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Dewey

HMO battle

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So, have been battling with my HMO about soo many things.  I have several complaints in to Medicare too, but the thing with my HMO, they can refuse to send my medical records to CMS (Medicare) and Medicare will close my case, so unfair.

Yesterday,  I went over a 5 page letter of issues with my HMO.  One issue I have with their prescriptions, is that if I do not call in to refill a prescription in 3 months, they will automatically cancel the prescription and I have to go back to my ordering physician to put in a new refill for me.  I was trying to refill Medropred for my status migraine and found out the system automatically cancelled the prescription.  This is a PRN medication and I only take it as needed, but my HMO will not hold open a medication for more than 3 months before they discontinue my script.  I am outraged about this.

Also, with labs, my HMO will cancel a standing order if I do not go within 30 days to have labwork done.  Some months, I can barely get out of bed, let alone travel far to the lab.

I want to get away from this HMO, but I get free prescriptions and free co-pays and I never go into the donut hole as I am covered 100%.  The beauty of this HMO is that it's a cost plan thru Medicare and I can go outside the plan and see a specialist.  However, Medicare is going to stop this Cost Plan in 2020 because Medicare is paying out too much money (80%).  I want to start a secondary plan and drop this HMO but because of my cancer background, my monthly premium quoted to me was quite high. 

 There are many other issues I am battling now, will see how my HMO answers all my questions. 

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I don't' think Medicare allows 90 day fills of Schedule II meds but they seem to allow everything else in a 90 day fill, getting a 90 day fill would avoid having scripts becoming invalid.

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17 hours ago, notloki said:

I don't' think Medicare allows 90 day fills of Schedule II meds but they seem to allow everything else in a 90 day fill, getting a 90 day fill would avoid having scripts becoming invalid.

I have been getting 90 day refills until recently. Still looking into this.  Planning ahead and all my PRN's will continue to fill monthly.  Learning how to play the system with my HMO. 

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