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Post by minx on Jul 15, 2018 11:31:45 GMT -5
Extra special edition just for Rally....
I already posted my rant about the whole CPAP thing. It's been a year since I complained to doctor #1 that I sleep all the time, and I am really no closer to an answer than I was before thanks to my insurance company's refusal to pay for proper testing in the first place.
Last week I went to get a prescription refilled (restoril - it's a sleeping pill). Got to the pharmacy, and the prescription wasn't there. Technician said my insurance had rejected the refill. Weird - I still had two left, and nothing on the policy had changed since the last refill. Pharmacist came out and said "Oh, we've appealed their denial of coverage - let me check on the status." Appeal successful - they filled my prescription (yay!)
Here's where you need to pay attention Rally
The original rejection reason boiled down to the nurse practitioners at BC/BS felt that I had been taking the prescription too long and needed to stop using it.
Yes, a NP who had never examined me or even seen my medical records decided that based on the number of years I have been on this medication that I had been using it long enough and needed to stop. They also decided this without any prior notification to either the pharmacy, my doctor or myself.
So a covered medication (which has no limitations on it), prescribed by a licensed medical doctor who I have a long-term relationship with, was rejected because someone at my insurance company decided I 'didn't need' it any longer.
Oh and the pharmacist said that unfortunately this happens 'all the time'. Just because they paid for this one refill, I shouldn't be expecting that they're going to allow it next month. Nice, eh?
The pharmacy said that as long as I have a legitimate prescription and it's not something that will cause a bad interaction with any of my other medications, they are happy to fill it, but I'd have to pay the full cost, which is $35.
I am lucky because I can shell out $35 for this, but not everyone is in my financial position.
It's great that we don't have faceless government bureaucrats deciding out medical fate though, eh?
(and FWIW, I still have no word from BC, and I was unable to call last week because work was busy, and I can't stay on hold for an hour)
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Post by k9krap on Jul 15, 2018 16:10:03 GMT -5
Yep. I go through this every year with my Restasis prescription, except I have to get my ophthalmologist to write a justification for it and send it to Blue Cross. And it’s $500 without insurance. Since I am able to get 2 or 3 doses out of the “one dose” vials, I was able to stock up on it this year so I don’t have to be without it like I had to be last year.
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Post by minx on Jul 16, 2018 9:25:40 GMT -5
Yeah - the pharmacist said that the doctor probably had to explain to BC that it was okay, but WTH?
I see the doctor again this Thursday, so I will ask then.
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Post by rally2xs on Jul 19, 2018 6:16:08 GMT -5
You said "every month." You might want to talk to your doctor and get him to make the prescription for 3 months at a time. I did that for a couple meds because my travelling for road rally, where it sometimes sees me gone for over 2 weeks at a time, makes a monthly refill to be a problem. I could run out in San Francisco, maybe - the "Highway Robbery" rally runs in Los Angeles this November, and then the as-yet-unnamed rallies in San Francisco run the following weekend. I need to slot 4 days to get out there, and 4 days to get back. I could run out...
OTOH, I have been taking these meds for about 3 years, and it turns out that, about once every 2 weeks or so on average I'll forget to take them. This means, over 3 years, I have a real pile of extra pills - about 70 for each of the pills, from not having taken them. I'm attempting to be more diligent and not forget, but I take them just before going to bed, and sometimes I'm tired enough that I just forget and crawl in the sack without taking them. If it keeps up, I guess I'll probably fire up Microsoft Excel and design a log where I check off each day as I take the pill, so I can be sure that I took it by marking off each day.
I don't seem to have any problems with BCBS refusing my blood pressure medicine or my blood thinner, its the blood thinner manufacturer's discount program that I have problems with. They changed the form that they use, and it confuses the pharmacy, and they end up trying to charge me the full $290 price. I think that's actually not the full price, just the portion that BCBS won't pay. I tell them no, no, no, I'm with Carepath, and they then go back and do it the other way, and it's $30. Early in the year, when this all started, I had to call Carepath, and then have them call Carepath, and then it got straightened out. I imagine eventually the manufacturer will ditch Carepath altogether and I'll end up paying the $290 / 3 months, but for this year, I'm good.
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Post by rally2xs on Jul 19, 2018 6:27:32 GMT -5
Oh,as far as the death panels thing, you are being f'd by your insurance company, not the gov't. With insurance companies, you can tell them, "f you, you're fired" and go get a better insurance company that pays what they are contracted to pay, or in other circumstances, sue their asses off. The problem with gov't making the payments is that if they refuse, you're screwed - you can't go anywhere else, at least under some "single payer" nonsense, so you just go without, and possibly die of they decide they don't want to pay. BTW, I've read that Medicare is the insurance "company" with the greatest incidence of refusing payment, far more than private industries. Maybe, maybe not, but either way, I wouldn't want to have to test it and lose.
As for the "existing conditions" problem, that's been fixed by Rand Paul's initiative to allow those in associations to buy group insurance. You are a baker, you join a baker's association. You're an EE? You join the IEEE. These associations are allowed to offer group insurance now, so if you become unhappy with one of the insurance companies servicing the group, you just specify a different insurance company. And of course if they P.O. enough people, I imagine they'd get thrown out of the program.
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Post by bobathon on Jul 19, 2018 6:38:41 GMT -5
Proving the point, rally. Why don’t you do some research into how easy it is to just swap insurance. Even for feds, who have a great selection, you get one chance per year. Now, do private companies offer a panoply of alternatives? Or do they mostly choose one provider?
Oh wait, you probably have no time to look into it. Washing the car, getting the paper from the end of the drive, hitting the Early Bird special, Dialing for Dollars - yeah, your day is WAY too occupied to do fundamental study.
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Post by rally2xs on Jul 19, 2018 6:50:49 GMT -5
I only _need_ once chance per year. And, in fact, BCBS has been quite satisfactory for the last 30 years or so, so I don't have a reason to switch. OK, I could maybe have used better insurance for my eyes about 8 years ago when I got the cataract surgery, and decided to go full Cadillac and get the multifocal lenses, which cost me $6K. But now I can focus close and far at the same time, which means the front sight and the target are both in perfect focus. Qualified 39 out of 40 on the M-9 and 79 out of 80 on the M-16 last time I went to Iraq, 'cuz I could _see_!!!
And, you may have seen my to-do list I put up yesterday. Yeah, I got LOTS better stuff to do than screw around looking up stuff on the internet. Got a couple of 'em done yesterday, one by deciding not to do something because it was too hard with marginal benefits, but there's LOTS of stuff behind those things.
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Post by bobathon on Jul 19, 2018 8:30:21 GMT -5
It was about everyone, and specifically minx’ situation, not yours. and she can’t get a scrip NOW, when is her open season to change? Don’t you get it? Don’t you understand how t works? Oh wait, you’ve shown us that you don’t get it.
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Post by Dave's Not Here Man on Jul 19, 2018 12:14:00 GMT -5
Extra special edition just for Rally.... I already posted my rant about the whole CPAP thing. It's been a year since I complained to doctor #1 that I sleep all the time, and I am really no closer to an answer than I was before thanks to my insurance company's refusal to pay for proper testing in the first place. Last week I went to get a prescription refilled (restoril - it's a sleeping pill). Got to the pharmacy, and the prescription wasn't there. Technician said my insurance had rejected the refill. Weird - I still had two left, and nothing on the policy had changed since the last refill. Pharmacist came out and said "Oh, we've appealed their denial of coverage - let me check on the status." Appeal successful - they filled my prescription (yay!) Here's where you need to pay attention Rally The original rejection reason boiled down to the nurse practitioners at BC/BS felt that I had been taking the prescription too long and needed to stop using it. Yes, a NP who had never examined me or even seen my medical records decided that based on the number of years I have been on this medication that I had been using it long enough and needed to stop. They also decided this without any prior notification to either the pharmacy, my doctor or myself. So a covered medication (which has no limitations on it), prescribed by a licensed medical doctor who I have a long-term relationship with, was rejected because someone at my insurance company decided I 'didn't need' it any longer. Oh and the pharmacist said that unfortunately this happens 'all the time'. Just because they paid for this one refill, I shouldn't be expecting that they're going to allow it next month. Nice, eh? The pharmacy said that as long as I have a legitimate prescription and it's not something that will cause a bad interaction with any of my other medications, they are happy to fill it, but I'd have to pay the full cost, which is $35. I am lucky because I can shell out $35 for this, but not everyone is in my financial position. It's great that we don't have faceless government bureaucrats deciding out medical fate though, eh? (and FWIW, I still have no word from BC, and I was unable to call last week because work was busy, and I can't stay on hold for an hour) Similar to my problem with my psycho. I had a lapse in coverage because I dropped the ball on something wrt the marketplace wanting some documentation. Finally got that resolved and policy is back in effect, so I can communicate with her again. I let her know that changing any of my scripts in any way without consulting with me was unacceptable. She wrote back (I wrote her so there'd be a record of the conversation) that her change was consistant with my usage and then tried to excuse it as "this drug is not for long term use and is only supposed to be for emergency/breakthrough anxiety"....... Well, I have been taking Ativan on a nearly daily basis for a decade, 4 years of which being under her care. So what it is is that the paper pushers, the lawyers, the accountants, the administrators, and the lawyers (yes I know it was twice) are making rules for the dispensing of these meds and probably hold it over the heads of the physicians. It's Kaiser so I'm using that in the same context of your insurers, like Anthem or whoever. |
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Post by k9krap on Jul 19, 2018 13:17:47 GMT -5
Ativan is one of those “controlled” drugs. My surgeon really balked when I asked him for some to take home after my last surgery. It really helps with the restless legs. He gave me 12, I think.
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Post by minx on Jul 19, 2018 13:31:17 GMT -5
Um Rally, my doctor writes me a FOUR MONTH prescription. That is not the point.
The point is that this is a COVERED medication, and was prescribed by a licensed medical doctor. The dosage is consistent with the manufacturer's recommendations.
So why should BC be the one who decides my medical needs?
As for saying F-U to them, don't make me laugh. I am extremely fortunate to be married to a federal employee, so I can switch coverage once a year to a different carrier should I choose.
As an employee of a private company, I can also make a change once a year as well - I get to decide if I want to pay for their insurance, or decline it. Regardless of what I choose, the carrier will always be United HealthCare, unless my employer finds a cheaper policy through someone else.
You truly need to wake up to reality. The ONLY time I have ever seen a 'choice' in carriers was with the Federal Government. I worked in healthcare for over a decade, and no employee gives you a choice between what carrier to choose - just the level of coverage that particular company will give you. And of course, those people are the lucky ones - they have a job that will provide insurance and pick up part of the cost.
Maybe you should venture out of your bubble and find out how others live, especially those with chronic medical conditions.
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Post by rally2xs on Jul 19, 2018 14:29:48 GMT -5
"Um Rally, my doctor writes me a FOUR MONTH prescription"
So why the remark about fighting with them every month? This should be an every-4-months fight.
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Post by k9krap on Jul 19, 2018 14:43:00 GMT -5
I think she means she gets a scrip good for 4 months, but refilled monthly.
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Post by bobathon on Jul 19, 2018 15:48:17 GMT -5
"Um Rally, my doctor writes me a FOUR MONTH prescription" So why the remark about fighting with them every month? This should be an every-4-months fight. It shouldn’t be a fight *ever*. That’s been the point from the get go. |
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Post by minx on Jul 19, 2018 15:54:43 GMT -5
It shouldn’t be a fight *ever*. That’s been the point from the get go. Thank you! If a service is covered by my policy, I shouldn't have to argue if it's necessary, especially if a licensed doctor is prescribing the service. I did finally get an 'authorization' from BC - it's good for a year. And I don't do mail-order prescriptions or fill more than a month in advance - my medications have been changed often enough that I don't want to waste money on refills I won't use. |
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Post by Dave's Not Here Man on Jul 19, 2018 15:55:05 GMT -5
Um Rally, my doctor writes me a FOUR MONTH prescription. That is not the point. The point is that this is a COVERED medication, and was prescribed by a licensed medical doctor. The dosage is consistent with the manufacturer's recommendations. So why should BC be the one who decides my medical needs? As for saying F-U to them, don't make me laugh. I am extremely fortunate to be married to a federal employee, so I can switch coverage once a year to a different carrier should I choose. As an employee of a private company, I can also make a change once a year as well - I get to decide if I want to pay for their insurance, or decline it. Regardless of what I choose, the carrier will always be United HealthCare, unless my employer finds a cheaper policy through someone else. *You truly need to wake up to reality. The ONLY time I have ever seen a 'choice' in carriers was with the Federal Government. I worked in healthcare for over a decade, and no employee gives you a choice between what carrier to choose - just the level of coverage that particular company will give you. And of course, those people are the lucky ones - they have a job that will provide insurance and pick up part of the cost. *Maybe you should venture out of your bubble and find out how others live, especially those with chronic medical conditions.*Good luck with that. *And that. Just wait until we have the pro big business conservative SCOTUS ruling on pre-existing conditions, coverage caps, and ultimately the final nail in affordable health care. I'll bet anyone here or anywhere a 1--- bucks there'll be no new laws allowing competition across state lines, measures to reduce prescription drug costs like purchasing from outside the US, and they have already pissed on tax credits/reductions/deductions for medical costs. WINNING (if you're really fucking fortunate, but most will not be)!!! |
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Post by rally2xs on Jul 20, 2018 5:27:11 GMT -5
"Um Rally, my doctor writes me a FOUR MONTH prescription" So why the remark about fighting with them every month? This should be an every-4-months fight. It shouldn’t be a fight *ever*. That’s been the point from the get go. True. |
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Post by bobathon on Jul 20, 2018 8:49:42 GMT -5
So today it’s my turn. My insurance won’t cover the dosage med my doctor prescribed, no matter how many times they resend the scrip. I’ve neen on it for a couple years at this dose. The insurer wants me on a higher dose. I JUST had a blood check, and it shows the current dose is effective. Why does my insurer refuse to cover the lower, effective dose? Why do they want to overmedicate me? They want a 10% increase. Did they see something in the blood test my doctor missed?
No, the higher dose is cheaper. So there’s another bean counter playing doctor. Hooray. At least it’s not an opiate.
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Post by minx on Jul 20, 2018 9:27:33 GMT -5
Ugh Bob - I am sorry. Fighting over a legitimate prescription is the total suck for sure. One relief for me was when all my mood stabilizers finally went to generic versions. Not only did the price drop dramatically (we're talking a $250 copay to a $30 copay), but I was able to relax and not worry that BC would reclassify them to a more restricted tier due to their price. And John, I totally hear you on the pre-existing conditions. I have never worried about rent, transportation, or even food to the extent that I have worried about continuous health insurance coverage that provided benefits for both prescriptions and mental health. I started out working for BC after college, and it was truly scary. Had to tell lots of people that things like cancer weren't covered because they must have had it before the plan started, so it was considered 'pre-existing'. I think the worst one was having to tell a father that we would no longer cover anything for his 16 year old schizophrenic daughter on ANY plan because she had met her lifetime maximum for mental health coverage. The poor guy just cried on the phone - I was on with him for close to an hour while he told me her heartbreaking story, and how her illness had shattered their family - they had already filed bankruptcy due to medical bills (mind you at the time we were covering 50% of her care), and he and his wife were divorcing - the stress had been too much for their marriage  THIS is the reality that every American with a chronic condition faces. Why don't more people seek mental health treatment? Have you looked at the price of a therapist? Last I checked it was $90 an hour, and you don't visit them once a year. Psychiatrist? Mine charges $250 for a medication check. We won't get started on the price of most psychotropic medications, especially since you'll be likely to either have to take a combination, or you'll cycle through more than one type before the right combination is found to help you. When you have no insurance, or crappy insurance, then you just skip it and try your best to make due. Of course, this also assumes that there is a qualified mental health professional within a reasonable driving distance. You'd truly be amazed how rare that is. Goes for a lot of people and a lot of different types of doctors. A large portion of Americans live in a 'medical desert' - no doctor nearby. |
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Post by Dave's Not Here Man on Jul 20, 2018 10:44:56 GMT -5
That is mind blowing, Bob. And there's people out there who want the government out of making healthcare decisions, but say nothing about shareholders.
Maybe get the higher dose and cut the pills in half? Yeah, the Walmart Way.
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DA
mob associate
Hello? Is this thing on?
Posts: 589 
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Post by DA on Jul 31, 2018 21:43:45 GMT -5
I'm glad I didn't get rid of my old medications from my surgery. Back/hip went bad from stretching in bed to where I can barely walk and have to rely on an old prescription which is 5 years past the use by date. Between that and some older NSAIDS I'm hoping I can get some relief for this. It is better today than it was yesterday, but not sure how much more of it I can take. Just thought I would add my pain and suffering to the mix. Carry on my wayward son.
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Post by bobathon on Aug 1, 2018 2:51:39 GMT -5
Oh yeah. My dentist prescribed me norco. Nobody had it, and they wouldn't tell me who did, I was going to have to drive around until I found someone who did. Old percocet filled in.
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Post by rally2xs on Aug 1, 2018 3:08:08 GMT -5
I was going to have to drive around... "Let your fingers do the walking through the Yellow Pages, Read the Ads, Learn the Facts, Find it Fast!" <G> |
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Post by Dave's Not Here Man on Aug 1, 2018 10:07:06 GMT -5
Oh yeah. My dentist prescribed me norco. Nobody had it, and they wouldn't tell me who did, I was going to have to drive around until I found someone who did. Old percocet filled in. Seriously? I guess pretty soon the only way to treat pain will be meditation and prayer. Or pay 10 grand to go to the ER with a gaping wound, which might get ya a Tylenol 3. |
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Post by k9krap on Aug 1, 2018 16:37:11 GMT -5
GoodRx.com.
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Post by minx on Aug 1, 2018 16:42:12 GMT -5
I blame people like my mom's doctor - mom went in a while ago, and said that her legs hurt (she's diabetic, and also has edema). My suspicion was a pulled muscle.
Anyway, doctor gives her vicodin! WTF? Not only that, the prescription is for 30 pills and says 'take as needed' This is for an 80 year old woman!
Year before last we went to France. Before we left, she was complaining that the doctor hadn't sent her vicodin prescription in time. Huh?
Turns out that every time she traveled, this quack was giving her a prescription, because her legs would ache from walking around the airport and being on the plane! And yes, 30 every time.
Mom would take one when she got to the hotel after dinner. Then the next day she'd be totally out of it. I always thought it was jet lag.
Just makes me wonder how many of her patients are addicts now. My mom was shocked when I told her that most doctors wouldn't prescribe something like that in the first place, and if they did, it would be a one day supply at most.
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Post by k9krap on Aug 1, 2018 17:00:34 GMT -5
Who is her doctor? LOL. May be worth the travel time!
There’s a doc in Fredericksburg that used to give out meds - anything you asked for. Shortly after I started seeing her, she has tightened up. Grrrr.
Actually, I’m looking forward to being relatively pain-free, or as pain-free as lupus allows, after my knees heal. It’s been so long I’m not sure what living without pain feels like. And I think that the restless leg issue will subside once the pain is gone. I’ve noticed that it has pretty much already in my right leg. Of course, now that I say this, I’ll be miserable tonight.
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Post by minx on Aug 2, 2018 9:32:15 GMT -5
I don't know if she dispenses them like candy anymore, but it totally blew me away. She also did the same with antibiotics - have a sniffle? Here's some amoxicillin.
My poor mom developed c-diff from taking too many antibiotics, and now can only take them in very rare situations. Yet, she loves this quack, because she's so nice and has a great bedside manner. Personally, I'd rather have someone who is matter-of-fact and doesn't over-prescribe shit I don't need.
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