Dear HoG: Out of Network

Horizons in Hemophilia, November 2010

Dear HoG,
I recently had a change with my insurance coverage.  When I called to order factor from HoG’s pharmacy I found out you are not “in network” with my plan.  What can I do?
--Out of Network

Dear Out of Network,
Insurance changes can be scary for anyone with a chronic disease.  Any time you know there will be a change in your insurance coverage there are several things you need to consider.  How does your plan cover clotting factor?  Factor can be covered under your major medical or under a drug card.  Does your plan include your primary care doctor and your HTC?  Is there a lifetime maximum on the plan?  Do you have the ability to go out of network and, if so, what is the coverage level?  As you can see, there is a lot of information you need to know.  HoG may be able to fill your prescription on your drug card, saving your major medical.  Due to our non-profit status, we also may be able to negotiate with your insurance company for coverage.  Please contact Michelle Fitzwater, Managed Care Contract Specialist, at the HoG office so she can assist you with your coverage.