it is a costly drug clocking in at over $10,000 a pop on my plan.  I understand that I have, through Nike, a prescription coverage that states I will pay 20% plus $20 copay up to my out of pocket maximum of $1,500 for name brand drugs.  Why does United Healthcare and Wallgreens tell me I owe over $7,000 for a 90-day supply for this drug?

Finally, Wednesday evening being completely frustrated I broke down and started crying during dinner.  I told SW I needed some help.

The next morning before 7am he began making phone calls.  Finally, United Healthcare has confirmed that I only owe the remaining balance of $900 to reach my out-of-pocket maximum for prescriptions and they are taking the lead on getting my situation corrected.

I’m keeping my fingers crossed that all of this gets resolved before my bottle of crizotinib goes dry.

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About kimmywink

I'm Kim. I've got advanced lung cancer. It sucks.
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23 Responses to Boiling Point

  1. Jamie says:

    Kim- I’m really sorry you and SW have to go through this BS with the insurance company. I’m pretty good at going to bat with them, so don’t hesitate to call if I can help in any way. xxoo

  2. Paula says:

    Kim, I can only imagine how frustrating and scary this has been for you! No one should have this kind of worry. Your only battle should be your health. Love, Paula

  3. istroud says:

    Excellent headway-making by SW! My first instinct is always to blame the insurance company, but I find that sometimes the pharmacy is the weak link. The folks at my national chain pharmacy were just not good at digging deeper and asking the right questions, and I’ve had fewer headaches since switching to an independent pharmacy with a pharmacist who actually takes a huge personal and professional interest in getting me the right drugs. Not crizotinib, which I get through a study, but other drugs.

  4. matissebradford says:

    Holy crap. I am sorry that you have to deal with that Kim. I wish I could help too :(

  5. spencerpdx says:

    FYI – I just confirmation from UHC that the problem is resolved and Kim will have her meds tomorrow.

  6. Tori says:

    Kim – sadly, I can totally relate to this. It’s kinda dumb, IMHO, that they put up a fight about paying for Xalkori. When I was on chemo, the cost was 3x more per month than a bottle of Xalkori.

    I’m so glad to see it all got worked out, and I am very glad to see you are still able to stay on Xalkori. Best of luck to you always!

    • kimmywink says:

      That’s really horrible. What if we were too sick to stand up for ourselves? I’d hate to see that happen…Although, I’m getting an idea that it does for other people far too often.

      The ironic part is all this work for a drug that I’m likely going to stop taking next month! Ugh.

  7. Mindy says:

    I got frustrated and annoyed just reading about this. Grrrrr.

  8. Mark Hawkins says:

    Kim and SW: I am glad you were able to get to the bottom of the misunderstanding! Hope you kept the good contact information for Christie, because you may need it again. Go outside today and enjoy the warm, moist Spring breeze.
    Oh, if I get any sales calls from SW, I’m hanging up … he is way too persausive!
    Take care. Mark H.

  9. grayconnections says:

    I’m so glad you were able to get this resolved. Hurray for SW! Not having necessary cancer meds is an ever-present fear for those of us who can’t live long without them.

  10. I often have Kenny make the calls. You would think that in 2014, it shouldn’t matter if it is a woman or a man making the calls. But Ken always gets better results than I. Hang in there Kimmy.

  11. g says:

    just read this post – happy you got this resolved!

  12. gwendolyn says:

    lots of love to you and happy new year too you too!

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