Case #68056404

Decision:
The Appeal Committee has maintained Medica's denial of Ms. _insert my full name here_ request to waive the 20% coinsurance up to a maximum of $200 per refill, for her prescription of Betaseron.

Rational:
1. The Appeals Committee had determined that the change in prescription benefits that took place on July 1, 2006 was clearly outlined in the Certificate of Coverage, BPL#75295, Section G Specialty Prescription Drugs. Formulary specialty prescription drugs, such as Betaseron, are to be received from a designated specialty drug pharmacy and the member is responsible for a 20 percent coinsurance up to a maximum of $200 per prescription unit or refill.

2. The Appeals Committee understood that the benefit change has posed an economic hardship for _insert my full name here_. Unfortunately the Appeal Committee cannot change or amend the Certificate of Coverage.
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I love this. So under bullet number one because the change was CLEARLY outlined is suppose to mean something. To me now it's clearly outlined and is also clearly an example of bad policy.

The second bullet point is priceless. I love how they state it's "understood that the benefit change had posed an economic hardship"... they should have finished that sentence with "but we really don't care and we are lame"

What I find most interesting is that I had my appeal on Tuesday and on Wednesday I posted about it on my blog and today when I checked my site meter it showed up that someone from Medica actually read my blog. I am curious what that is all about. Maybe whoever from Medica has read this blog would care to comment?