So let me see if I've got this straight...

[theboss]

190. You're not insane

Unreasonable and irrational maybe. But so is every other person when dealing with their health care. I'm used to it. We do a terrible job in educating people how this actually works.

Case in point: I was in a meeting on ACA last month and we went on the healthcare.gov site and were looking at various plan options. Everyone in the room - all people who work in healthcare - gasped at the premium costs. I asked each of them how much they contribute to their plans on each pay period. Hardly anyone knew. I asked them how much their employers contribute. No one knew. I asked them to find out, add that together, and then figure out if the premium costs were out of line.

My advice:

1. Call Anthem and ask for a clinical specialist. Try to get temporary approval for the meds until the appeal process is completed.

2. Write an appeal - without profanity - documenting everything you were told at every step. Use the phrase, "We relied on this advice provided by your employee" repeatedly. Get a letter of medical necessity from your doctor to include in the appeal. If you can, find out what the industry standard is for the drug. Do other BCBS plans approve it? Medicare? UHC? Humana? Aetna? You can probably find the top five carriers in NH and use them as an example.

3. Find out what alternative treatment options are as a backup. Like I said, this sucks, but it happens to a lot of people every year.

4. Find out what is covered under plans in neighboring states and - I dunno - move to where there is coverage or something.

PS

My suspicion is that her prior coverage was a rarity.