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unblock

(56,126 posts)

1. when you say "benefits maximum", what do you mean?

Reply to Humanist_Activist (Original post)

Sun Oct 5, 2014, 03:35 PM

Oct 2014

do you mean the plan won't pay for absolutely anything, they're done? that i believe is not permitted.

or do you mean they won't pay for more than a certain quantity or refill frequency for a particular medication? this i believe does happen and is permitted, stupid though it may be. my own plan limits me to 12 zomig nasal sprays per month, and even for that i needed a "prior authorization". if i get a 13th migraine in a month i'll have to go to the e.r. and my insurance company will be out far more than they would be had they just let me get a few extra doses.

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Well this is a load of bullshit, just had someone exceed benefit maximum for prescription coverage.. [View all] Humanist_Activist Oct 2014 OP

when you say "benefits maximum", what do you mean? unblock Oct 2014 #1

They won't pay for any prescriptions for the rest of the year. Humanist_Activist Oct 2014 #3

Well, it could depend on the particular drug itself. Liberal Veteran Oct 2014 #2

I'm keeping things general, but this is NOT a drug you can stop taking, outside of some... Humanist_Activist Oct 2014 #4

looks like there are a few loopholes for the annual limits (though not on the ban on lifetime caps): unblock Oct 2014 #5

Were those loopholes part of the ACA or were they created by HHS after the fact? Wella Oct 2014 #8

at least some are in the aca -- unblock Oct 2014 #11

Then it will take an act of Congress--impossible now Wella Oct 2014 #12

Is it related to the Medicare drug benefit debacle? etherealtruth Oct 2014 #6

Most of the ACA regulations cover plans on the exchanges jeff47 Oct 2014 #7

I'm suspecting this is close to the truth, it is an employer plan... Humanist_Activist Oct 2014 #9

That explains it - jazzimov Oct 2014 #13

Sorry about this. I just posted this: Beware of Shifting Options Within Medicare Plans. elleng Oct 2014 #10

That is an excellent article, BTW. femmocrat Oct 2014 #14

Is it actually a ACA eligible plan? 99Forever Oct 2014 #15

HIPAA is Not Issue in Discussion if No Patient Info Involved Indykatie Oct 2014 #16