DISQUS

AMERICAblog: BlueCross just cut off my prescription coverage for the year

  • Blissable · 1 year ago
    BlueCross refused to cover a surgical procedure I had a couple of years ago on my left leg for a vascular problem. Medically necessary. The doctor wrote up a complete justification & history of the condition. I'd had the same procedure 10 years prior, but this time it was deemed "experimental" by BlueCross and therefore not covered. I had to cough up $4500 on my own. They covered nothing. Why bother even paying premiums?
  • RevDrBillyBob · 1 year ago
    You're going to be going to Europe SOONER than 20 years from now, dude.
  • GaJimmy · 1 year ago
    I have Blue Cross and have given up except for emergencies. Try pricing your drugs out of Canada (I use CanadaDrugs.com - that is not a plug for them but I can vouch from experience they are reliable and real). I take Welbutron and a month supply here in the US costs $170 and BlueCross does not cover. I can get a three month supply from Canada for $150.00 - exact same stuff.

    I have never had problems with customs or anything like that. It never hurts to give them a call.
  • JohnInTexas · 1 year ago
    I have BCBS and have never had a problem. I have had Aetna in the past, and others, and this is the best and Aetna was really good. Mine is through the company I work for, not for self employed, but I would think the same plans would be available for either. (I take 6 prescriptions daily, and out of pocket would be about 2500.00 a month - BCBS my cost is about 200.00).
  • judybrowni · 1 year ago
    EVERYONE thinks their health insurance is good, until they have an illness or health concern that their insurance company just. doesn't. feel. like. covering.

    EVERYONE I know who got really sick, or racked up an expensive care situation, has been unhappily surprised.

    Ya know what the Canadians say about us? "America is a great place, unless you get sick, or old."
  • JohnInTexas · 1 year ago
    I have HIV, high triglycerides, hypogonadism, insomnia, high blood pressure and of course...drum roll depression. If you think my insurance is not excellent, when the cost of the one HIV medicine ALONE is 1500.00 a month, the testosterone replacement is about 750.00 a month...those are 2 meds alone. The lab every 4 months is about 500 to 700 dollars, 90% is covered. I am healthy, have a good job, and GOOD insurance. My part of the monthly premium is about 160.00 a month, my employer pays the other 60%. Don't tell me what "really sick people" think, I walk in their shoes every day. I've had kidney stones, a shattered leg, and several biopsies for skin cancer as well. So I've been "really sick" so you shouldn't generalize. Some of us will be in deep shit if the government isn't very careful how they mess with the healthcare industry. You get what you pay for, if you're too cheap or too stupid to get the best coverage offered, you'll pay a lot more in the long run.
  • aquarius2 · 1 year ago
    THat is the point. Some people are neither stupid or cheap, they simply cannot afford the high cost of insurance, especially those over 65.
  • DebG · 1 year ago
    I sympathize. Back in 2004, my husband was unemployed. When our COBRA ran out, we tried to get health insurance. I was turned down by Blue Cross/Blue Shield because they had paid for my therapy back a few years earlier. And our older daughter was turned down because she has a pre-existing condition: cerebral palsy. So my husband and our younger daughter could have been covered under a policy, but we could not. So I looked into the State of Illinois's coverage. My older daughter and I were eligible if we wanted to pay through the nose for a policy that was administered for... wait for it... Blue Cross/Blue Shield. They rejected us as individuals but we could get a policy administered by them for exorbitant rates. We decided to go without health insurance, and, thankfully, we were all remained healthy. When my husband finally got another job, it was a huge relief.
  • Soaplady57 · 1 year ago
    Contact Michael Moore. I am SURE he would be able to get Blue Cross to sing a different tune!! They can all kiss their asses good bye anyway now that we have this great new president. Hopefully, nobody else will die because they got "too sick" for insurance to take care of them properly!!
  • seohio · 1 year ago
    John: I work in a pharmacy and feel your pain. I see people paying more than they expect because these companies change formularies.

    What do you take for allergies? May I suggest Claritin, which is over the counter. It works the same way most other allergy meds work. Generic preparations are available for it, and they are cheaper and the same thing. And some cholesterol meds are available generically too. Anthem BC/BS forced my physician to change from Crestor to generic Pravachol earlier this year, and the results are better. As for the lung meds, (I assume inhalers), man those are expensive.
  • John Aravosis · 1 year ago
    Thanks. The problem is that I"m not taking drugs for my allergies, so to speak. I'm taking a series of drugs to stop my chest from being inflamed, to stop sinus congestion that she thinks is causing the lung constriction, etc. It's not just a matter of taking Claritin. I'm calling my allergist tomorrow to discuss options. I am so pissed.
  • Soaplady57 · 1 year ago
    John, I sell teas and herbs. I have my husband on a GREAT tincture for Cholestrol. He has lowered his by 29 points. The VA doctor wanted to put him on lipitor, he refused after I read up on it. There are a lot of things you can do "herbally" that may help instead, if you are into that. The cholestrol meds nowadays will kill your liver and cause all kinds of other problems.
  • seohio · 1 year ago
    OH I see. Unfortunately most of those products don't have generic options for them, and are very expensive. My ex-wife had the same health condition as you, so I know a little of what you're going through with the meds and costs.

    Best of luck with your fight.
  • RIPWAMU · 1 year ago
    Definitely try the sinus cleanse or get acupuncture.
  • seohio · 1 year ago
    Another thing. It looks to me as if your carrier would WANT to pay for the
    prescriptions because if you do not take them, you run the risk of
    hospitalization. We all know that hospitalization is quite more expensive
    than preventative medication, using the prescriptions.
  • ArizonaSnow · 1 year ago
    Hey John, this country has one long list of duties for the next prez.. As far as the prescriptions, my parents go to a prostate group luncheon every week and have some friends that swear by www.alldaychemist.com. They have pretty good prices, and the couple have been using them for years. Good Luck!
  • RIPWAMU · 1 year ago
    You can get the generic equivalent of Zyrtec (called Aller Tec) at Costco for $16 for 300! That is almost a whole year for $16. They also have the generic Claritin for around the same price.
  • Radardan · 1 year ago
    I once met the head of Blue Cross here in Arizona and found him to be such an idiot that your experience is totally in line. It is the same kind if thinking that airline management uses: those pesky customers have to be put in their place!!!
  • DavidinPS · 1 year ago
    Another example of how MBA's are ruining the country. All of it. The reason this happened is that the MBA's believe the health care system's first responsibility is to the STOCKHOLDER, not the PATIENT.
    Until we correct that it will only get worse and worse.
  • cyninbend · 1 year ago
    I agree 100%! The entire focus is all wrong. Everyone is afraid of losing their stake.....well, people are dying! DYING! Just because of insurance. End all private market participation etc... Revamp the system.
  • Older_Wiser · 1 year ago
    John, you should research Vytorin. I believe there was a report on it that showed bad side effects, resulting in death. Lipitor is what I take,and it will be coming off patent very soon which means there will be a generic for it. If you can get your doctor to write any generics for you, get him to do it. Then call WalMart and find out if they are covered under the $4 charge.

    My son has no insurance and got a lung infection from the flu this past weekend; he had 3 Rxs, 2 of which were written for generic (prednisone and an antibiotic, both of which were $4 ea.) and an inhaler, which was $32.32, for a total of just $40.32 for 3. That's a lot better than the probable $200 it would have cost him with name brands.

    You can get gold plated BC/BS, but it's going to cost you a hell of a lot more than you're paying--say triple.

    I hate how the pharms and the medical industry as a whole are ripping people off. Even Medicare has a cap on Rxs as well, as my next door neighbor found out. Luckily, at age 67, I only need high blood pressure and high cholesterol drugs. And if you don't have supplemental coverage (and even if you do), you are going to wind up paying something on your doctor and hospital bills over what Medicare pays.
  • seohio · 1 year ago
    Hey, man. do you mean "pharms" to be pharmacies? Pharmacies are not ripping people off--we are getting ripped off ourselves by the insurance industry as well. When we fill a typical prescription on Medicare Part D, for example, we only are reimbursed about $2 more than what we have paid for it. And it gets even worse with the other insurance plans, including Medicaid. When I started in this business 20 years ago, Medicaid used to be the highest third party reimbursement; now all of them suck.

    There are some plans out there that reimburse your local pharmacies less than what they actually pay for the drug.
  • Older_Wiser · 1 year ago
    Pharms, as in pharmaceutical companies. Should have said pharmas, I guess.

    And I generally use my local pharmacist, not a chain to get my Medicare drugs...$2.35 co-pay for generics and $5.25 co-pay for the Lipitor. I only used WalMart for my son since he did not have insurance.
  • seohio · 1 year ago
    OK, I thought that was what it was, but some people shorten pharmacies to "pharms." But I guess now it's out there for all the readers to see and read that local pharmacies are getting fed up with some of this crap too.
  • judybrowni · 1 year ago
    Yeah, Medicad used to be a high reimbursement, until guess what? 20 years with a Republican Congress, and 8 years of a Republican president.

    Who want to scare doctors and pharmacists away from government health care.
  • jebauer · 1 year ago
    Capitalism in health care is a disaster... if you make money off of sick people, what motivation do you have to make people well? There are good people working in medicine that want to heal... but they don't have the proper tools and some get blinded by the drug pushers... all are slaves to the insurance companies that mandate the time they're allowed to spend on each patient... and that's just a fraction of the problems. I hope we're able to chart a new course.
  • Soundboy_jeff_meanie · 1 year ago
    John, you're still paying less than my Husband was...

    before we registered as Domestic Partners, he was paying $640/month with a $3000 deductible... the insurance co-pay on one of his meds was $.39 (the drug was $130 a month) so he got to pay $129.61 every month.

    by registering as DPs, I added him to my insurance... it costs me an extra 40 a week, but his meds are only $20.

    oh, I should mention that in the last year of having his own insurance... it went up, twice! I think he visited the doctor once that year.

    insurance is a scam in this country... there's supposed to be a HUGE pool of money from people who pay into it and don't get sick.

    now I'm starting to wonder if, thanks to deregulation of the markets, the insurance companies invested that huge pool of cash in bad mortgages.

    that'd explain insurance limits.
  • Older_Wiser · 1 year ago
    Wouldn't be surprised if your last statement was true, since it's being reported that insurance companies are wanting bailout money these days.
  • unrepentant_expat · 1 year ago
    John, a little something, I hope it helps...

    http://www.immigration.ca/assessment.asp
  • iamevolved · 1 year ago
    Quote: "These people make me sick."

    Careful. You don't have the coverage for that. Fucking insurance bastards. To quote Lance from Pulp Fiction: "They should be fuckin' killed. No trial, no jury, straight to execution."
  • Soaplady57 · 1 year ago
    When I lived in San Diego, I used to drive down to Tijuana to get all my prescription meds. I know there are a lot of senior citizens that live in Texas who do that too, just because they cannot afford it!! There are also the Canadian Online Stores (somebody mentioned) that are great too!!
  • judybrowni · 1 year ago
    I tried that, but Tijuana has caught on, and the main street stores only carry the most used drugs: and for no cheaper than you can buy 'em online, depending on the drug.

    Here's another little irony: for one drug, my insurance company charged me $120 copay -- I can buy it cheaper than that online!
  • Soaplady57 · 1 year ago
    The trick is NOT to go to a store on the main drag. Stay off the beaten path, they are a bitch cheaper. The further down into Mexico you go, the cheaper it gets. I never had any trouble getting anything I needed except for heavy-duty stuff, which I didn't want in the first place.
  • tlsintx · 1 year ago
    John, i'd recommend mixing in some complementary or alternative treatments like acupuncture and traditional Chinese medicine (herbal)...once you get on a healthier track you may not need so many drugs...

    i have done this and am rarely ill, only rarely see the doctor, and it's much cheaper...i think the pharma/insurance industries are making us sick.
  • Butch1 · 1 year ago
    John,

    These are the stories that our Congress needs to hear over and over again before they change the health care for something less than what we need. I am retired and have the Part D program of Medicare and it has a three tiered system where I could end up like you, having to pay for the entire prescription if I go over the allotted amount decided I can spend per year. This is insane. I want universal health care for everyone in this country. To hell with these republicans deciding what is "American" and what is not. We used a form of socialism to pay off the banks and Wall Street, what's the difference in helping them out but what we are asking for is socialism? Enough!
  • Older_Wiser · 1 year ago
    I have a program called Silverscipt ("A CVS Caremark Company" but I don't use CVS) which Medicare put me on because I couldn't wade through the bullshit. Since I only use a couple of Rxs, have only use $1200 this year and have $3500 left before catastrophic coverage would kick in. Now, I also get help from the state, since my income is low. You might check on that, depending on your circumstances. I would also check out other Rx plans; generally those "Medicare Advantage" plans aren't all that great, as my neighbor found out (she has Humana and was in an HMO).
  • Butch1 · 1 year ago
    Many thanks. My policy is with Humana.
  • judybrowni · 1 year ago
    I had to drop my $1,000 a month individual Cigna policy (which also didn't cover $500 acupuncture, which had been the only thing that saved my life.)

    I've now cut the acupuncture down to twice a month, and the herbs got me off blood pressure medication: bringing my health costs down to one $25 a month prescription (boiught out of pocket), and another $200 for acupuncture.

    My acupuncturist is also a brilliant diagnostician, and tells me when I should resort to western medicine.

    Find a good acupuncturist (they all now are required to know Oriental medicine as well, which treats the whole system, rather than just symptoms, like a lot of western medicine.) You may find yourself in better health, on fewer prescriptions.
  • triple7s · 1 year ago
    Good advice. A great acupuncturist, as well as a combo of eastern and western medicine is a distinct advantage for almost any condition from hangnails to cancer.
  • Butch1 · 1 year ago
    Thanks for the advice. My regular insurance jumped over $300.00 in one year and became something I just couldn't afford so I looked into the Part D of Medicare which can not refuse you for any pre-existing diseases. As it turns out, the meds I take for an host of things will not max out within a year. It all rolls over again for the next year. Some of the meds are determined by the insurance company over-riding my doctor's prescribing. I do not like that but, until it is changed in the nex year or so, it is something I will have to put up with. My Part D does not pay for acupuncture. Unfortunate.
  • woodroad34 · 1 year ago
    Blue Cross/Blue Shield here in California has the worst rep. When I first came here in the 70's they were the pinnacle of insurance providers. But after hearing stories about Scrooge-like behavior such as what you've experienced, it just reconfirms what I already knew -- I'll never go with Blue Cross/Blue Shield. I currently don't have insurance, mainly because I can't afford it, but also I feel "what's the use." They'll take your money and not provide anything. Talk about a money pit.
  • RIPWAMU · 1 year ago
    I have BC/BS IL and they pick and choose what things will be added to my deductible. One month I wasn't charged for a blood draw the next I was. Some labs weren't charged to my deductible, others were ($570 worth). I am a medical coder with a lot of billing background and I can't figure them out anymore.
  • woodroad34 · 1 year ago
    Also, does DC have an Insurance Commissioner that regulates insurance. Is there someway to complain to that office?
  • Damned_at_Random · 1 year ago
    If there is a Costco near you, call their pharmacy for prices- they are cheaper than any of my local phamacies and for 2 of 4 drugs cheaper than my BC/BS mail order plan (with Medco).
    In Oregon and California, you do NOT need a Costco membership to use their pharmacy.

    Also, tell your Dr you are over your coverage limit - he may have some samples to get you to the first of the year. Or he may be able to prescribe cheaper alternatives for some of your prescriptions.
  • RIPWAMU · 1 year ago
    Good luck with that. I have worked for countless doctors and the doctors and staff horde those. Not to mention the drug companies have cut down on samples of high price meds so it doesn't cut into their profit margin.
  • cyninbend · 1 year ago
    It is sooo important to talk to your doctor about costs. When I had insurance, they all prescribed oxycontin for my pain...around $300/month. When my insurance ended, my doctor switched me to methadone...which, with my Soma, is $100 at that same pharmacy and just $28 at Costco. And way less withdrawal symptoms bothering me daily....
  • Peaches · 1 year ago
    This is the reason why we need Single Payer Universal Healthcare!
  • MNUSA · 1 year ago
    Do you have an individual or group policy? You probably couldn't switch companies now if you have a pre-existing condition. I know people who died because they waited too long to get medical care because they didn't have insurance. I'd like to see the insurance companies cut out completely; maybe then we could afford health insurance. Otherwise people go into the emergency room when it becomes an emergency.
  • Peaches · 1 year ago
    You are right about that MNUSA. THe insurance companies need to be eliminated completely.
  • PeteWa · 1 year ago
    John, I don't know that this will help you, but I had serious sinus problems for years, and medication never really helped me too much.
    Sure, the latest steroid-whatever would clear it up for a little while, but then it would return...
    Anyway, I finally went to an acupuncurist for the problem, and it did wonders for me... haven't had a serious sinus problem for over seven years (and it was a chronic problem up to that point).

    I know this is a little off topic from your insurance aggravation, and I hope you can get that cleared up too.
    Insurance companies in this country are a scam.
  • Hardy_Haberman · 1 year ago
    John, I hear your pain. I live in the Great State of Texas, ugg! And here the insurance companies really run the state house. If you have ever been sick a day in your life that required any kind of significant medical expense you get put into the "high risk pool". It's a scam set up by the state and the health insurers to give them political cover. They can say they will insure everyone, but some will have to go into the high risk pool. Well that means that for me, a middle aged guy who has asthma and allergies, I have to pay $1500 a month for limited health insurance. As a self employed writer/designer that is not even a possibility.

    We need national health insurance in this country, no question about it. The problem is too many people are making a fortune off insurance. If you can't afford it, you just stay sick or die. Welcome to America! This sucks and has to be changed!
  • marblex · 1 year ago
    I've said it before and will say it again: THE INSURANCE INDUSTRY NEEDS TO BE EXPELLED FROM THE HEALTH CARE BIZ

    The private insurance industry stands between patients and doctors as a middle man. Until and unless the insurance industry is EXPELLED from the health care arena -- an arena into which the insurance industry insinuated itself in the late 60s based solely on their claim that malpractice cases (over 99% of which are voluntarily settled) were driving up their costs. The insurance companies then raised medical malpractice insurance rates sky high (without any real justification for doing so other than the industry's nefarious plans to market their new product -- health insurance) -- that health care providers had to raise their own rates.

    And so the saga began.

    Then of course, the infamous Edgar Kaiser/Nixon meeting during which they CONSPIRED to deny health care to millions whilst charging them a kings ransom for it and the "managed care" -- that is health care parceled out to the wealthy -- was born (http://www.empiremovies.com/movie/sicko/13681/r...)

    Neither of the presidential candidate's plans was acceptable to me: neither plan will ensure anything but that people PURCHASE HEALTH INSURANCE. The discretion to provide health care will still be left to insurance companies.

    Health CARE not insurance, is what we need. Single payor, universal health care.

    PERIOD. Accept nothing less. And YES I would rather have the "government" regulating and making health care determinations NOT FOR PROFIT than some moneygrubbing greedy insurance motherfucker who is more interested in profits than in making sure that policy holders get the health care they NEED.

    The hallmark of a civilized country dedicated to improving the lives of ALL of its citizens is PUBLIC HEALTH CARE. No other "civilized" country forces its citizens to live on the street in poverty just because they got sick.

    ENOUGH OF THIS ALREADY.

    SPUC

    Single Payor Universal Care.

    Accept NOTHING LESS
  • flash123 · 1 year ago
    John:
    I was on Vytorin 10/40 for over a year, before I read several reports that said new research studies indicated that Vytorin worked no better than generic statin drugs (like Simvastatin) for cholesterol. I checked with my doctor, and he agreed & wrote me up a new prescription for simvastatin, which costs me about $4 for a 90 day supply, vs $70 (which will jump to $100 next year) for Vytorin.
  • WadeMD · 1 year ago
    The thing is Vytorin is simvastatin + ezetimibe. The simvastatin is all most really need. I would recommend taking the statin and then adding ezetimibie if cholesterol isn't controlled. Unfortunately, ezetimibe won't be generic until 2013 from what I hear.
  • fostert · 1 year ago
    John, I feel for you, but you are still one of the lucky ones. I can't get insurance. I will likely get cancer, and there is no way I can pay for it. My plan is simple: I can afford to buy a lethal dose of heroin. I will never be able to afford to live, but at least I can afford to die.
  • David Liao · 1 year ago
    As relatively free United States citizens we certainly do have the right to kill ourselves. People at Guantanamo aren't so lucky.
  • fostert · 1 year ago
    It's really sad that there are people less lucky than me. It's really scary that I should feel lucky that I have the option of suicide. But lucky I am. For whatever that's worth.
  • David Liao · 1 year ago
    It's actually not that sad once you get used to it. I'm not afraid of death. I wish to avoid a life lived poorly.

    That being said, I took a first responder course, and as an atheist I feel compelled to make clear to the world that I do have a conscience. So, I feel compelled morally to ask, I don't need to call the suicide hotline on you do I?
  • Webster · 1 year ago
    Why? Is there some reason you would want to put fostert in a position where she/he would have to pay for the treatment she/he just said IS NOT AFFORDABLE?!

    Do any of you people HAVE A CLUE WHAT IT'S LIKE TO BE OUT HERE UNEMPLOYED AND WITHOUT HEALTH INSURANCE!!!???

    DO YOU HAVE A CLUE???!!!
  • David Liao · 1 year ago
    Ugh.
  • Webster · 1 year ago
    Try not to let anything like compassion get in your way.
  • devis1 · 1 year ago
    Damn they don't even offer the donut hole option?
  • falloch · 1 year ago
    Every time, before I go back to NY to visit with my mum, I renew all my prescriptions (for chronic eczema and asthma), because I know that if I'm stuck out 'there' I couldn't afford it at all. My mum still insists that my UK medical programme is 'socialist' , while meantime she is in awe that a dentist checkup/cleanup for me costs about 40 dollars, with a filling about 20 dollars more. I am not smug about this - I know it is under threat, from a stupid Labour Party that wants to be Amurrican (Thanks Tony Poodle), but so far is still struggling on. American medical insurance companies are trying to gain a foothold here, and I hate that; I recognise their names from the letterheads of horrible grasping companies trying to take back money from my dad's insurance policies after he died in NY from cancer. In the (supposed) richest country of the world the health system is a disgrace, for both relatively well-off, and certainly the not well-off, well actually the poor, a category completely absent from both presidential candidates. One mentioned middle class; one mentioned middle class and even occasionally working class, but neither noted the fact that there are poor people in the US, real clear poor - and until the life, the plight, whatever you deem politically correct to term it, of real, poor people is accepted, and dealt with, then we've no chance of righting the wrongs that have blighted America.
  • nothingasitseems · 1 year ago
    Your story is just one of the many that is evidence that the revolution is coming... if Obama doesn't make significant strides to fix the destruction of the middle class (and the coruption of the health care system is just a weapon in this destruction), then there will be a second American Revolution. What's amazing about the rich is that they don't see that they are bringing about thier own downfall. The healthier a middle class you have, the less you have opportunity for outright revolt by the poor. The middle class is actually protection for the rich against this revolt. But if the rich continue to destroy this barrier between the poor masses and the few elite, they will bring about thier own destruction. The greed of the health care system is just helping to foster what will probably be inevitable if our government doesn't make significant strides within the next few years. Sorry to hear about your problems, bro. I'm a 31 year old student hoping and praying that I don't get sick within the next year and a half because I don't want to give these bastards the money they don't deserve.
  • Forty2 · 1 year ago
    Fish oil, flax oil, and a nightly niacin will help the cholesterol. I got mine down about 40 points just with that. My MD wanted to put me on a statin but I wanted to try the alt. regime first, which worked.

    Too bad there's no cheap alt. to Nexium, but that's the only Rx I take now, $100/90-day supply. Ouch, but it beats screaming in fiery acid-drenched pain. And no, Prilosec isn't realistic as I had to take it 3-4x daily vs. one Nexium.
  • ShirleyGoodnessanMercy · 1 year ago
    Some say krill oil is good for controlling cholesterol, too:
    http://shop.mercola.com/Supplements-New_and_Imp...
  • sam2300 · 1 year ago
    John -- GET OFF VYTORIN immediately! It's nasty stuff and you may not even need it. There's nothing wrong with cholesterol in and of itself -- only if it's clogging your arteries. You need to have a scan -- that's the only way to can tell if your high cholesterol is really a problem.
  • NWTRNR · 1 year ago
    I feel your pain John. Man, oh man. I also need to rant about the dire state of our broken U.S. health system -- especially health insurance.

    Being a family who has been lucky to have been on group plans for the past many years, I wasn't as familiar as some on the whole f****d up state our system is really in until having to shop for some coverage for my kids the past couple of months.

    It's a big f'n mess! Coverage stinks, the cost is horribly exorbitant, and there's all these sneaky little outs for these companies hidden in the plans. My kids are healthy too. And the whole process of getting individual coverage has been a big huge headache.

    First off, the fine print is ridiculous. Really a lot of bait and switch. Plans sound OK on the front end, until you start pouring over the details in the policies. One example -- prescription drug coverage. Most every plan I looked at, or was available, had either super low coverage -- for example they might only cover prescriptions up to $2500 in a calendar year, and/or it might only cover "generic" drugs, etc.

    Well... for relatively healthy people who don't need to use their coverage much, that's no big deal. Antibiotics usually aren't all that much. But, I was talking to a sister of mine who is in the medical world, and she told me that -- God forbid -- you come down with something like MS then you could easily be facing monthly prescription charges that exceed $2-3k -- and that's for non-generic, non-formulary drugs. So, you can see how little your policy would help if you had one like this.

    The policy we ended up applying for, at least had a stop-loss amount -- or so I thought. Basically it was advertised as the most out of pocket per year was $7500 per child. After that, it would cover 100% of all costs. That gave me some peace of mind knowing that if again -- God forbid -- something awful happened (accident, bad illness, you-name-it) at least I knew that once I hit the $7500 amount, I wouldn't be worrying further. Well -- this was all fine, until I got the actual policy and figured out that this limit didn't apply to prescription drugs -- I'd have to keep paying 50% for those indefinitely. I've filed a complaint with our state insurance commissioner about this blatant misrepresentation, but what's that going to do? Probably nothing other than a "correction" by the insurance company. BFD.

    We opted to switch to an HSA-eligible account (with its federal oversight) -- that policy (which I have yet to see) appears to have REAL stop-loss built into it -- that includes RX. That is something you might want to look into John. The total stop-loss is $5000 per person as I recall. Granted, it doesn't start to pay until you cover the $3000 deductible, and then it's 80% up to the stop loss. But at least there are no caps on RX or anything else out of the regular -- I think.

    Anyway, I could keep going on, but I'll stop. I'm just sick of this whole broken down system. We've got to do something different here. Too many people don't have any insurance, and many of those that do (like you) -- don't have very good coverage, and won't find/figure out until they really need it.
  • WadeMD · 1 year ago
    Stories like these make me sick. I'm a physician but sadly I'm one of the few who thinks quality, low-cost healthcare should be for everyone.

    As far as the scripts, see if you can take generic. Vytorin is a combination of simvastatin and ezetimibe. I know simvastatin is generic, I'm not sure about ezetimibe. If they both are, you could take two generic pills with same benefit at a much reduced cost. What happens is when a brand-name drug's patent runs out and companies can make a generic, many will combine generics to make a new name-brand and jack up the price. Greed, pure and simple.
  • WadeMD · 1 year ago
    Actually, I just found out ezetimibe isn't generic until 2013. Try taking simvastatin alone and follow cholesterol levels for a while, it should be dirt cheap.
  • hawkseye · 1 year ago
    I am very sorry you have to go through this. I also have a chronic condition and have to pay for treatments out of my own pocket.
    I hope our national health care situation takes a cure soon.
  • Mickey7 · 1 year ago
    I can't get private insurance because of a history of hypertension since I was a child--most likely an inherited problem. Brokers won't even respond to my request for quotes. I mean I can't get it at any price. Drives me nuts when people talk about it like it's a choice. I developed a clot in my lung recently after being stuck on a plane for nine hours and all I could think of lying in the ER was "ka-ching, is this the event that will finally push me into bankruptcy?" We should be embarrassed about our system. I work with medical researchers and physicians from Europe. Not only does their health care cost less, they are doing a much better job with providing good care and collecting crucial epidemiological info to help improve over all knowledge of and treatments for diseases. Despite what the right says, national healthcare is not the nightmare they'd like you to believe it is. Healthcare is also a serious economic issue. Until we get it under control, it will continue to be a drag on the economy.

    BTW, the most recent report on infant mortality shows that 28 other countries do better than we do at keeping infants alive in the first year. The top ten are countries with national healthcare. The report attributes this unconscionable outcome in the US primarily to "lack of access to prenatal, neonatal and maternal" care and secondarily to the epidemic of obesity in this country--also an issue tied directly to poor health care.
  • acb · 1 year ago
    I second the Costco recommendation if you do need to pay out of pocket for drugs. Nationally their pharmacies are required to be open to the public - without a membership card. Also, you can get to the one in Pentagon City via Metro.
  • RIPWAMU · 1 year ago
    Yes, when I didn't have insurance I used Costco. If you are a member they track your out of pocket and will send coupons or other discounts.
  • gwpriester · 1 year ago
    Being an old fart, I have Blue Medicare Rx. In the last year, the cost for a Level 2 drug, that is a name brand vs. a generic, has gone from $40 for a 3 month supply, to $96. In one year. Next thing you know BCBS will be requesting a bailout.
  • NWTRNR · 1 year ago
    One additional suggestion. If you haven't tried this before -- I HIGHLY recommend it. Neilmed Sinus Rinse Nasal Wash. It has drastically cut down on my sinus symptoms. I use it almost every day.

    http://www.neilmed.com/usa/sinusrinse.php
  • driver1076 · 1 year ago
    3 years ago when My youngest daughter was born My exwife caught a staff infection C-Diff while at the hospital,even though she caught it there they still sent Me a bill for 390,000.00 7 weeks in the hospital removal of her colan hours away from death because of there incompatince and they still had the nerve to send the bill,I walked into the hospitals administratration office and put the bill on there desk plus all the other bills told them to kiss My ass and walked out the door
  • RIPWAMU · 1 year ago
    CMS just passed rule that hospital cannot charge insurance companies for these "never events". Still unclear on whether a private pay can be charged.
  • met00 · 1 year ago
    John, you have it EASY!

    I have diabetes and heart disease, and am 50 years old. I had to split my policies six years ago. I had a policy for me, HIPPA 80/20PPO from the last job, where I am covered with a $5K deductible at $1K/mo from BlueX. I had another policy on the wife and kids 80/20PPO for $600/mo with a $1K deductible. The end result, my insurance was costing me $19,200 plus 20% plus up to $6K in deductible. Call it $25K/yr. at the low end.

    So, a year ago I took a picture of myself wearing my "poor" clothes and holding up a sign that said "Will work for healthcare" and sent it out to a few of my regular clients. The end result is that he pays me about 10% above the cost of what his healthcare plan would cost me as an employee, but I have to buy my healthcare at 100% through him as an employee. I still do what I did before as a consultant. Now I have a plan that is about $1.3K/mo for the whole family. It's HMO/PPO with no deductible on the HMO and $500 on the PPO.

    Total cost savings, about $10K/yr. Also since I was paying taxes as a 1099 on what he paid me before, but now don't as I only report the income above what I get in healthcare, it lowered my taxable income as well.

    When about 30% of your income is going to healthcare, 30% to housing and 20% to food - clothes - auto repairs/maint. - gas - etc. It's hard to "save up" for that new car, or the kids college, or much of anything else. I remember when a holiday meant going somewhere. Now it's about taking the tent into the backyard.
  • ShirleyGoodnessanMercy · 1 year ago
    Until America wakes up and demands socialized health care like France and Britain have, all Americans will remain in debt and unable to save a dime.
  • cdm9002 · 1 year ago
    I'm sorry to hear about your situation.

    I'm from the UK, living in the US at the moment, and just can't believe how expensive the health care system is here.

    I hear people say how great it is, how they wouldn't want to have nationalised medicine, but they have never tried it - you have, now you understand.

    US healthcare is great if
    1) you have a good company's scheme, and
    2) you aren't actually ill.

    And god forbid you do get ill, because the costs soon get crazy with deductibles, out-of-pocket and prescription fees.

    I just had a check-up scan (I'm not ill, but have a "condition") which costs $1500, plus drs. fees plus a $40/month prescription that doesn't make me feel any different. I requested a generic instead, which is at least cheaper.

    The only cost in the UK would have been £7 (about $11) for the prescription, payable since I am a working adult (free for children and pensioners).

    Now, I'm not saying the UK healthcare is the greatest in the world, but you can be confident you will get treatment for free. And you always have the choice to buy private health insurance if you can afford it.

    American Dream (terms and conditions apply: only for the rich, employed and healthy).
  • FunMe · 1 year ago
    This should be Obama's #1 project to correct starting in January 2009.

    Now that we have momentum, we have to CEASE THE MOMENT.

    John and Jacki: anything we can do from our end, let's us know. I know it will be a fight, but this is one fight I am sure MOST Americans are ready to fight.

    I feel Obama will not be like Clinton with his "compromise" which really means having the republiCONs continue to have their way. That era of the GOP getting their way even when they are out of power is OVAH!

    We have the power - we have to use it to make the changes to our insurance industry in 2009.

    In my case, I rarely go to the doctor. I cut my finger in a glass and had to go to emergency. I think it cost me $600 or so for the 2 visits. And I have company insurance!

    I can imagine how much more others have to pay that don't have insurance or have to pay insurance on their own like John. This is WRONG.

    How did our nation allow this to happen?

    Time to OVERHAUL the medical industry big time. The days of $$$$profits$$$ over lives of Americans are OVAH!
  • Webster · 1 year ago
    Many of us don't have any insurance at all. I don't. I get sick: I die. Period.
  • LLDEM · 1 year ago
    John, I empathize. As someone with an existing HIV condition, I too was Royally screwed by Blue Cross.

    I've moved my coverage to Kaiser and have found that as a model it's pretty good, but it comes with a price. I have 3 prescriptions that must be filled 4 times a year (I get them in 3 month chunks) but first I have to hit my minimum out of pocket of $1500. My monthly premium is nearly $600 a month (more than a car payment, more than my utilities for a month, more than some folk's rent) Behind my mortgage it is my second largest monthly cash outlay. Kaiser however takes a very pro-active approach to keeping folks healthy and the copays for visits, xrays, blood tests and all are pretty moderate. If there's a model to be studied for healthcare in the US this is one. Just so long as you don't lose your job.
  • Soundboy_jeff_meanie · 1 year ago
    OT...

    please sign the petition...

    http://www.petitiononline.com/seg5130/petition....
  • Indigo · 1 year ago
    So far, I"ve been fortunate. I go to a chiropractor for regular adjustments, take yoga classes, maintain something of a (non-vegetarian) Ayurvedic diet, take a few food supplements that include red yeast rice (for cholesterol) along with fish oil (for heart issues) and eat Cheerios (for cholesterol) every morning. Any oat-type cereal would do, even hot oats cereals. I'm retied and on Medicare now and it's working pretty well, I have a supplemental through my former employer that I pay for out of my laughable pension. I go to my regular nurse practitioner once a year for blood tests and nothing is ever far enough off profile to justify medication. My major health-related expense is my gym membership where I work out on the elipitcals twice a week for cardiac health. At some point in the foreseeable future, these things will change because of my age (I'm 67 now) and then I'll have to adjust accordingly. I confess without snarkiness that your outrage surprised me since I took it for granted that you would already know what a cheesy, cheap-skate system we live in.

    Health care is not an abstract concept.I've heard your outrage before, usually from Republican acquaintances who have a history of skating along blithely as if there's nothing wrong. Here's my rude response:
    Welcome to Amerika, was it nice where you were?
    [/snark with apology]
  • dancinfool · 1 year ago
    Yes, insurance companies suck. However, I'll just mention this in case no one's mentioned it yet:

    See if any of your prescriptions can be changed to a generic drug. For instance, with my BC/BS policy, I copay $5 for generics, $20 for approved non-generic, and $40 for unapproved non-genetic. When my doc found out I was having to copay $40 for Lipitor, she prescribed simvastatin instead. It's an earlier generation statin drug, and if your brand name cholesterol drug is a statin too, perhaps your scrip could be changed.
  • John Aravosis · 1 year ago
    the other thing I'm doing is moving all my prescriptions to drugstore.com, they're a decent chunk cheaper.
  • 2008 · 1 year ago
    JOHN-
    Try Prevention, too! Don't just feed Big Pharma!

    Get an IQAir Filter to give your respiratory system a break.

    I guarantee you will feel better and it will reduce your allergies,
    which can be a serious drag on your entire health!!!

    The IQAir Health Pro Plus is found on the www.costlessair.com site. It's a godsend for me!

    I haven't had an asthma or allergy attack in years! No drugs even needed. (Unfortunately, I don't have a pet cat either. But, I used to have so many respiratory problems living in a polluted city well before my cat problems...)

    Seriously, PLEASE don't rely on drugs!

    Just stop the particulates from getting into you in the first place!!!

    P.S. D.C. Air quality is one of the reasons the Enviros fight so hard-- Record asthma rates in urban D.C!!....
  • ShirleyGoodnessanMercy · 1 year ago
    America needs to copy the French system. It is the best in the world. Our current "system" is barbaric and unconscienable.
    Insurance companies only succeed when they keep us from getting medical care. IT DOES NOT WORK.
  • elRey · 1 year ago
    ARUUUUUGHHH!!!! That really sucks, but, buy your medicine John, don't risk your health. If it wasn't for my work here, I'd take advantage of my dual citizenship and move to europe.
  • aquarius2 · 1 year ago
    OH baby, just wait until you hit 65 and start searching for "supplemental" coverage to Medicare. My cousin just told me that the cost of a decent coverage ( like what they had when they were working) for her and her husband is about $600 to $700 a month. They can afford it but have decided to go the HMO way, still going to cost around $300+ for the two of them.

    Now you see what a pathetic dilemma senior citizens, with fixed incomes, are going through. Not all seniors get the max SS benefits, for many it is much lower.
  • ProgressiveMom · 1 year ago
    My 19 year old son can't stay on my husband's insurance because he is not in school full-time. He also isn't working full-time. He takes meds for depression.

    If we purchase coverage for him (IF we can get it with his history of depression), it will cost a minimum of $1200 per month.

    With no drug coverage at all.

    $340 per month sounds like heaven to us, even if I do understand why you are angry....

    BTW, with full coverage last year, we paid an initial $7000 out of pocket BEFORE any bills were paid for him.

    ....and (you knew this was coming)....my husband works for a managed care organization.....
  • Soaplady57 · 1 year ago
    I'm certain that your son can get his meds through the county you live in for next to nothing. They go by income most of the time. I didn't have to pay anything when I lived on the West Coast and worked part-time while I attended school back then. Your son needs to know he has to STAY on his depression meds, that is very important!!

    Good Luck!
  • bluestockton · 1 year ago
    I hate Blue Cross. They forced us into bankruptcy when they wouldn't cover my husband's bypass on the ground that it was a pre-existing condition.
  • cyninbend · 1 year ago
    "pre-existing"--cuz he was born with a heart?
  • putaro · 1 year ago
    I hear your pain John but let's look at the economics here. You're paying $340 a month and you have $250 a month in prescription drugs you're taking. That leaves $90 a month to cover any other services you might get *and* pay into an insurance pool for everyone else.

    Everyone can't take more out of the insurance pool than they put in. It just can't work. You're a fairly young, fairly healthy person. If you're not putting in more than you're getting out who will?

    The insurance companies are scum, I agree. There's another problem, though, and that is that health care is just too expensive. Pharmaceuticals are a major scam. Too many drugs are being developed to suppress chronic conditions, thereby guaranteeing a continual revenue stream. We need to develop treatments that cure chronic conditions.

    As a country we need to start focusing on how to bring health care costs down. That doesn't necessarily mean rationing - I think we need to start researching on how to provide better care for less cost and start coming up with real cures to chronic problems. Just about every other industry provides a better product for less cost than 40 years ago.
  • John Aravosis · 1 year ago
    Well, I've had 20 years of being pretty damn healthy and kicking into that pool As for the insurance companies, I don't trust people who refuse to tell me exactly what they're doing. I'm a lawyer and I can't figure out my coverage at all. I don't know anybody who can. That's suspicious to me.
  • putaro · 1 year ago
    I agree with you that not being able to figure out your coverage is ridiculous. No, it's not ridiculous, it's fraudulent and should be criminal. When I hear the stories of people hitting these limits while seriously ill I just want to smack some people.

    I'm currently living in Japan so you might find our health insurance system here interesting.

    My wife and I (early 40's) run our own small business and we have two small children. We're currently enrolled in the Japanese government health insurance though we have the option of switching to a private health insurer. Our total household income was about US $100K last year. Our health insurance bill is now up to about $800 monthly. That may seem a little high but there's a few other things to consider.

    Because we run our own business our income has varied pretty wildly over the last five years. Some years we were only making $30K in household income. When that happened, our health insurance payments were more like $60/mo - unlike Joe the Plumber I appreciated paying less while we were trying to get our business established and am willing to pay more now that we're successful. Additionally, there is no "Medicare tax". I looked that up and for the US that is 2.9% of your annual income (with no cap). Factor that in and our monthly payments look more like $560 a month in the US.

    No system is perfect and there are definitely drawbacks to the Japanese system. However, I have never heard anyone here complaining that the health insurance system didn't cover them or pulled their coverage. No one except the doctors and hospitals ever talk with the health insurance company. You can go to any doctor - when we were in the US, even with a good PPO we had to look through the damn list of doctors to figure out who was in the plan and who was not. And, when you go to the hospital you get one bill with everything you have to pay put on it, not dozens of bills from every specialist and testing lab that was involved.

    The US system is broken and there's a lot of other models to look at and take the best ideas from.
  • devlzadvocate · 1 year ago
    "That leaves $90 a month to cover any other services you might get . . . " You know little regarding insurance finance and investment. Your premiums are invested and the returns are built up and compounded into BILLIONS of dollars from the pool of money NOT paid out for others. Insurace companies have reserve funds of billions they refuse to let go of unless forced to. They also pay reduced fees for routing patients to providers who accept their members.
  • katymine · 1 year ago
    My employer is one of those who push and sell "consumerism" in healthcare products........ Which for me until last year hasn't been an issue but on 10/4/2007 I had emergency surgery for kidney cancer and was inpatient for 7 days. With all the consults, CT scans, follow ups and tests between 9/11/2007 to 12/31/2007 my billed charges was over $72,000. Yes I had to fight to get bills paid, once one of the reps told me that the reason they were not paying was to do an investigation for pre-existing conditions. I contacted the Arizona Department of Insurance and had that issue cleared up right away.

    Out of that I had a $1500 deductible and $3000 out of pocket expense until the policy started paying 100%, that started on 12/1/07....... and I had to start all over again on 1/1/2008. Now my employer has one of those HSA where they give me $500/yr and I have Medical savings account "this year" except it goes from 7/1 to 6/30 which is off sync with my annual deductible so I cannot use my pre-tax dollars as the $1500 I put aside for the year is going to be gone before the end of this year AND then I will have to start over again in January......

    The kicker...... in the ER where I waited 9 hrs to navigate through their triage system, they tried to hit me up for my $100 copay. Twice while admitted they tried to hit me up for the $723 that I still owed for the deductible.... once in writing and once calling me in my hospital bed the day of discharge. I made a stink and was told that the business office REQUIRES that all discharged patients to be taken to the business office to pay before they are allowed to be discharged...... I refused.

    The hospital billed the insurance $52K and as a PPO they paid them $13K...... BUT If I was uninsured, I would be stuck for the whole $52K to pay.

    If you have issues you cannot resolve with your health insurance contact your state Department of Insurance as they are the watchdog organizations in every state. In Arizona they really are an advocate for patients regarding issues especially with denied claims and appeal rights.

    At the least I want Medicare for All, but I dream of French health care .......
  • Andon · 1 year ago
    Now, Americans, tell me again what exactly is wrong with single payer state-run medical insurance with prescription medicine subsidies and bulk buying. I do not understand how or why I have been able to enjoy these programs in any part of Canada, and with portability between parts of the country and between employers, for 40 YEARS and counting while you all have enjoyed the tender mercies of corporate capitalist enterprise in the medical care sector. Do you think your orthodox rightwingery will be richly rewarded in the Heaven you will visit prematurely or something? It makes no sense to me at all. Are you all mad? Can you not add? Do you simply not care about what happens to others? Do you not see that you are collectively demeaned by the shoddy treatment you accord the sick, the poor, and the politically powerless? Neighbor sheeple wake up!
  • Deb in VA · 9 months ago
    I don't blame you for the attitude you have towards Americans. As a country we have failed to care for one another and we have participated in what I believe was absolute fraud when we entered into the Iraq War. That being said, there are still plenty of Americans that do care about those less fortunate, and we have stood up to the Bush and Cheneys of the world by demanding a massive change in Washington. Yeah, it took us 8 years to get it together, but we're still here. Don't give up on us yet...we are still a great nation and we will prove it in our actions and relations with other countries. I'm very disappointed in the choices our government has made these last 8 years, but I'm still proud to be an American.
  • cyninbend · 1 year ago
    I feel terrible for you. But welcome to the world that many of us live in. At least you are just visiting and can leave soon.

    Blue Cross refused to even quote me when my COBRA benefits through my ex's work ran out. They said there was no point because it would be over $1000 a month--in 2004. I had back surgery in '94 and '96, but never ever will again, and fibro...so I am on meds for pain (Soma for cramping and methadone for pain. But they just cost $28 a month at Costco (or $100 at Safeway, figure that out!) TOTAL! Not co-pay LOL And now I'm starting Lyrica, but that will just be $68/month.) Anyway, it's not medical costs that makes them refuse to quote me...it's the fact I take ANY meds at all. (And here in Oregon, no doctors will treat me for anything else because I am on pain meds. They have a clinic that doctors set up for medicare patients to see a nurse practitioner...younger than that and you are SOL.) I stopped the Gynecologist because who wants to know they have cancer if they cannot afford to treat it? We really live in the wild west....no joke...

    My best friend (in Illinois) lives without insurance, since her husband is self-employed and they just could not afford $1000 a month. Her daughters are covered through their their dad, her ex. She tried to get in to see their doctor when she was passing out and dizzy--but was told they were not taking "new" patients when they found out she was not insured with her daughters.

    We just live with the knowledge that anything like cancer is a death sentence. Everyone knows not to call an ambulance if I fall to the floor, heart attack or car accident.....I'd much rather be dead than homeless! The hospital would own my house before I might regain consciousness. I used to be a deputy city attorney, but because the city "opted" out of social security, I lost my ability to get social security until I am 65...and because I waited over 10 years to claim it (I was not sick...was working duh!) I cannot get the disability version.

    There are traps everywhere to deprive us of coverage, and you don't know until you happen to fall into one... We are hoping President Obama helps us--we are not sick! No high blood pressure....no diabetes...no cancer.....yet no insurance either! We'd just love preventative coverage, hospital coverage....cancer treatment if ever necessary. We are middle class normal people who eat carefully, don't smoke...but we live with the same knowledge they did one hundred years ago. Get sick, you die.
  • heathwood · 1 year ago
    John, I feel for you. I, too, am self employed and since I pay my full insurance coverage, I have decided to pay my prescriptions out of pocket for fear my monthly premiums will sky rocket. So far I have been able to cover the costs but I have found myself missing daily doses to stretch the prescription. I heard, again, from some right wing nuts I know, how terrible the Canadian health care system is, but I don't believe it. I go to my regular doctor and wait usually anhour to see him. Then basically all he does is give me pills. That is not a health care system that can brag about anything.
  • devlzadvocate · 1 year ago
    People with long-term health conditions (e.g. HIV), should check with their individual State health care programs to see if they qualify for assistance. There are programs that cover both the full cost and copays for HIV drugs in certain states and, I believe the Ryan White assistance programs is still funded in several western states.
  • jimpharo · 1 year ago
    John, did you not read a newspaper in the last 10 years? This is what everybody faces all the time. Hence the whole "need to reform healthcare" thing.

    Welcome to America, John. Besides adventures in health care, we also have adventures in education, adventures in unemployment, adventures in poverty, adventures in housing, adventures in unemployment, adventures in working conditions/pay...

    ...it's different when it hits home, though, isn't it?
  • Dumbo · 1 year ago
    John, Jacki, I hope you get around to reading this.

    Order your drugs from Canada. I could name my own favorite pharmacy that I use, but I don't want to spam, so google your own.

    I pay a FRACTION of what I would pay from a local US pharmacy for Canadian drugs. All you have to do is send them a fax of your prescription and a driver's license. They can sell you ninety days worth of medicine at a time. The drugs take one to two weeks to get here.

    Prices for AMERICAN-MADE drugs from Canada are about 50% of what they cost here. Just let that soak in for a moment. The very same drugs are cheaper AFTER they have crossed the border twice than when they are bought in their country of origin. Is that fucked or what?

    Also, because you are buying from Canada, you can get generics for many of the drugs that aren't available in generic form yet, here in the US. That can lower your costs down by 80% in some cases.

    One more trick: Have your doctor write your prescription in the highest dose available, and then cut them up at home into your dose. For instance, if you are used to taking fifty mg. pills, but they sell them in 200 mg., have your doctor write your prescription for 1/4 of a 200mg dose daily. For some reason, in both countries, a 200 mg dose of a med cost only slightly more than a 50 mg dose, rather than 4 times as much, which you would expect. You can arbitrage your own meds for a saving.

    This is terrific advice for anybody without pharmaceutical insurance. It saves me hundreds each month.
  • sparta99 · 1 year ago
    Sorry John, but your assertion that Blue Cross has "super secret" limits on your drug benefits is bullshit. Take a look at the contract you signed; I guarantee the drug limit is explicitly described, as is required by the laws of the state in which you bought the insurance. If the contract doesn't describe the limits, then Blue Cross is in violation of the law, and you have grounds to appeal any claim denial, something you can also take up with state Insurance Commisioner.
  • BobWalters · 1 year ago
    The answer is for Americans to learn to have courage and face their own mortality. I'm amazed that Amercians seem to feel entitled to health care fit for a king. We aren't kings and we don't live forever. Accept your fate with dignity and courage. Washington and Oregon both now have legalized compassionate access to drug assisted self-deliverance. This should be legal in all fifty states.
    I've really never bought into the idea of insurance. To expect a for-profit company to maintain a relationship with a client that is a money losing proposition, is fundamentally flawed.
  • SoLeftImRight · 1 year ago
    Interesting time to highlight this issue...campaign promises aside, what will Obama and our Democratic Congress ultimately come up with to deal with this major problem? After the economic crisis and Iraq, this is the biggest issue that must be dealt with now...oh and then there's education, and social security, and everything else...but I honestly believe we can revolutionize heath care in this country, but it's going to take a lot of work and PARTICIPATION! I work for a Fortune 500 company and, all else being equal, I have stellar health care. But my company had to tell everyone that this year, they're passing another 5% of the cost onto the employee, and of course, it's going up, as it does every year. I paid for Rx the other day and had to pay $130 for two! I didn't even ask the real cost, I can't imagine. With the same company, when I started over 10 years ago (mainly because I wanted to find a job with health coverage), I would have paid a max. of $40 for the same. I'm not complaining, because I can afford it, it's not a long-term drug regimen, and hey, I have better coverage than most people, but this is yet another an indication that things are out of control. I'd like to change jobs, if I found something better (I am feeling kind of stuck) but would I have to deal with "pre-existing condition" claims by a new insurance plan? It's all to crazy.
  • TaiPan · 1 year ago
    I too was self employed and paying for health care and my prescriptions once upon a time. I was diagnosed with heart disease at the age of 28 and degenerative spinal disease this year at the age of 32. I just recently canceled my policy that was costing me $1200/mo. with a $10,000 deductible. I now work at Starbucks for health insurance. I'm thinking about taking my first cardiologists advice and moving to a country with socialized health care.
  • mgardener · 1 year ago
    I am disabled and have been for 10 years with back problems. I have SSI/Medicare and BC/BS federal plan through my husbands job.
    He retired in May and we can't afford to keep up the BC plan, even though it is partially paid for.
    I am on considerable amounts of Morphine extended release and other meds that cost about $100/month after insurance.
    It was recommended that I try a spinal cord stimulator. The hospital told me that I would have to guarantee $20,000.00 ahead of time because the insurance would not pay for the procedure because they do a trial first, to see if it works, and then go ahead with an implant. They will not pay if it doesn't work=no relief.
    Needless to say, I am still taking the meds. I have very good days and other days I am in bed.
    I am grateful that I can walk and contribute to my family and community and I love that I can come online and visit with all you guys, but........
    We are the greatest nation in the world.
    My daughter went to McGill University in Montreal, Canada. She had their health insurance. It did not cost us anything(of course the exchange rate was 30-40% at the time) but she got great health care. Bad experience with a dentist though!!!!!!
    Canada is a wonderful country. Montreal is beautiful,clean and safe. We had a wonderful time when my daughter went to school up there exploring the city.
  • jaango · 1 year ago
    As a Chicano and a military vet from the Sonoran Desert, I write for the Chicano Veterans Organization at their web site on the internet.

    And for several years, we have been advocating that universal health care be 'rolled-into' the VA's medical and hospital systemic. Thus, the low-income, seniors, and our Brothers and Sisters-military vets all, would stand in the same line accessing our medical care together. For in doing so, egalitarianism will reign for all. Consequently, military vets, low-income and seniors, would eventually go out behind the barn, negotiate a reasonable political 'compact' and advocate this compact that would incorporate other vital issues important to this newly established class of voters while determined to stand together. Unions could also become part of this 'compact' should their self-interest motivate in our direction.

    And there's an old-fashioned adage here in the Sonoran Desert, and it goes something like this, "If you listen to the bald-headed white guys on both sides of the political aisle, you will go hungry!"

    And of course, the all-important question to be answered is, "How will all this be paid for?" The easy answer is to let Congress figure it out since they get paid the big bucks to find the solution, and thusly, allocate the dollars necessary in response to the "demand' that is to be visited on each member of Congress. And isn't a re-election opportunity wonderful in order to exercise a tad of political leverage and which has a definitive cutting edge to it? :-)

    Jaango
  • redjb · 1 year ago
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  • vkobaya · 1 year ago
    Single payer healthcare. As for the insurance companies, may they go bankrupt without a bailout and without any goddamn "effing" executive bonuses.
  • Deb in VA · 9 months ago
    Agreed! If caring about the health of the average American citizen is socialism, then bring in the socialists and kick those greedy bastards to the curb!
  • Ellie · 1 year ago
    Hey, do you think it would be possible for you to take advantage of WalMart's $4 prescriptions? I think Target and other "bad" big box pharmacies have similar programs. My insurance does not cover my medication because it is for a preexisting condition (hypertension), so I just go to WalMart and get a 30 day supply for $4 or a 90 day supply for $10.
  • ArtMofo · 11 months ago
    John,

    Dump the Vytorin -- it's likely to do you more harm than good. Sub with generic Zocor, which is far cheaper and proven as effective, if not more effective, than Vytorin. The recent research on Vytorin is a bit scary.
  • Debin VA · 9 months ago
    Thank you John for your insightful comments about our health care crisis (or system, as some try to call it) and your experience with medical bills while overseas. We have been wanting to travel to Paris and were afraid we might get burned on our insurance coverage while we were there but it sounds like we're better off there then we are here in the U.S!
    Now that Obama is in office, I feel a sense of hope that things might actually change and America can return to being a country full of success stories of those who found the American Dream rather than those who continue to live the American Nightmare.
  • pharmacy technician · 6 months ago
    "And I'm on Vytorin for cholesterol control."

    Vytorin is Zetia and Zocor. You don't need zetia if you eat healthy, and zocor is available as a much, much cheaper generic (simvastatin). It is no coincidence that Vytorin was released and ad-blitz right before zocor went generic.

    PLEASE do not quit taking your cholesterol medicine due to the high cost of Vytorin. Talk to your doctor about switching to generic simvastatin. If you are taking 40 mg or less you can even take a higher dose pill and split it into halves. 30 pills in any strength of simvastatin should be less than $25 cash from a local independent pharmacy (avoid chain stores; they price-gouge cash patients on generics). 15 pills split in halves should be less $15 or $20.

    If you let me know what your three allergy meds are (I left my email), I could give you suggestions to talk over with your doctor.

    And, yeah, I'm absolutely 100% in favor of universal healthcare.