Health Care - Who should pay

[For-Life]

One more insurance issue to add.

I just received a letter in the mail from my health insurance company today. In it they explain that due to the high cost of prescription drugs they are changing the Rx policy. Our plan was set up with $10 generics, $40 'formulary' brand name drugs, and $50 'non-formulary' drugs.

The new policy is $10 generics and the only brand name drugs covered were listed on just over half a page. If your brand name medication is on the list, you will pay $40 or 40% of the retail cost, whichever is higher. If your brand name drug is not on the list, you will pay the full retail price with no insurance coverage.

Luckily, the 6 different medications that my daughter has to take every day are all available as generics. However, there are no ophthalmic brand name drugs anywhere on the list.

The letter goes on to say, (paraphrasing) if the medication that you take is not listed, speak to your doctor and request to have your medication switched to one of the covered brands.

I couldn't help but notice that about 75% of the covered brand names were from a single manufacturer...coincidence??

With health insurance like this, we don't even need doctors. Next time I'm sick, I will just call the insurance company and ask what they want me to take.

Just something else that points to the fact that insurance companies are what is ruining healthcare.

You should watch the movie The Corporation. It discusses part of the drug costs in the US. I forget the main issue, but it had something to do with US drug companies being able to patent diseases. Therefore, would have the ability to be the only producer for drugs for those problems.

[bob_f_aboc]

Why watch a movie about it? I'm living it.

[For-Life]

Why watch a movie about it? I'm living it.

well it gives background information and talks about more than just drugs

[Spexvet]

...There is one situation that I remember hearing that happened in Oregon. A woman on Medicaid tried to make an appointment with her gynecologist for a yeast infection. They told her it would be about 2 months for an appointment. She then got the idea to go to the Emergency Room. When she got there, there was about a 12 hour wait. She left the ER and went home. When she got home, she called 911 and had an ambulance sent. I don't know what she told the operator when she called, but the ambulance was sent and she was taken to the hospital and seen immediately for her yeast infection. Total cost to her, $0. Time saved, 2 months.

The system is definately broken. But bringing everyone down the the lowest level is not going to fix it. When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.

Currently, we have a for-profit system, and we have to deal with this type of situation:

Doctors at UCLA determined she needed a transplant and sent a letter to Cigna Corp.’s Cigna HealthCare on Dec. 11. The Philadelphia-based health insurance company denied payment for the transplant, saying the procedure was experimental and outside the scope of coverage.
The insurer reversed the decision Thursday as about 150 teenagers and nurses rallied outside of its office. But Nataline died hours later.

[Spexvet]

...The system is definately broken. But bringing everyone down the the lowest level is not going to fix it. When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.

Do you accept Medicare at your practice?

[bob_f_aboc]

Do you accept Medicare at your practice?

Yes!

We still have claims from May of 2008 that haven't been paid yet. They have been submitted electronically and denied, submitted on paper and denied, submitted through a clearing-house and denied.

I can only imagine what this will be like when the government has its hands in ALL the insurance plans.

[Spexvet]

Yes!

We still have claims from May of 2008 that haven't been paid yet. They have been submitted electronically and denied, submitted on paper and denied, submitted through a clearing-house and denied.

I can only imagine what this will be like when the government has its hands in ALL the insurance plans.

Then you need training on how to correctly file the claim. Why are you blaming everybody/everything else but you? We participate with Medicare. They reimburse VERY well,(better than any for-profit plan that I know of) and we have very few problems getting paid. Try calling them directly - they'll help you get your claims right.