Insurance

[anonymous]

Hi

I;m coming over to america for 3 months and have insurance with the university i will be working with. I just wanted a deciphering of the inusrance talk (don't have to deal with medical insurance in the UK so i have no idea!). I did ask someone involved in the insurance but there answer doesn't make much sense to me. I want a bottom line answer - how much would a prescription (for say the creon 10000) cost? Here is the email:

It appears that you will be enrolled as an Rx employee for a 3 month period therefore I believe you would qualify under the typical Rx-EMP coverage. In that regard:
$200. deductible
20% Copay 80% coverage
$25K Cap( this one is from memory and may have to be double checked with member services) then 100% out of pocket

As far as the meds:

Tobi= We do not stock but have ordered it in the past, but is extremely expensive; it
requires refrigeration and comes in a box of 48 X 5mL for Nebulizer. Each box would retail at $3041.00 I'm not sure how much you would use, but this medication alone could eat up your benefit very quickly

Creon 10=Approximate usage per month would be #1500 retailing at $1275.00

My suggestion would probably be to have you bring the Tobi if at all possible and we could order the Creon-10 for you, but the Rx would have to be written by one of our doctors. In that regard, it would make sense to have your clinician at home write you the Rx(or Rxs) and bring them to YHP so your assigned clinician at YHP would have a record of your medications and be able to rewrite the Rx(s)....we can not accept foreign Rxs in the pharmacy.

Thanks for any help deciphering that for me!

Oh i'm assuming Rx means prescription?

 

[anonymous]

I am not familiar with Rx in UK. I would try to get a 3 month supply if possible and bring it with you. If not, fill your Rx for Creon prior to coming and possibly have a relative pick up Rx in UK and ship to you.
I would guess, worse case you would have to buy Creon for 2 months. It would cost you $455 for first month and $255 for the 2nd month. Tobi cost would be $760 month. The deductible appears more like medical and not a prescription benefit. If this is the presription benefit...it sucks. I pay $40 for 3 months of Creon10 and $40 month for Tobi--when needed.

 

[anonymous]

They way I figure it is the first $200 of RX (yes that means prescriptions) is not covered at all. After that you are responsible to pay 20% for each RX. Once the the insurance has spent $25K you would have to pay 100% (But since you are only going to be here for 3 months, I don't think that will be a problem)

As an example, with the Creon....say this is the first RX you get filled
$1275 total cost
<u>- 200</u> deductible (you pay)
$1075 remaining
- 860 80% insurance
- 215 20% you pay

So for your first prescription of Creon you would pay $415. For all other precriptions after that you would pay 20% of the total

Creon $1275....20% = $255
Tobi 3041.........20% = $608.2


Hope this helped!

 

[Bumblebee]

hmmm i'm definately bringing over my lovely exceptionally cheap
medicine in a big bag then (£100 a year flat for EVERYHTING -
that's about $180).  I can't believe that's how much you guys
have to pay, even $40 a month for just one drug is extortionate to
my mind.  At least my inpatient and outpatient stuff is 100%
covered with this plan.  I can't believe you guys all pay so
much for insurance and then have to pay all that for
prescriptions ....wow!<br>
<br>
Thanks for the info

 

[Chaggie]

We also pay a lot less income tax, so there is a trade off for
some.

 

[thefrogprincess]

A dedudctible is a once a year thing. You pay the first $200 of any medical visists, procedures, or perscriptions. Once your deductible is met for the year you do not pay it again until the next year. It is not per visit/procedure/perscription. Typically a co-pay is a set amount regardless of how much the perscription costs, $20 for example. I have never heard of a plan where you have to pay a percentage of the cost of a perscription. But that doesn't mean they don't exhist. If you can get more details on this, preferably something straight from the insurance company I would be happy to look it over for you if you PM it to me, I have had more experience with insurance companies than I care to remember.