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Started By
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re: How can an insurer just decide they will not cover/pay for a medication?
Posted on 3/16/22 at 4:46 pm to Jimmy2shoes
Posted on 3/16/22 at 4:46 pm to Jimmy2shoes
My insurer tells me to take a specific brand name of a medication. They won’t cover generic. With insurance discount, it costs twice as much as the generic without insurance discount. So I still get the generic and it just isn’t covered by my insurance and doesn’t go to my deductible. It’s complete bullshite
1
Posted on 3/16/22 at 4:52 pm to leftyloosey
quote:
Contract is renewed every year. You can always opt out if you want another carrier.
But yes, insurance exists to make money, not serve the greater good.
Lol. My carrier quit paying for an indigestion medication for my wife. Her Dr said watch this and the insurance paid $131k for an esophageal litigation or something like that. That's about 40 years or more of the previous medication.
This post was edited on 3/16/22 at 4:54 pm
Posted on 3/16/22 at 5:02 pm to Jimmy2shoes
They call it evidence based medicine.
Cost cutting.
Cost cutting.
This post was edited on 3/16/22 at 5:03 pm
Posted on 3/16/22 at 5:06 pm to Jimmy2shoes
Posted on 3/16/22 at 5:07 pm to Jimmy2shoes
Insurance (medical, home, flood) is the biggest scam in the world
Posted on 3/16/22 at 5:14 pm to TutHillTiger
quote:
It’s that fricked up system that we created to allow non medical people to take the profits out of medical industry
Here is the BS about medical billing.
I had to have some bloodwork done a few weeks ago. The hospital tried to bill the insurance over 800 dollars for the blood work. Blue Cross them steps in and says hey that same blood work under their contract with the facility is supposed to cost 108 dollars. Also, we are not paying it because our client has yet to meet his deductible so bill him. So, now I get the bill for 108 dollars. Why not just bill the 108 dollars instead of this back and forth and shooting for the moon only to know that you are only getting fraction of what you are asking for.
Is their some sort of tax kickback scheme that a hospital can claw back some of this reduced billing? At some of these inflated costs, you would think some hospitals and even some small hospitals are multi billion dollar businesses, but they are only able to collect and charge for one tenth of the paper charges.
This post was edited on 3/16/22 at 5:24 pm
Posted on 3/16/22 at 5:17 pm to Upperdecker
quote:
They won’t cover generic.
The system is designed to drive costs up. They won’t make as much money on generics I’m afraid.
Posted on 3/16/22 at 5:26 pm to Jimmy2shoes
Your doctor (or someone in the office) fills out a form and your insurance will pay again.
Posted on 3/16/22 at 5:32 pm to leftyloosey
quote:
You can always opt out if you want another carrier.
Unless, of course, you are in the majority of Americans that get their health insurance through their employer, and thus don't have a choice of carrier.
Posted on 3/16/22 at 5:40 pm to Tarps99
quote:
Here is the BS about medical billing.
Medical billing
US Tax Code
Two systems that are insanely, intentionally complex because the more complexity you have, the more you can rip someone off.
quote:
The hospital tried to bill the insurance over 800 dollars for the blood work. Blue Cross them steps in and says hey that same blood work under their contract with the facility is supposed to cost 108 dollars.
I call it "fantasy billing".
quote:
Why not just bill the 108 dollars instead of this back and forth and shooting for the moon only to know that you are only getting fraction of what you are asking for.
Because the idiots that most hospitals and dr offices employ as "billing specialists" are too lazy to look up, for each patient / insurance, how much the insurer will pay. So they just submit bills with the same amount for each patient, regardless of what their insurance plan is. And since different insurance plans pay different amounts, they just choose a super high number to make sure it covers every plan.
Posted on 3/16/22 at 6:23 pm to Jimmy2shoes
Wait, are you saying you should have some kind of guarantee of health coverage?
F outta here commie.
F outta here commie.
Posted on 3/16/22 at 6:36 pm to dyslexiateechur
My health insurance was so bad at my last job, prescriptions were way cheaper off the insurance.
Posted on 3/16/22 at 7:16 pm to Jimmy2shoes
One of my meds cost $240,000 per year, that’s why.
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