These are some of the most frequently asked questions the Fund receives:
Q. How can I tell if my doctor's in the Personal Choice network?
A. Check the directory you received from Personal Choice or, even better, visit the Blue Cross website at www.ibxpress.com. You can find participating providers, you can check on the status of your own claims, you can read about the latest breakthroughs in medicine. There's a lot of good information on this website. Don't hesitate to take advantage of it.
Q. What's a "formulary" drug?
A. It's a brand name drug on a preferred list of eligible drugs. The Fund saves money when you use formulary drugs because we get rebates from the pharmaceutical companies. For some great information about formulary drugs, log onto the ExpressScripts website at www.express-scripts.com.
Q. My medicine isn't on the formulary list. What else can I take?
A. No one in the Funds Office has the background to advise you on what alternatives would work for you. That's between you and your doctor. Show your doctor the formulary list you received with your prescription card. Ask your doctor if one of the less expensive, formulary brand name drugs would be appropriate for you.
Q. I use the mail-in prescription program. How much do I have to send with my prescription?
A. There are three mail-in copays, depending on whether your drug is generic, formulary brand or non-formulary brand. The best way to get the exact cost is to log on to ESI's website at www.express-scripts.com. Or you can call ExpressScripts at 1-800-467-2006. If you send less than the prescription costs, ExpressScripts Home Delivery Service will fill your prescription and send it to you, then bill you the difference between what you paid and what you owe.
Q. I always got a three month supply at the pharmacy and now they're telling me I can't.
A. They're right. You can't. If you were able to get a three month supply at the pharmacy, that was a mistake. The Plan has always had a limit of a one month supply at the pharmacy level. If you want a three month supply you can either use the mail-in program or return to the pharmacy each month. Using the mail-in program will save you money.
Q. Are injectibles covered under our prescription plan?
A. They are now. If the injectible medication is for chemotherapy or diabetes it is covered under the flat copay of $10, $20, or $40, depending on whether it's generic, formulary brand or non-formulary brand. If the injectible medication is for anything but chemotherapy or diabetes, it is still covered under your Prescription card. But instead of a flat copay, you will pay 20% of the price of the drug.
Q. I'm on Medicare and I don't understand this new deductible.
A. The Welfare Fund has always paid your in-patient and out-patient Medicare deductibles. Effective July 1, 2003, the first $250 in payments that the Fund would pay will instead be applied to your annual Welfare Fund deductible.
Q. Do I still have to send my Medicare statements in?
A. Absolutely. We need to process each claim so we can calculate whether or not you've met your deductible. With each claim we process we will send you an Explanation of Benefits (EOB) that shows your annual deductible, how much of your deductible has been met, and whether or not any payment was made.
Q. Am I going to have to pay the $250 deductible again in January?
A. It depends on when you meet the $250 deductible threshold. The $250 annual deductible is based on the calendar year January - December. However, any part of the $250 deductible that you meet in the last three months of the year (October-December) will be carried over toward your January deductible. For example, let's assume you meet $100 of your deductible in August, $50 of your deductible in September, $75 in October and $25 in November. The $75 and $25 we applied to your deductible in October and November will be "carried over". Beginning in January, instead of having to meet a full $250 deductible, you will only need to meet $150 ($250 less $75 less $25).
Q. How do I know what I owe my doctor?
A. Wait until you get a bill! There's no reason to pay a doctor or hospital until you receive a bill showing what Medicare paid and what the Welfare Fund did (or did not) pay.
Q. I'm on the Standard Dental Plan. Can I use any Dentists I want?
A. Yes. BUT if you use a Fidelio participant dentist you will receive a discount on your charges and this can mean less out-of-pocket expense for you. To find out if your dentist is participating, call Fidelio at 1-800-262-4949.
