Hospice vs. Blue Cross. Gun fight at the not so OK corral.

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Well, as anticipated, when Mama's Xarelto required a new prescription, we are unable to get her prescription because Hospice and Blue Cross BOTH refuse to pay for the meds, saying the other one should pay...while they circle the wagons, Mama is stuck in the middle and I have been at the center of what has turned into a ridiculous debate over who shot John. I am not a doctor or a nurse, so when Blue Cross is asking me all these diagnostic questions, I can only answer with what I know...Mama broke her ankle, anesthesia did a number on her during surgery, she ended up back in the hospital right after Christmas, and subsequently while there was found to have extensive blood clots in her right leg....She has been relatively sedentary for the past two years prior and now is totally bedfast, so whether the clots were there prior, whether there could be others...I do not know...Bottom line, she started the Xarelto due to the discovery of the blood clots and now her prescription has run out. She was supposed to continue the meds, Hospice says they are not paying for it, Blue Cross says they are not paying for it...the pharmacy has been a godsend as they have given me a few extra pills while the arguing goes back and forth and now the meds are gone....totally gone...and no one will pay...NO ONE.....the doctor has allegedly done all the forms for the preauthorization, etc. and also supposedly has called Blue Cross, still each argues the other one owes and so no one is doing anything....I am beside myself....definitely not something I would have anticipated going through by our hospice provider...with this last development, I am finally realizing I think it is time to change hospice providers altogether....there have been other red flags along the way and this is kind of the final straw. In all honesty I see Blue Cross point, but either way, Mama needs her meds, they can sort that out themselves....our hospice folks told me this morning we can just pay for them ourselves....wow


Can your mom go on another anticoagulant? Or how about the generic, rivaroxaban?

After the first of the year, out of nowhere, one of my own prescriptions was all of sudden not covered. I had been on it for 15 years and I discovered that the insurance wouldn't cover it anymore after 4pm on a Fri. when nothing was getting done anywhere. But I desperately called my Dr., talked to several people, and they got me on the generic which was covered by insurance.

Where there's a will there's a way!
I don't know. I am trying to review the CMS guidelines for payment of Hospice Part A coverage and her Part D coverage. From what I have read thus far, it appears that the meds should be paid through her Hospice, but as this particular hospice griped about bathing foam the nurse had ordered and demanded it be pulled from my Mom, I am guessing a pricier drug is not going to be paid for...I am by no means a stupid person, but I am starting to feel that way. My mind is so overloaded already with all the things we have to do and remember and handle and now to be having to go through this ...I don't know...I don't really even know what to say.
Is it possible that this drug is no longer on BCBS formulary? My husband's doctor prescribed a drug that had to be the more expensive version, rather than generic. The drug is on the Medicare formulary but not on BCBS formulary. The doctor filed a formulary exception form, stating that the other two drugs they said for him to use had failed and therefore, he had to have this version.
It is my understanding the drug is on the BCBS formulary. Mama has been on it for three months since being on Hospice. The script needed to be renewed and that is when the chaos began. I just received a call from Mama's provider who said her drug had been approved and all I needed to do was call our pharmacy of choice and request the meds, which I did, and now am being told they are waiting for a script from her hospice doctor....it has all been so confusing...hopefully we're about to get it handled, but how sad to have to go through this kind of insanity with everything else we're dealing with....and as I am now finding out, Hospice could have handled all of this from the outset...I am thinking this provider is not very proactive...which concerns me going forward for if you cannot count on help when you go into crisis mode, where are you??? thanks for the info re the formulary exception form...you never know when we might need those.. :)

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