Pretty sure I literally gave myself shingles by stressing about turning 26 this month and losing BCBS PPO+. Getting Cigna OAP through work. Please help ease my mind!
Hi! I am 26 year old female and my state is Illinois.
I’ll try to keep this short so it’s digestible. I use my healthcare a lot. I see a psychiatrist once a month and a therapist a few times a month. I take medication, I have been dx’d with ADHD, depression, and anxiety. Right now with my health insurance usually everything is quite affordable. My copays are usually $20.
I was completely freaking out because 1) my therapist does not take anything but BCBS and I can’t really afford to pay like $130 a session 2) I take Vyvanse and my work offers “pharmacy 3 tier value” through Cigna. Vyvanse is NOT covered through this list.
I do not want to switch off Vyvanse. I took adderall in college and it made me (literally) want to die. I’m paying $40 a month for it as it stands (with my current insurance, it would be $100 but I also use a savings card from the brand)
I will only have to pay $87 a month at work for the plan, there is only one plan option. I work for a huge company with thousands of employees, and I believe they subsidize the health care costs more than other companies do (at least this is what I’ve heard).
Here is some plan info
Deductible info
In-Network $1,450
Out-of-network $2,900
“Amount employee contributes to your account: up to $500/individual…” (idc about the rest because I’ll be the only one on the plan)
In-network preventive care, immunizations, in-network prescription drugs, emergency room visits covered before deductible met
Out-of-pocket limit for the plan is $4,450 in network and $8,900 out of network.
Coinsurance is 10% for in-network providers and 30% for out-of-network providers
Prescription info
Generic (tier 1): $10 copay/prescription
Preferred Brand (tier 2): 25% coinsurance, not less than $35 and not more than $70
Non-preferred Brand (tier 3): 35% coinsurance, not less than $55 and not more than $110
It mentions on the drug list that you can have your doctor request approval for the drug you are taking if it’s not covered. But I don’t understand how much Cigna would cover it.
Does the deductible mean that for my therapy appointments, I will have to pay $130 per appointment until I meet the out of network deductible? I also don’t really understand what the “account” my employer contributing to is. Can I contribute money to it and is that taxable? What can you use the money on?
I can’t find it at the moment but there was something about “transfer of care” for doctors. Would this apply to therapists? I just can’t see myself going to a different therapist. I will make my pocket hurt and just go less if I have to pay $130 a session.
Thank you very much for any insight you can give. I feel very overwhelmed by all of the terms and things there are to understand. As I said in the title… I have shingles right now, and I am not immuno-suppressed so I am not surprised if the stress of all this is what made it pop up.