I signed up for an Advantra Freedom 5 Medicare Advantage plan in March 2009. An independent agent told me that the Orencia treatment I was taking was fully covered with no co-pay. Prior to that I was on a plan that did not charge a co-pay for Orencia treatment at a cost of $61/month. The agent advised me there was no monthly charge thru Advantra and the Orencia treatment would be covered without a co-pay. My first treatment was in March 2009 and Advantra sent me an EOB with a copay of $314. I immediately contacted the agent and advised him of the copay. He advised me he had other clients on this same treatment that did not have a copay. I appealed to Advantra and was notified on 6/16 that the copay does apply. What are my legal rights to appeal or sue for the cost of the copays. My treatment is done once a month so this will be an ongoing problem until resolved.
