It rained the whole time and update on appeal

Yesterday at the picnic at hubby’s work, I kid you not, it rained the entire time!  I tried to get some pictures of my son fishing and even took my flip video but with the rain it was a no go, I tried, I will have to edit but I was afraid to ruin my digital camera and flip video in the rain.  He was really bummed at the end of the contest.  Twice he got a fish, one was a good size one too, but his line kept getting tangled, either with someone’s line or from the rope lining the pond.   Hubby said we get them a fishing license and he take him fishing, I mean my son really loved it!!  They were soaking wet but they had fun and that is what matters.  Hubby then played corn hole with my daughter.  He promised her that he would.  So he did something with each of them.  Of course the drinking started right at noon so the day was interesting as it went.  I tell you I don’t think the owner is going to remember half of what he said LOL.

I was so very cold, I wanted to come home to get my jacket, I even asked if he just drop me off but he wouldn’t.  The weather plays a huge part with migraines believe it or not.  Then with everyone trying to crowd under cover, wasn’t good.  I couldn’t eat and barely got a can of root beer in me!  Hubby was proud to show us around the shop and office.  Its nice to have a mental picture of where he is now when he is at work!

When we came home I checked the mail and there was a letter from the insurance company.  I was nervous opening it.  Of course the way they word things is very confusing to say the least.  It was regarding their decision to my appeal.   First it says the appeal to waive the cost difference between brand and generic is approved.  Then says in making this decision the relied on the guidelines on our plan certificate summary description which then is the NON formulary brand name.  (which is where we initially stand NOW).  Then it says its been determined the above mentioned cost difference for the brand name is eligible to be waived as there is documented medical necessity for providing this level of co-payment.    So I thought that meant then its what we were paying before!

So it states to call Medco, which I did, but when I called, however they are still making us pay “more”.  How our plan is, anything I take month to month all the time, we HAVE to do mail order!  But if just for a month or two its $30 for brand, $20.00 for generic.  But mail order for 90 days WAS $60.00 brand, $40.00 for generic!      NOW we have to pay more.  To get started back on right away a retail one month supply (to fill at a local pharmacy) is going to be $50.00, then for the 90 days is $100.00.  So if my appeal was approved and the cost difference was “waived”, then why are we still paying more than before?  Grant it they were having us pay WAY more than this, but I don’t understand the cost increase if it says its been waived???   There is like three pages worth to this letter too!!  Couldn’t they make it simpler??