Daniel Oquendo says he's the type of person who is always active, always doing something or working on a project. So, when he suddenly felt exhausted and not wanting to do anything, he knew something was off. Soon after, the pain started.
"Why is my jaw hurt? And you know, and then I felt the chest pain," Oquendo explained.
Days later, he was at the hospital with a heart attack.
"They said, 'you have a widow-maker'... my left side was clogged up," Oquendo said, recalling the hospital staff moving quickly to get him treatment.
Oquendo received several stents and is recovering. A big part of his recovery treatment involves medication.
But recently, he received a letter that made him think his medications may no longer be covered by insurance. That would mean he'd either lose access or have to pay a huge amount out of pocket.
He reached out to Let Joe Know.
The letter, from CVS Caremark, states the consumer's medications are being moved to a 90-day prescription supply program only being offered through CVS. If the consumer wants to use a different pharmacy, they have to actively opt out.
The part Oquendo found the most concerning reads: "If you don't take action, your medications will not be covered, and you'll have to pay 100% of the cost."
"How can you tell somebody where and when they can get their medication?" Oquendo questioned.
He says he has nothing against any pharmacy but doesn't have a CVS close by, while several other pharmacies are within a few miles.
"Why am I going to travel all the way out there?" he added.
We asked his insurer, Anthem Blue Cross Blue Shield of Kentucky, about the letter in general and why customers must opt out of a program they've never opted in to use. A spokesperson cited HIPAA privacy rules, stating, that without a release, they couldn't talk about anything related to Oquendo and pointed us toward CVS.
However, just days after we reached out, Oquendo says he received a call from his insurance. He says they explained the letter was meant to explain a possible cost-saving program for users with CVS, his insurer-preferred pharmacy, not a mandated change.
But Oquendo says it's just adding more stress.
"I said, 'you really need to change the wording on this because...I was worried I couldn't get my medication,'" he explained.
Oquendo says he opted out but will have to do it every year.
Have you received a similar letter? Do you have a problem or question you want us to look into? Email joe@abc15.com
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