Surprise Emergency Room Bill

I’ll put this here

This sounds like an absolute total nightmare

If we aren’t going to go single pay or at least make it do stuff like this doesn’t and can’t happen
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When you take up residency in Cancerland, as I did when I was diagnosed with Stage 4 lung cancer in 2020, you regularly hear yourself described as “battling” cancer.

With my one-pill-a-day biomarker-directed therapy, I prefer to say that I’m “tackling” cancer. But if I am at war, it’s with an insurance system that works more like an extortion scheme.


In mid-January 2022, my phone rang early in the morning. This is my recollection of that call.


“Hi, this is Unintelligible Name from SaveOn.”

“Who? I don’t use Sav-On pharmacy.”


“We’re not Sav-On pharmacy, we’re SaveOnSP, specialty pharmacy.”

SaveOn is pronounced exactly the same as Sav-On, just to be more confusing.


“I just changed insurers,” I said, “and I’ve been in close contact with my new plan. They contract with Express Scripts, who’ve assigned Accredo as my specialty pharmacy.”


“Yes, and we’re your specialty pharmacy’s specialty pharmacy. If you don’t sign up through us you’ll be charged the full amount of your co-pay of $4,500 every month for your specialty medication. We have all your information. You just have to verbally consent to let us manage your account.”

I was stunned and so sure this was a scam call that I neglected to ask how they had arrived at this $4,500 co-pay, and how that could even be possible because that number was larger than my plan’s deductible and out-of-pocket maximum.


“You’ll receive a bill, but don’t pay it,” my caller continued. “Working with us ensures that you have a zero co-pay.”


“Okay?” I replied. Was there a real choice?

I’ve had lengthier consent discussions for a one-time hookup. I promptly forgot about the call and received no paperwork, but a few weeks later my monthly shipment of medication arrived along with an invoice from Express Scripts for $4,445.

It noted that I might not owe this amount; nevertheless, it had a detachable payment slip, and a return envelope was provided. Remembering the caller’s assurances, I tossed the bill into my ever-expanding, supersize file I’ve labeled “insurance gobbledygook.”

But when I visited an ATM the next day, my balance was significantly lower than I expected. $4,445 had been deducted by Express Scripts.

After I discovered that ginormous deduction from my account, I spent the majority of my waking hours that week ping-ponging between customer service representatives of my insurer, Express Scripts and Accredo.

(The name SaveOnSP appeared neither on my invoice nor on my account portals at Express Scripts and Accredo.)

I was transferred so many times in my crusade to satisfy the gods that govern the peculiar ecosystems of customer service call centers — which require you to offer up your member ID, Social Security number, date of birth, Zip code and sacrifice of the first born, and shriek “operator” over and over into the void — that I can’t remember which representative informed me that they didn’t show me as being enrolled with SaveOnSP…….

https://www.washingtonpost.com/outlook/2022/09/09/insurance-copay-specialty-medications-cancer/