Discussion about insurance companies

[NaMeaHou]

I have had insurance for about one million years, and never used them for anything. They have sure as hell used me for many, many years though. My salary has been not increased as much as it could have because the company has to pay more and more and more each year for coverage. I must have given up dozens of thousands of dollars over the years in order to keep my insurance. Just in case.

Well. I didn't need it for a big reason the other day. I went to the doctor for a checkup and blood test. In the course of conversation, I told the doc that I smoke, had tried nicotine replacement, it didn't work for long periods of time, and I was wondering about Zyban. He was fully in support of it, and gave me a prescription for smoking cessation.

The insurance company informed the pharmacy that they don't cover smoking cessation. I guess they are hoping that rather than have a stroke and be hospitalized at $1,000 per day for weeks on end, I'll croak with a heart attack.

My physician then asked if I had a problem with depression. I told him that I do have an ongoing low-level depressive problem and told him the symptoms. He then prescribed Wellbutrin for depression. It is the same drug as Zyban. The same drug.

The insurance company refused to allow it without receiving my records from his office showing proof that I indeed needed this medication for depression. The doctor is providing this, but it will take at least over the weekend, and maybe not until Tuesday, until the HMO Gods decide whether or not I should receive this medication.

If I pay for it myself, it is $131.00 per month. If they pay for it, I still have a $40 deductible. They have to pay $91.00 per month.

How much money and time have they already wasted in refusing to okay this medication? The doctor, the assistants, the fools at the insurance company. I am sure it is more than $91.00.

I am now smoking more than ever, and very irritable to boot.

Thanks for letting me rant.

[soleft]

1. I work in the legal Dept of an Ins Company

It's like being the defense attorney for Charles Manson

[greatauntoftriplets]

4. soleft, that is so true.

Even my doc hates the insurance companies.

[Grey]

2. Stopping smoking

When I stopped, the Doctor gave me a three month supply of Zyban and it cost me about $95. I got 80% of that back through medical at work. end of problem. of course, this is Canada. Good luck, you can do it. I was a smoker for about 35 years and some times up to 2 1/2 packs a day.

[NaMeaHou]

3. Thanks for the positive message

I know I can do it, but was hoping for a little assistance.

Lucky Canadians (Canadiens?)

I can spend the money for it, but think it is so "unfair." It seems like the guy that drove his car 50 years without an accident and faithfully paid the bastards, but they canceled his insurance because he was, in their eyes, too old and risky.

I'm not old or risky, and insurance is spending more money to fight the prescription than it would take to approve it. Stupid.

[NaMeaHou]

5. I believe it was wrong to move this thread into the lounge

It is a discussion of insurance companies and their effects on those who depend upon them. It is a discussion of the unfairness and inane policies of those insurance companies. It is a discussion, hopefully, of what may be changed to make those policies work better for the individuals involved. I used my personal story to illustrate what is happening to thousands of people across the country every day.

This was not a vanity post, and does not belong in the lounge. It should rightfully have stayed in GD.

end of non-rant.

[Booberdawg]

8. This is not a political topic. Doesn't belong in GD

[NaMeaHou]

12. It is every bit as political as a discussion about

welfare, rush limbaugh, or any other number of topics currently on the board.

If the ability to pay for and benefit from insurance isn't a political topic, then neither is anything else that congress periodically takes up to convince us they have our best interests in mind.

[pasadenaboy]

6. I work for an insurance company.

Although we don't do health insurance, we do auto, homeowners, commercial, etc.

To answer your question, my guess would be it isn't an overall effective method to quit smoking. Insurance companies are motivated by profit. If they could get people to quit smoking for a few hundred dollars, they would do, as it would be less expensive than the other options. Another option could be your employer doesn't want it included, so, since they drive what type of coverage you can buy, they might have chosen a cheaper coverage option which didn't include smoking cessession. I don't know.

I really like the insurance company I work for. I've worked there for 8 years, and have never been encouraged to do anything unethical or unfair. I don't know why everyone hates insurance companies so much. You should judget the companies individually.

[Booberdawg]

7. I can tell you why.

I worked in health insurance claims for 11 years. Health coverage does not cover elective treatment, i.e., medication to stop smoking would be elective but if same medication is prescribed to treat depression then it is covered. That's why.

[rbnyc]

9. After my cast was removed...

...I had to go back into Physical Therapy. The Physical Therapist needed to approve my visits through both the no-fault insurance company that is supposed to pay for everything related to the accident, and my own insurance, in case we reach the cap on the no-fault. They told me that in order to have my insrance company approve the visits, my doctors office had to call them. My doctors office told me that they're prohibited bt law to call my insurance company until I reach the cap on the no fault. I'm nowhere near reaching the cap on the no fault. After getting the run around for over 2 weeks, I had to go to another physical therapist and lie about having my own insurance in order to get the therapy I need.

BTW, I pay over $200 per month to insure my husband and myself. My employer pays about $600 per month to insure us.

How are businesses supposed to pay $400-$600 per month per employee and keep their doors open. We've had 2 hiring freezes, a wage freeze and a raise cap in the past 3 years mostly because of the cost of benefits.

[baldguy]

10. Tom Tomorrow on insurance:

Just think: there are now almost as many people without health insurance as those who voted for the current occupant of the White House.

[Lars39]

11. We have catastrophic insurance.

Pays 50%, has high deductibles($1500/person,$5000/family, $4000 out of pocket), for about $350/month. Two unexpected surgeries within 2 months showed us what kind of insurance we have. We owe $4000. Don't know if that's good or bad. We would have been better prepared if we had pretended the the monthly premium was $700 and put the difference in the bank, but hindsight,etc. :shrug:

[Padraig18]

13. My insurance carrier

About a year ago, I began having pain in my ring, small amd middle fingers. I went to my doctor who said he couldn't find anything 'much wrong' except some arthritic changes and prescribed ibuprofen and mild stretching and strengthening exercises for my wrist and hand. Conservative and reasonable, right?

My condition worsened, and the pain became MUCH worse about 3 months later, and I returned to my doc. He ordered X-rays and made a referral to a neurologist for consultation. My HMO refused to pay for the neurologist, but I went any way and paid for the exam and tests out of pocket. The neurologist said I most likely had an ulnar nerve entrapment, based on the EMG and nerve-conduction studies, and HE referred me to an orthopaedic surgeon.

Again, my HMO refused to pay for me to see the orthopaedic surgeon, but again I went and paid out of pocket. He examined me, saw the X-rays my doc ordered and evaluated the test results from the neurologist, and he agreed that I have an ulnar nerve entrapment. He reccomends surgery. I hesitate (*shudder*), and ask if I can think about it. he said 'No problem, there's no need to rush, although yoou won't get better until it's done.'

Before I allow Dr. X to take a knife to my living flesh, I want a second opinion, and ask my doc to make another referral; he does, and again my HMO refuses to pay, so I pay out of pocket. Dr. Y examines me, and SHE agrees with a.) my doc, b.) the neurologist, and c.) the first orthopaedic surgeon that I do indeed have an ulnar nerve entrapment and that only surgery will allieviate the problem.

Armed with ALL this info, I again approach my HMO about paying for Dr. X to do the surgery, etc., and guess what? They want me to 'try physical therapy' and see if I *might* get better!

WTF? :wtf:

On edit: Who are these bean counters and button sorters to substitute THEIR judgment for that of FOUR licensed phsycians whose combined medical experience over 80 years? Something is SOOOOOO wrong about what my HMO is doing! :grr:

[FloridaJudy]

14. Idiots!

Dumb, dumb, dumb, dumb, dumb!

So what else is new? Health care here in the U.S. is mostly paid for by Insurance Companies and Government. Neither Corporate CEOs nor Politicians seem to be big on long-range planning.

I'm a Health Care Provider; I want to scream at least ten times a day when my ability to care for my patients is thwarted by some petty bureaucrat. These cretins seem to think that preventative medicine is some sort of *luxury*! Let's not pay for health care for the uninsured: oh no, we'd MUCH rather folks with hypertension and diabetes show up in the E.R. with strokes and heart attacks, and run up several hundred thousands of dollars of hospital bills before they croak! Never mind that those hospitals are going broke.

Mammograms and pap smears? Okay, we'll pay for those; they're cheap. Of course if - heaven forbid! - these show something ugly, well, we've done our job. We told *those* women they might have cancer; it's their own damned fault if they don't have good insurance or a couple of thousand dollars in savings to have it taken care of. What the hey, they're no great loss. It's not as if they own stock in Halliburton or something. Of course, paying for foster care for their orphans will be a major drag for the tax-payers...

Most recently, the state of Florida instituted what has to be the criminally stupid "cost-cutting" measure of all time. They no longer pay for "Family Planning Medicaid". No birth control pills. No IUDs. No patches, rings or condoms. We're supposed to be pushing abstinence...

Do the math; the most expensive birth control method - the Mirena IUD - costs $600. It's good for five years. Birth control pills/patches/rings cost about $500 a year at retail prices, less than half that if bought in bulk.

Locally, Prenatal/Delivery care for an unintended pregnancy starts at $4000 for an uncomplicated vaginal delivery, and at $12000 for a Ceasarian. Of course, if either mom or baby runs into trouble the cost could be millions.

I can usually be found at the end of the day banging my head against the nearest sturdy wall, chanting "Eighty-seven BILLION dollars! EIGHTY-SEVEN billion dollars. Eighty-seven billion DOLLARS! Dear Goddess, give me eighty-seven billion dollars, and I'll show you a Health Care System that is the envy of the rest of the world!"

Thanks me letting ME vent!