Why U.S. health insurance sucks...

Discussion in 'Too Hot for Swamp Gas' started by bakaduin, Jun 21, 2013.

  1. bakaduin
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    bakaduin Moderator

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    My wife started having migraines recently. Basically has had some level of headache every day for the past 2 months but it has gotten pretty bad the last 48 hours so I finally convince her to go to the doctor. The doctor prescribes her medicine great! I go to pick it up later that night when it should be ready and they inform me that they can't fill it because they are waiting on a call back from the doctor saying how many episodes my wife has a month. It is of course after closing time so the medicine isn't getting filled today. I think this is a stupid pharmacy policy and the next morning call the doctor to get her to call over there and what not. I find out from the pharmacy it isn't their policy it is the insurance policy. I can get the medicine without insurance for a cool 160 bucks for 10 pills or wait until they approve it. Outcome: Wife still has a migraine and we are waiting on insurance. Someone needs to fix this broken system.

    END RANT.
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  2. G8trGr8t
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    G8trGr8t Premium Member

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    similiar thing happened with us. bought it and submitted a claim after the insurance approved it. a pain no doubt but wife with pain was much more painful. imagine the process when the gubmnt gets involved though. think drivers license bureau efficiency meets pharmacy
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  3. rpmGator
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    In the meantime, try ginger for movement symptoms and the herb butterbur has been found over time to stop the headaches.

    Ginger helps with all sea, car, and air sickness caused by movement. It helps some, not all.

    Riboflavin helps as does laying off sweets, dairy, meats and nuts.

    Try to find the cause and that may help.
  4. CHFG8R
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    CHFG8R Premium Member

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    Deductible increased by $1,000, payments by $10/Week and the addition of a $350 Prescription Deductible. Let me pay full price (Nexium, $300/One month supply) on first order then had the nerve to send me a letter letting me know that I was approved for "less expensive generic."

    FU! As far as they are concerned, I'm now a Porsche man when it comes to medicine. Got my doctor to change script to Dexilant (better and more expensive) and push it hard. They finally relented.

    What's sad is that both BCBS and myself have the exact same agenda. They don't want me to use their service and I don't want to use their service. I'm about getting it done. New script doesn't have to be taken every day and I actually use less (less refils). Same with my Chiro. I can go to her and solve the issue pretty cheap (One visit, about $60 total cost to BCBS), but they want me to go to the dumbass Ortho guy, who will just schedule a bunch of PT appointments. . . all of which are more expensive than the single Chiro visit.

    And if you don't think they've already figured out how to "game the system" with Obamacare, I've got some swampland to sell you at oceanfront prices.
  5. oldgator
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    tip for you and your wife in regards to the migraines.

    if you have any paint, paintings, objects around the house,etc that are a bright yellow in color(especially if there is bright light lighting the yellow) you can help her a great deal by getting rid of or covering the bright yellow objects. That color is particularly aggravating to people with migraines. Might want to also come up with a protocol for you to have for when she has migraines
    ---dimmer lighting
    ---setting up bedroom so that it is darker and quieter.

    ------

    in regards to the snafu with getting the medication---

    I'll probably shock some on here by not coming down hard on the insurance company on this particular incident.

    I attribute the foul up to the pharmacy and your MD. Chances are the pharmacy has had such issue with migraine meds in the past in regard to additional info insurance companies require. At the time you dropped off the prescription the pharmacy should have contacted the MD office for the info. Problem with this is that the pharmacy may have had a tech on duty and no pharmacist in the store at the time. In which case the incident is just another example of insurance companies setting added on criteria that impede timely delivery of medical care.

    Further complicating the matter is that each insurance company has its own set of criteria/parameters regarding medications, lab tests, surgeries, etc. For major drug stores this is fairly easily remedied(major drug chain can maintain a database the techs and pharmacists can readily access that has each insurance companies criteria required for medication to be dispensed. That sort of database is a breeze for large drug store chains. But for smaller drug store chains or mom and pop drug stores it would be impossible to set up and maintain. The sheer number of insurance companies combined with number of medications would make the task a nightmare to implement and maintain.

    The ideal solution for medications such as those for migraines and other non addictive meds(or meds not overly prescribed) is for the insurance company to provide for a 24-48 hour supply of the medication for the pharmacy to provide. But for additional medication the info from the doctor would be required.
  6. CHFG8R
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    FWIW, my mother was crippled by them and went the traditional route with no success. Finally found an acupuncture guy who has helped tremendously, not just with on-site treatment but a guide of foods to stay away from, etc. Rarely if ever has them now and it's been this way for almost 20 years (since she started going to this guy).
  7. PIMking
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    my fiance has been dealing with the migrane issue for months, finally they ended up finding out she had too much pressure in the ventricles of her brain and they put a shunt in her brain to relieve the pressure.
  8. g8orbill
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    I am surprised the pharmacy didn't give you one pill for the night
  9. mocgator
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    This is why my company is the fastest growing health care company in Georgia and one of the fastest in the country. We solve for this exact problem. PBM's are the devil. We help fight the devil while making sure a patient stays adherent to their medication protocol.
  10. CHFG8R
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    CHFG8R Premium Member

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    Who is your company? My company is HQd out of Atlanta and we're currently w/BCBS Ga. (even me, in Florida).
  11. brainstorm
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    If I remember correctly each state BCBS is independent. Some are good at approving and paying on time. Some are horrendous.
  12. mocgator
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    mocgator Well-Known Member

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    I got your PM.

    Anyone feel free to PM me about this.
  13. CHFG8R
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    Sweet. If my boss asks me what I'm doing right now, I'll just tell him "Networking."
  14. mocgator
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    mocgator Well-Known Member

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    Research...
  15. dadx4
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    dadx4 Well-Known Member

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    Ours does, they will give us a day or two if we have to.
  16. oldgator
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    "Ours does, they will give us a day or two if we have to."

    especially if the pharmacy contacts the MD. The MD would typically say go ahead and I'll have their required info to you ASAP.

    Thing is, those sort of requirements by insurance companies are just another example of their over-riding MD's who are the ones seeing the patient.

    In the instances cited in this thread the patient suffered additional pain needlessly. Other instances of insurance companies over-riding MD orders or delaying MD orders from being carried out have resulted in loss of life or limb many times over the years.
  17. philnotfil
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    The only problem with US health insurance is that people think it is there to help them get service. It exists to earn a profit for investors. It may also help customers get service, but that is a secondary concern. Approach it from the perspective that the insurance company wants to deny every claim that you file, so you need to learn exactly what you have to do to avoid being denied, and you will be able to get better services. It seems a little antagonistic for something like healthcare, but that is teh way the system currently works.

    At least it doesn't cost us twice as much for nothing meaningfully better than those other systems.
  18. RealGatorFan
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    True, but not all BCBS are for-profit. BCBS of AL is not-for-profit which means any profit in a year is added to reserves and some goes to infrastructure (and some goes to pay for losses). They have been resisting going public, since it would change their focus from customers to shareholders.
  19. Row6
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    My mother was covered by medicare for her last years and we never experienced any hold up or red tape in pharmacy pick-ups, procedure approval, or any other medical care.
  20. el_lagarto
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    which is why the program is going broke.

    insurance companies 'manage care'..which is why their overhead is so high, patients generally dislike them, and their ceo's make millions.

    medicare does not, which is why there is so much fraud and tremendous overutilization , AND PATIENT SATISFACTION, and impending shortfalls.

    somewhere in the middle is 'the truth'.



    its 2 polar opposite means of paying for//providing health care. one encourages too much care and one encourages too little care.

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