Obamacare

Insurers sometimes deny coverage citing lack of progress, labeling patients’ conditions as chronic. Yet if they do make progress, insurers have also used that to argue patients no longer need treatment.

Doctors are left to walk a tightrope. Read more: https://propub.li/4i4mwU9

mickeyrat said:

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files.

“We literally click and submit,” one former company doctor said.

(Published March 2023 with The Capitol Forum)
https://propub.li/3Foz1f7

My wife has been on Humira for about 15+ years, since it was pretty much new. She was forced to go on the generic about 6 months ago, even though it isn't the same. Even before then she'd get periodically denied for no reason, and have to jump through a bunch of hoops to get the medication she was on for years.  And has already happened with the generic once since she's been on it.
And we've been fighting to get a new med for my son covered for about a month now too. It's just so ridiculous that we can pay 2k a month in premiums just to get denied prescriptions that our doctor is giving us.
I've said before, insurance fraud should go both ways. If a company or persons are wrongfully denying coverage to save money, they should be held to the same standard of fraud as someone who is faking an injury to get money.

nicknyr15 said:

mace1229 said:

mickeyrat said:

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files.

“We literally click and submit,” one former company doctor said.

(Published March 2023 with The Capitol Forum)
https://propub.li/3Foz1f7

My wife has been on Humira for about 15+ years, since it was pretty much new. She was forced to go on the generic about 6 months ago, even though it isn't the same. Even before then she'd get periodically denied for no reason, and have to jump through a bunch of hoops to get the medication she was on for years.  And has already happened with the generic once since she's been on it.
And we've been fighting to get a new med for my son covered for about a month now too. It's just so ridiculous that we can pay 2k a month in premiums just to get denied prescriptions that our doctor is giving us.
I've said before, insurance fraud should go both ways. If a company or persons are wrongfully denying coverage to save money, they should be held to the same standard of fraud as someone who is faking an injury to get money.

Sometimes it Makes me think it’s better to not have insurance 

I haven't researched it myself, but there was that news story from a couple weeks ago with that guy in California who paid double using insurance than what the "uninsured discount" was.
Really does make no sense in California if you pay thousands a month and still end up paying more for services. 

The FDA has found problems at an Indian factory that makes generic drugs for American patients, including one medication that was made there and has been linked to at least eight deaths.

The inspection comes after a ProPublica investigation revealed that drugs made at the plant accounted for an outsized share of U.S. recalls for pills that didn’t dissolve properly and could harm people.

Read the full story: https://propub.li/4l2Pc1N

NEW: An Indian drugmaker, investigated by ProPublica last year, has recalled two dozen medications sold to U.S. patients.

The drug recalls cover a wide range of commonly prescribed medicines — including ones that treat epilepsy, diabetes, multiple sclerosis, heart disease and high blood pressure: https://propub.li/43UCoVh

If I didn't know better, I'd think that wrapping everyone's health into corporate profits was a bad idea.

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life. 

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing. 
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though. 

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened. 

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life. 

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing. 
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though. 

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened. 

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.