I have chronic migraines, which are treated with Botox and Nurtec, and severe eczema and asthma which are treated with Dupixent. If I don’t have access to these medications leaving the house is near impossible between the migraine pain and asthma attack triggers. With these medications I can fully do my job as a firefighter just as well as the rest of my crew.
That being said, I’ve been offered my dream job and they get insurance through Anthem BCBS. I’ve only ever heard bad things about them, including horror stories about other migraineurs showing up to their Botox appointments only to find that they can’t get their injections because Anthem is so far behind in paying the office. If something like that happened, I would legitimately lose my job as I wouldn’t be able to perform my duties or even show up to work.
Can anyone speak to if I would do okay with Anthem? Or is there another option? I’ve already looked into individual plans and since I’d be ineligible for the tax credit as I’d have employer offered all of the ones that cover what I need would be roughly 1/3 of my income.
ETA: my concern is not getting the medications covered, while I don’t know the specific plans offered, I did look up multiple formularies for Anthem BCBS plans in my state (Maine) and I am eligible under their prescribing guidelines. I’m concerned with delays in care, Anthem suddenly getting dropped from doctors offices, excessive waits on prior authorizations, things that might prevent me from having access to medications that eligible for.
Each insurance plan has its own medical guidelines for Botox and medications, so no one can say for sure. You’ll need to check your plan’s guidelines for Botox. Your doctor will also need to submit a pre-authorization request for it. If the request or any appeals get denied, Botox offers a savings program.
You’ll likely need a pre-authorization for the medications as well.
The issue with BCBS is that it’s made up of many different insurance companies under one brand. If your feedback is from Anthem BCBS in your area, it’s likely accurate, especially if you use your insurance a lot. My experience with BCBS hasn’t been great. While 97% of my cancer treatment bills have been fine, 3-5% were denied without reason, leading to about $18K in denied bills. It’s also been hard to get appeals processed and get enough info on the claims to appeal them properly.
I have chronic complex migraines, which turned out to be part of a rare degenerative neurological disorder that spread to other parts of my body. I tried treatments like Botox, Nurtec, Qulipta, Emgality, and Ubrelvy, all while on an Anthem BCBS plan. At the time, I was on a marketplace plan in Virginia when my migraines became chronic, and I needed specialists to figure out my symptoms.
Dealing with Anthem BCBS was a nightmare. I’ve had more than twelve appeals against their “medical” decisions, and I’m still dealing with them. Managing my illness became my full-time job since I couldn’t work anymore. Just because you meet medical guidelines for Botox or Dupixent doesn’t mean they won’t deny prior authorizations to delay treatment and save money. They often list providers as in-network, only to change that after the bills come in. You might be on a medication that works, and then they change the formulary, so it’s no longer covered.
Make sure the staff at your doctor’s office who handle prior authorizations have all your medical records ready on the day your plan takes effect. Ensure your doctor is prepared to do peer-to-peer discussions if Anthem denies any appeals. Stay on top of the process, help your doctor’s office where you can, and know how to report insurers in your state. Keep a detailed log of every call you make to Anthem, noting dates, times, and names. Hopefully, you won’t need to do all this, but I found it necessary with Anthem. I’m a trained attorney, and even after reading all the fine print, we ended up switching to a different insurer in 2024. While no insurance is perfect, it has been a huge improvement.
How much leverage do you have with your new job offer? Can you discuss with HR that you might need their help to address insurance claims, or else it could impact your work performance or make you eligible for ADA accommodations? I know a few people who took lower-paying jobs because HR was willing to accommodate their specific healthcare needs, such as special coverage or network exceptions.