I dreaded signing up for the health insurance under Obamacare, because I figured it wouldn't cover the very expensive drug Xolair, that I'm getting for an off-label use. The drug costs me almost $10,000/year. I complained that with health insurance, people like me who have unusual problems fall through the cracks, and health insurance does everything it can to pay as little as it can and has caused me a lot of headaches and stress in the past.
I did sign up for health insurance, Blue Cross Blue Shield. But my predictions have come true - and worse!
The insurance company is indeed very unlikely to pay for Xolair for me - an allergist I'm seeing told me that it's very difficult to get Xolair covered even for on-label use. He thought I shouldn't even bother trying.
But ALSO, almost all my drugs are made for me at a compounding pharmacy, because I'm allergic to the usual fillers. I get sick if I take regular drugs. The pharmacy buys drugs in bulk powders from FDA-approved manufacturing facilities, and puts them in capsules for me, with a hypoallergenic filler.
My drug expenses are almost all of my health care expenses! Besides the Xolair, I pay roughly $6000/year for other drugs.
When I was shopping around for health insurance, I called this insurance company 2 or 3 times, and got several representatives to find out if the insurance would cover my compounded drugs. I told them I was allergic to the fillers, so the compounding pharmacy makes the drugs for me without the usual fillers.
Each time I checked, the representative got back to me and told me the compounded drugs should be covered, that they would be insured as "specialty drugs".
BUT, when I actually got some prescriptions refilled, I was told the insurance doesn't cover "bulk powders".
So the insurance isn't covering almost all of my medical expenses, and this health insurance would only be an added financial burden for me!!! At a time when I have horribly high medical expenses already, because of my allergy crisis.
I asked my doctors to fill out the insurance company's "medical exception request forms", to try to get my compounded drugs covered. However, a supervisor at BCBS told me she'd never seen that particular medical exception granted. A pharmacist at one of the compounding pharmacies told me the insurance company would end up covering the compounded drugs, they just want to make it really hard for people by making them fill out the forms, making doctors write letters, etc.
BCBS did a bait and switch with me. I sent a complaint letter to the state office that administers Obamacare.
So BCBS is acting exactly like those horrible insurance companies from my past - doing everything they can to wiggle out of paying claims.
The other Obamacare options in my area are no better about covering compounded medications, according to the pharmacists.
I may try to start a class-action lawsuit, because this is completely unfair! I cannot be legally required to buy insurance that doesn't help with my medical expenses.