As large corporations trim their health-care costs it is worth your while to read the fine print. If you start receiving booklet after booklet from your former employer it should raise a red flag.
Let me share what I found last year in my “fine print.”
Prescription Drug Plan Tied to Medical Annual Deductible
The selections given me last year during my “enrollment window” were AT&T Opt. 1 & AT&T Standard. While the columns clearly stated the deductibles that apply under each plan they did not state the provider and whether the provider was an In-Network or Out-of-Network provider.
My prescription drug coverage went from Medco mail-in to Caremark mail-in and the co-pays stated $8.00 for generic; $17.00 for preferred and $35.00 for non-preferred 90 day supply of medications.
What was not clearly spelled out is this. The medical deductible had to be met prior to the above co-pays being applicable.
Depending on the Opt. 1 or Standard selected the prescription co-pays did not apply until the $1100.00 medical deductible was met.
Imagine my surprise when the first shipment I received had a costs of $318.20 for Nexium that I previously the prior year had paid on $66.00/90 day supply.
Then mid-year the osteoporosis drug, Forteo which is a daily injection bone building drug was completely removed from the preferred drug list and would now cost $1200./mo. out of pocket.
Preferred Provider Caveat
We carefully chose our surgeon and hospital from the preferred provider booklet given my husband from FedBlue to ensure we were keeping costs down and staying within the network for his shoulder surgery.
Months later we received a bill from the Anesthesia and Radiologist Groups that performed work the day of surgery only to find they were not in a “preferred provider category.”
We went back to FedBlue and ask was it not a reasonable expectation to get preferred providers when following the booklet to chose the surgeon & hospital? Their answer was “no not necessarily.”
Needless to say we did not know or ask the morning of surgery if everyone involved in the outpatient procedure was from a preferred provider list. We simply didn't know we needed to ask!
Both of these bills were outrageous since they are under no obligation to accept negotiated fees.
Lesson learned: when signing all those papers make a note that you will not accept charges from anyone that is not considered to be a preferred provider by your insurance company. 
Mary Riggs is a Baby Boomer entrepreneur that wishes to share her experiences in business and in life.
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