aaaargh! stupid insurance company!

Monique Y. Mudama wrote:
On 2006-05-22, penned:

Hang in there Monique. I've been round-and-round with insurance
companies before, and after all the fretting and worrying I did, they
always paid. Even when I was told sometimes they would not. It will
all get ironed out, but you're probably in for a lot of phone time and
hassle, which you don't need.

That's exactly it. I told DH, "I would happily pay double the
insurance to not have to be on the phone all the time with these
people." He just stared at me, uncomprehending. But it's not *just*
the phone time, it's also the several week lag between the phone time
and the next time you see the EOB. In the meantime you have no idea
if the problem was really fixed or not. And I feel bad for the
doctors who are waiting patiently. But even if they're willing to
wait, I still get the automated statements.

It's just one more thing nagging at the back of my mind, one more
"make sure this gets taken care of" item. I like to pay my bills the
instant I get them, so that they're out of my mind and I don't have to
think about them anymore. This forces me to do the opposite.

I'm very upset with mine also; they've decided out of the clear blue
sky they won't cover one of my meds. I don't think they ought to be
able to change the rules in the middle of the game; I think they ought
to have to make changes on Jan. 1 when we renew every year.

I would agree. It seems very odd that they would go from covering
something to not covering it. Were you able to ferret out an
explanation?

--
monique, who spoils Oscar unmercifully

Pfft. The drug is called "Folbic." It's basically B vitamins and folic
acid, which is prescribed a lot for vascular patients. The insurance
company says over-the-counter vitamins are "comparable." Except you'd
have to take about six of them every day to equal Folbic. And that's
way more expensive. But the beef I have is, they have paid for the
stupid drug for five years now.

Sherry

wrote in message
oups.com...

Pfft. The drug is called "Folbic." It's basically B vitamins and folic
acid, which is prescribed a lot for vascular patients. The insurance
company says over-the-counter vitamins are "comparable." Except you'd
have to take about six of them every day to equal Folbic. And that's
way more expensive. But the beef I have is, they have paid for the
stupid drug for five years now.

[this might have be a duplicate]

Tell the insurer that they may want to have a long talk with the FDA as to
who in the insurer is making bioequivalence decisions. Preparations
containing more than a certain amount of folic acid are prescription-only. I
know my one-milligram tablets are prescription drugs, but, ISTR, the limit
is 800 micrograms or so.

If a drug manufacturer were to introduce a generic version of a branded
folic acid preparation, it would have to go through FDA bioequivalence
certification. That is less than a full clinical trial, but I suggest it's
a bit more formal a determination than your insurer is allowing.

wrote in message
oups.com...

Pfft. The drug is called "Folbic." It's basically B vitamins and folic
acid, which is prescribed a lot for vascular patients. The insurance
company says over-the-counter vitamins are "comparable." Except you'd
have to take about six of them every day to equal Folbic. And that's
way more expensive. But the beef I have is, they have paid for the
stupid drug for five years now.

[this might have be a duplicate]

Tell the insurer that they may want to have a long talk with the FDA as to
who in the insurer is making bioequivalence decisions. Preparations
containing more than a certain amount of folic acid are prescription-only. I
know my one-milligram tablets are prescription drugs, but, ISTR, the limit
is 800 micrograms or so.

If a drug manufacturer were to introduce a generic version of a branded
folic acid preparation, it would have to go through FDA bioequivalence
certification. That is less than a full clinical trial, but I suggest it's
a bit more formal a determination than your insurer is allowing.

On 2006-05-23, penned:

The pharmacist says they can choose what they pay for and not,
without any excuse at all. Which sucks. You can tell the ones they
don't like. They don't like Nexium, either. They are always kicking
up about it. Neither do they like to pay for Zocor--it costs me $40
instead of the normal $25 copay. I know this is not ethical, but I
spend so much money on medicine, I asked the dr. if he could
prescribe 80 mg., I can break them in half and they last twice as
long. He did that for me. I'm about to ask him to do the same thing
for DH's Mobic. We have to pay $130 a month for it. That's what
makes me so angry. They will pay for *other* arthritis drugs, but
not Mobic. It is like they are trying to control what the dr.
prescribes. Sherry

I got a month's worth of this GI medicine today. Also $40 copay.
Guess they don't like this one, either.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

wrote in message
ps.com...


The pharmacist says they can choose what they pay for and not, without
any excuse at all. Which sucks. You can tell the ones they don't like.
They don't like Nexium, either. They are always kicking up about it.
Neither do they like to pay for Zocor--it costs me $40 instead of the
normal $25 copay. I know this is not ethical, but I spend so much money
on medicine, I asked the dr. if he could prescribe 80 mg., I can break
them in half and they last twice as long. He did that for me.
I'm about to ask him to do the same thing for DH's Mobic. We have to
pay $130 a month for it. That's what makes me so angry. They will pay
for *other* arthritis drugs, but not Mobic. It is like they are trying
to control what the dr. prescribes.
Sherry

As I said in another post, this is what kept me from getting additional
medical
insurance in the past few years.
Without insurance, I can choose to spend my money on whatever
drugs I need and not dictated by what is covered and what is not.
Of course I can still pay for drugs not covered by insurance, but it would
be
very costly as drugs not covered are usually expensive ones.

I have a friend who spent hundreds of dollars a month on a cancer drug that
was not approved yet and not covered by her insurance.
This was at a time when she couldn't work and
probably lived on disability insurance if she had any.
She lost the battle with cancer.

Winnie

"W. Leong" wrote in message
...

wrote in message
ps.com...


The pharmacist says they can choose what they pay for and not, without
any excuse at all. Which sucks. You can tell the ones they don't like.
They don't like Nexium, either. They are always kicking up about it.
Neither do they like to pay for Zocor--it costs me $40 instead of the
normal $25 copay. I know this is not ethical, but I spend so much money
on medicine, I asked the dr. if he could prescribe 80 mg., I can break
them in half and they last twice as long. He did that for me.
I'm about to ask him to do the same thing for DH's Mobic. We have to
pay $130 a month for it. That's what makes me so angry. They will pay
for *other* arthritis drugs, but not Mobic. It is like they are trying
to control what the dr. prescribes.
Sherry

As I said in another post, this is what kept me from getting additional
medical
insurance in the past few years.
Without insurance, I can choose to spend my money on whatever
drugs I need and not dictated by what is covered and what is not.
Of course I can still pay for drugs not covered by insurance, but it would
be
very costly as drugs not covered are usually expensive ones.

I have a friend who spent hundreds of dollars a month on a cancer drug
that
was not approved yet and not covered by her insurance.
This was at a time when she couldn't work and
probably lived on disability insurance if she had any.
She lost the battle with cancer.


There's a delicate balance of medical and commercial interest when deciding
what drugs to cover with insurance. Remember, you also have a pharmaceutical
industry that grabs for market share. When a successful (patented/brand
name) drug comes out, other pharmaceutical companies may introduce slight
variations to go for market share, but the clinical improvement from these
variations may be minimal. It/s not unreasonable for anyone doing an
approved formulary (not just insurers, but hospital pharmacies don't stock
as many drugs as retail pharmacies) to look at general therapeutic
equivalence, and then select the cheapest in the group. It is unreasonable
to require a specific drug when there are clinically significant
differences. In other words, the insurers, pharmacies, and manufacturers are
all gaming one another.

Much more difficult are the situations where a drug may have some temporary
benefit in an irreversible disease, or where the evidence of efficacy isn't
clear -- and the drug is very expensive. Beyond that, it gets into a matter
of social policy, largely ignored in the US, when the health budget, as a
whole, can tolerate specialized drugs. I have no answer to the economics of
where various genetically engineered drugs can effectively treat genetic
diseases, with situations such as a cost of $100-200,000 per year to arrest
Gaucher's Disease, a cost that will continue lifelong.