THE CHALLENGE: We know that medications can be expensive, especially new or experimental treatments. Sometimes, the big pharmaceutical companies will discount or even give away drugs that are out of reach for low-income patients. And sometimes they don’t. Insurance companies, meanwhile, will sometimes cover certain drugs and sometimes won’t. That reality was what our client’s employee was facing after she was diagnosed with an autoimmune disorder that required a high-priced injectable medication that was not covered under the pharmacy benefit portion of her employer’s healthcare insurance plan. Understandably, she felt as if she had run out of options.
OUR SOLUTION: As patients, we’re not only dealing with a disease but often the struggle is in navigating the complex bureaucracy that is part and parcel of the health care system. It’s not just doctors and nurses. It’s the insurance company, the claims forms, the copays, deductibles and so on. In other words, without a bit of help, it’s easy to become overwhelmed. There are plenty of employee benefits brokerages who believe their jobs are done once they’ve sold your company a policy. We view life differently and, as a result, decided to step into the picture to see what could be done.
THE OUTCOME: We probed, we prodded and we didn’t settle for quick answers. While we confirmed that the medication in question was not covered by the pharmacy benefits portion of the plan, what we discovered was that it was, in fact, covered by the medical portion of the policy. Once we made that discovery, the patient was able to begin the drug therapy her doctor had ordered and receive coverage that helped pay for it all. This wasn’t about going the extra mile. It was more a matter of just asking the right questions.
Want to learn more? Contact CCIG Employee Benefits Account Executive Storma McMurry at StormaM@thinkccig.com or 720-212-2069.
Click here for more case studies.