I'll try to give a little insight to your situation. In no way am I saying it's okay, but I just wanted to respond.
1. The insurance companies have "preferred" pharmacies, that they have worked out some sort of deal that steers their subscribers that way. All of them do it to a certain extent. Most are pushing for the mail-order pharmacies.
2. The waiting list to see the new pcp is an unfortunate byproduct of less and less interest in the medical profession as a whole (My own observation). But no doctor is going to prescribe medication to a patient they have never seen.
3. It isn't "illegal" for the cardiologist to see you without a primary care referral. Your individual plan may require referrals. I know it can be frustrating, but this is caused by rampant overuse of benefits over the years by doctors and patients. it's the insurance plan's way of making sure you "need" the cardiologist, to keep total patient costs down. If you're barely seeing the cardiologist, consider seeing if your pcp is willing to prescribe and monitor it.
4. As far as the excessive 112,000 bill, I will assume that was the actual bill and not an explanation of benefits. That's why the No Surprises Act was enacted in 2022. It's meant to prevent those crazy bills where you are seen at an in-network facility but treated by an out-of-network doctor. You have to be given prior warning by the hospital that you are going to be treated by a provider that may be out of network with your insurance. Now most of them probably put it in the small print when you fill out your forms, so you or your loved ones have to be diligent.
5. For your Eliquis co-pay, I would have to know more about your specific prescription plan, but generally speaking... If your copay is that high, your insurance may cover the generic Apixban at a cheaper cost. Or, they should have a cheaper covered alternative. Like Pradaxa, Xarelto, or Warfarin. You also mentioned using CVS, are you using a local brick and mortar CVS? A lot of plans now want you to send it to CVS Caremark mail-order. A lot of times there is no copay, or a much cheaper one. You may also have a deductible for prescriptions built into the plan as a way of keeping the monthly costs down. It may be to your benefit to look at a slightly higher plan that would end up being cheaper in the long run when you factor in prescription costs.
Just some thoughts.
Had bladder and prostate cancer years back so these are Urostomy bags/pouches . Why send me back to a surgeon that performed this 3+ years ago ? What are they thinking , that this operation will heal itself and I no longer need the supplies ?
