Toprol Xl Coverage Denied

I’ve been on Toprol XL for years. I got a blue letter in the mail months ago. Medicare switched me to another part d plan. I didn’t get the letter until two months after they said they sent it to me. I thought I was getting junk mail from WellCare in Florida, so I ignored it. Little did I know that they had enrolled me into that plan without my knowledge. WellCare denied my exception for Toprol XL. I’m appealing the decision. They’ve had me on the phone for hours and lied to me. Silvercript (my former insurance) also lied to me. They told me that I had to pay $50 a month and I receive Extra Help. I looked it up, it was supposed to be $7.20 a month or zero a month. Unless I’m missing something. Anyway the bottom line is that WellCare won’t approve my exception and Silverscript approved it for years. I can’t afford the $50 premium for Silverscript. I can’t take the generics, I’ve had allergic reactions to them. There are no plan D’s with Toprol XL in the formulary that I saw. My prescription runs out in a few days and they want me to pay $138 for a 90 day prescription. I have no money as it is. I don’t know what to do, I’m afraid I’ll end up without any medication. I have heart problems and I collapsed at Logan AirPort in 1994. I’ve been on this medication ever since. What a crime, people have to suffer that are poor. I don’t have to state that, we all know that. I’ve been fighting and scratching for money and good health my whole life. Not to mention I was in a car accident recently and the health insurance is looking for $1000 from me for my Urgent Care visit. Does anyone have any ideas? You guys are great, you’ve helped me in the past. Thank you.

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I don’t have any advice. I just wanted to tell you that I also got a letter from Silver scripts more than a month after they claimed they mailed it. I guess suddenly now I have to pay for my part D coverage even though I have never had to do that before, and this letter was telling me that if I don’t want to pay I need to switch before whatever the cut off date was in December; unfortunately I received the letter weeks after the cut off date for open enrollment. So now I have to pay $10 a month until next year when I can switch.

Sounds like Silver scripts was holding the mail so they could screw people over.

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I don’t know if it’s still good, but when I had to pay cash for medication I used to go to the pharmacy at Costco and it was about 30% less than the regular chain pharmacies. And you don’t have to have a membership to use the pharmacy. But I haven’t had to do that in 10 years, but it might be worth calling them if you have one in your area.

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Re: Sleepy (# 1)

Thank You, that was very helpful. I will definitely look into that. Right now I’m spinning my wheels. I’ll try any kind of discount or program. I filed an expedited appeal to my exception denial. I don’t think I’ll get accepted. I meet all of the requirements but for some reason they are denying me. I can’t believe they have the power over someone that should be entitled to something. You talk about crooked. I’d like to sue them but there is some clause stating that you can only report them. What good is that going to do? A basically poor person with nothing, reporting a billion dollar insurance company. Now that’s a laugh. They can do almost whatever they want because they have money. They just have to pay a fine. In the meantime I hoping to somehow get my BP medication in a few days so I can stay alive. Have a good weekend

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Re: Sleepy (# 1)

I went through something similar. I guess the $10 is the premium. You can switch to the lowest premium plan. I was assigned to WellCare because of the premium. The premium is o. I don’t know if that is because I get Extra Help or if it’s just o in general. I know that there are plans with a lower premium. Call Medicare, they have all or most of the answers. If you switch out of the plan early I think there is a penalty.

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I appealed my denial for Toprol XL that wasn’t in their formulary. I requested an expedited appeal. I had to write out my whole history about the medication. A day later I received a phone call and a message. I was afraid to call them back but I knew that I had to. I asked the woman if I was approved, she said no. I was upset but I asked her why? She looked it up again and said I was approved. I was happy but dismayed. If I didn’t ask why, I would have walked away and been in a heap of trouble with my health. I still won’t be convinced until I get my prescription in my hand. I asked for a letter but she wanted to talk to my pharmacy. I said no because what I’ve been through, I figured things could get worse. She was a nice woman but that’s not the problem. I got two different answers within five minutes. If I didn’t question the first one, I would have never known that I was accepted. They are playing with people’s lives. Where is the regulation of these companies? From what I’ve experienced, I don’t see any. They seem to do whatever they want.

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Re: Sleepy (# 1)

I just want to tell you that you could be right about the mail. When I talked to Silverscript they weren’t the same people. They were rude and all they wanted to do is talk about is me paying a premium. If you want help I would recommend going through Medicare. These companies seem to adore $ over people.

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I appealed the exception denial. When I called them the woman told me that I was denied. I asked why? She said give me a few minutes to check. She came back and told me that I was approved. I got two different answers from the same person in five minutes. That’s scary. I still wasn’t sure if I was going to be able to pick up my prescription. Luckily I was able to pick it up. It’s hard to deal with these people.

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I wanted to know if anyone knew if Vitamin D causes mania In Bipolar people. I’ve had a lot of trauma in my life and I’m afraid to take it.

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Re: Russ (# 4)

No I can’t switch because the letter didn’t come until after the open enrollment period ended. They mailed it in time according to the date on the letter but I didn’t receive it until well after open enrollment ended. As far as I understand we can’t just switch plans in the middle of the year unless there’s some kind of qualifying factor.

But oddly I haven’t seen them charge me for February yet and it is the second. I don’t remember specifically what day the bill is due as I set it up for auto pay. Then I reapplied for extra help because I assumed I was getting the bill because extra help expired. I got a letter saying I don’t have to apply for extra help because I still have it, so maybe they made a mistake and I was not supposed to get billed in the first place.

Either way, the point of my post was that they sent the letter so late or the USPS took so long to give it to me I missed the open enrollment period so I am unable to switch until next year.

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Re: Sleepy (# 9)

When I spoke to Medicare, they told me that people with Extra Help don’t have to wait until the next Enrollment Period to switch plans. I think they said that they can switch every three months after the Enrollment Period. You might want to check with them.

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