We changed insurance companies on the 1st. Just got this in the mail.

[Horse with no Name]

It is the medications that they will--or more importantly--will not cover.
They won't cover any allergy medications. They suggest you take Benadryl or another OTC medication.
They won't cover H2 blockers. They suggest you buy OTC Zantac or Tagamet.
They will ONLY cover Nexium or Prevacid if you have Grade III Erosive Esophagitis confirmed by endoscopy.
They will not cover name brand high blood pressure medication UNTIL you have (documented) proof that you cannot take one of the generic equivalents.
You cannot take Celebrex or Mobic. They want you to take one of the older (and more dangerous to your stomach) medications.
But the BIGGEST TRAVESTY is the meds for depression. Many who have taken these KNOW that it is very difficult to find something that works effectively with the least side effects. Well...our new insurance company has decided that they know more than you and your Doctor and have an APPROVED list of older ones that have high incidences of side effects.
It is criminal. Our premiums, copays, and office visits went up 40%, yet our coverage went down tremendously.

[Norquist Nemesis]

1. The best insurance Pharma can buy!

It's sickening.

[Horse with no Name]

2. Actually I am more thinking that Big Pharma would rather

the insurance companies paid for their more expensive drugs.
In fact, looking at the list of approved medications...it is almost identical to the same list that Walmart has for their $4 prescriptions. Those are the things that make you go hmmm....

[alfredo]

11. Will my $1.25 sleeping aid script cost $4 at Walmart?

[Why Syzygy]

3. Why did you change insurance? n/t

[Horse with no Name]

6. Our company changed.

We had no say in it.

[Missy M]

4. It is criminal and just reading what they are doing makes...

me filled with anger. To add to that a 40% increase is outrageous. Was it a company you work for that made the change?

[Horse with no Name]

8. I work for a hospital that is owned by a corporation.

They have cut staffing, pay raises are stagnant, they are cutting middle management positions, and now they are cutting benefits.
Not only did they do this...but one of our "benefits" is sick time.
However, we can't use it unless we have 40 hours accumulated and then it only starts paying after the 3rd day you are out AND you have to have a Doctor's excuse if you miss 3 days. So...that is another $30 just to use a "benefit".

[Missy M]

14. How ironic that you work for a hospital and they are doing...

this to their employees. It makes me think we are all doomed as far as jobs and health insurance.

[Horse with no Name]

15. We have always been the longterm trend

Believe it or not. I have worked in hospitals for over 20 years and can name ONE good insurance policy that we had.
Traditionally, Walmart has better insurance for their employees than hospitals offer us. At least in Texas.

[Missy M]

16. Has there been talk of closing hospitals in Texas.....

like they are planning to do in New York State? Many here, including me, are opposed to the plans to close these hospitals, some Catholic run and some run by corporations.

[Horse with no Name]

17. We have one not too far from here that is slated to close

People in our community HATE the corporation that owns our hospital. They don't support it.
Rumor is it is on the auction block...they just fired the administrator and brought in a corporate hatchet man to cut the fat.

[TornadoTN]

45. No talk of it here in Tennessee, but they are having to clean up their act

We have two competing corporate hospitals in the area. They have been buying out all of the smaller hospitals in order to consolidate their hold on power over the past 10 years and their service suffered. Now that they have bought out all of the small players, they have had to clean up their acts (much credit to Gov. Bredesen for making some of the changes necessary).

One Mountain States Health Alliance hospital was so bad, so egregious that people stopped going to it in favor of the Welmont facility a town over. People in accidents were requesting (if they could) to be taken to the Welmont facility in lieu of the closer MSHA one. They are now trying to fend off Welmont from building a hospital just down the road from the MSHA one just to handle the demand from the neighboring city.

Guess which one tends to treat their employees better and has a more progressive management style? If you guessed Welmont, you guess correct.

[Missy M]

47. It seems like the trend is all over the country to consolidate....

hospitals because they are under one corporation. They are even downsizing our health care. It all comes down to more profit and health care is secondary.

[quiet.american]

26. That is sick. n/t

[LonelyLRLiberal]

28. That sick leave policy is really stupid for a hospital.

I guess if you are sick with something contagious, you just come on in to work and pass the germs along to other staff and the patients?

[Horse with no Name]

32. You know

They really don't care.

[Xenotime]

5. This is why we need equal healthcare for all.

Then these problems would go away.

[CountAllVotes]

7. how awful!

That really does SUCK!

After reading this, I just reordered my allergy medication (Allegra 180 - not cheap - copay = $75).

:argh:

:kick:

[fasttense]

9. Nice to know they know better than your doctor what is best for you.

They will ONLY cover Nexium or Prevacid if you have Grade III Erosive Esophagitis confirmed by endoscopy.

What if you have an infection with the bacterium Helicobacter pylori? Prevacid was the only thing that stopped the pain for me. Stupid insurance companies do not consider all possible illnesses and make ridiculous blanket policies based on their profits and costs.

[Kosmo]

10. I sometime wonder why my boss even pays for our medical.

We have a ridiculous deductible of $2500 for my family. $1250 for the single guys in my shop. The copays are crazy and the very limited number of prescriptions covered is not worth while. When it is all said and done we as employees are paying almost as much for medical as we would without insurance at all. Yet the big guy in the office still whales about the cost of our insurance plan. Paying so much for so little just makes no sense at all. The insurance industry has reached a profit pinnacle and they are wallowing in it.

[Mnemosyne]

18. Welcome to DU Kosmo, from a former Cosmo and

nearby DU'er! Enjoying the snow? If only it didn't have to be on the roads! :)

Cosmo was Dad's nickname for me from 1964 until he died in 2004. I miss hearing it. Thanks for the memory bump! :hi:

[Mnemosyne]

27. Tried to edit too late -

My doctor has fought with the insurance company for a few years now, trying to get them to pay for enough of a medication for GERD. They decided that 30mgs is all I need, the doctor and I disagree. He gives me two weeks of samples. I am very grateful for any help. Why allow tests to diagnose illnesses, etc., but not allow sufficient treatments?:crazy:


on edit re: OP -

I am stunned at the deductibles being paid and the costs, but most of all the shrinking benefit coverage. Why the hell do many, including Medicare, cover the cost of hearing evaluations, yet do not pay any of the costs for aids to restore it?

Insane system, benefiting, as always, the corporations and investors.

[leeroysphitz]

12. You're right. It's time for some serious and meaningful change.

Why aren't our representatives in government even talking about this?

[Ilsa]

13. The stuff about anti-depressants is damned scary.

It is hard to find the best fit for a person because one-size-fits-all chemistry isn't appropriate.

I can understand the insurance companies being concerned and wary about some of the new drugs. I remember hearing that some of the anti-inflammatory drugs didn't work any better than generic ibuoprofen except for certain diagnoses, but docs were writing the scripts for the expensive because the big pharma reps were doing a good job at selling the new expensive stuff, and the docs weren't reading the research showing the relative lack of difference.

Maybe the ins cos need to make exceptions for certain diagnoses or accept a letter from the doc. I know it is more paperwork, but sometimes if the docs would spend more time on reading the research, they would use these new drugs as a last resort, not the first drug to be prescribed. And then move on to the more expensive drugs if the older proven drugs aren't working for the patient. I think that for some (less critical) diagnoses, a conservative approach is warranted.

[RB TexLa]

19. They do have to fight the drug industry telling everyone if you have this and this

go to your doctor and tell her you want our drug, don't worry about costs, your insurance will cover it. Not at all saying anything you need or have been prescribed isn't legitimate, but that is what they are having to fight.

[Parche]

20. Stomach problems

WOW sounds like you have stomach problems like me,
acid reflux, close ulcer....etc....


What good is health insurance if it doesnt take care of things like this.

[Horse with no Name]

34. Thankfully I do not...anymore

I had severe GERD at one time. It was fairly severe and was causing aspiration pneumonias.
I had a surgery called a Nissen Fundoplication and it pretty much cured it.
Prevacid wasn't controlling the acid damage to my esophagus so my doctor recommended it.
Whereas before...there was never any relief, since then (it was the early 90's) I could probably count the number of Rolaids that I have had on one hand.

[Parche]

35. gerd

Best wishes in your return to health.

I have had ulcers at 3times in my life, now its the acid reflux

I dont have health insurance yet, (next month finaly)

I take tagamet, and prilosec most of the time.........


"I feel your pain"

[Greyhound]

21. How long will it take before we realize that the only problem with our

health care system is the insurance industry? They have been destroying the infrastructure of our national capability to care for our citizens for decades, quality and capability have been stretched to, and in many cases, beyond the breaking point by staff reductions and facility closings. Fewer patients get less care, while the surviving employees workload has doubled or tripled, salaries have declined or at best stagnated, and all the while executive salaries profits have soared.

When everybody except the insurance industry is suffering, it isn't too hard to figure out what the source of the problem is.:banghead:

[Greyhound]

22. K & R

:kick:

[Straight Shooter]

23. Find out what the high-level execs in your hospital receive in health insurance benefits.

I bet you they've got their butts covered royally.

[smoogatz]

24. You people and your gold-plated health insurance.

I suppose next you'll want them to pay if you have surgery or something. Sheesh.

[pacalo]

25. Please tell us the name of the insurance company. It's getting scary.

[Horse with no Name]

31. Blue Cross Blue Shield of Tennessee

However...what we have might not necessarily be what you have.
The employer chooses the coverage levels and how much they pay and how much you pay.

[TornadoTN]

36. I have the same carrier through my workplace and they are screwing with the drug plan

The plan is very similar, especially with regards to the anti-depressants.

I happen to take on particular formula and it works very well. Now, I don't have an extreme case or anything, it's just enough to control what little symptoms I do have that occur from time to time. Since Blue Cross, Blue Shield has changed their list of "accepted" prescriptions, mine is no longer included and they have effectively told me "if you want it, go pay for it yourself. You will take whats on our list".

Luckily, I worked my way up the chain and finally got through to someone that said that the generic would be acceptable on my plan. It's insane that people are having to make these choices and pull themselves off of medications or change to another one that may not work for them. Anyone that has taken anti-depressants can tell you that its a trial-and-error process in finding the right one for you and once you find one that works, you stick with it. Trying to change or pull off of one is extremely difficult. At best you might get headaches, others have far more serious complications that can even lead to death.

[Horse with no Name]

39. I wonder how many suicides

will be enough?

[TornadoTN]

44. With the money they are raking in, its neglible no matter the number

I was talking to my family doctor the last time I was in for a checkup and we started talking about this very issue. He told me that no matter the lawsuits, at the rates they are currently charging and manipulating, they can simply pay out for the settlement and still be making money hand over fist. He was very concerned about his patients on anti-depressants, especially the ones that have exhibited any types of suicidal behavior. Luckily, I'm not one of them, but I can't imagine going through the uncertainty that is playing through all of their minds.

But what struck me even further is that it seems that these pharma changes in the prescription plans is drawing a battle line between doctors and insurance. When the lawsuits start to pile in, it naturally falls on the doctors at first. However, with the doctors being forced into a corner over these issues, they are going to fight back and fight back hard.

American's should never have to be faced with this and all the uncertainty associated with it.

[Jokinomx]

42. Many of our local doctors here in West Michigan dropped

Blue Cross and Blue Shield because of all the problems they had with them paying up. At the time we had them as our provider and I can't tell you ONE time that we didn't have problems with them paying.

Fortunately we had a choice to drop them and we did.... then I here their commercials on the radio and tv and just about want to puke.

Get a different company if you can.... trust me... they are nothing but trouble.

Good Luck

[Mnemosyne]

29. They want proof that you have suffered sufficiently

before they allow anything that actually works and , if you are very lucky, has no annoying or serious side-effects.

I find it sickening at how the insurance company is screwing you, Horse, along with too many others. I'm sorry.

I commented in another reply here, how it makes no sense that these companies allow the cost of certain tests, but not treatments, i.e. hearing aids, glasses, wheelchairs... the list grows.

Must be better money in the testing field for our "investor" class.

[SoCalDem]

30. "Secure Horizons/Medicare" denied my elderly friend a hearing aid

Know what the "claims person" told her husband?

"She's 78 and she has cancer, she doesn;t need a hearing aid"..

Walter broke down in tears when he told us what they said. Thelma did pass away a few months later, but what they did to her was criminal.

When she was first diagnosed with breast cancer (at 75), they did a "minimal" surgical procedure and told her she "didn't need" chemo or any other treatment. THAT worried me, but she seemed fine for a few years. When it came back, they basically just wrote her off.. :grr:

[Mnemosyne]

48. Sometimes I just want to scream at the way the

elderly and disabled poor are treated. I honestly believe they hope we all die to save costs. Or maybe I'm just getting older and more cynical. :shrug:

Please give Walter my deepest condolences at his loss of Thelma. I am so sorry they were treated that way! :hug: It just breaks your heart to know these things happen every day.

Anyone that needs a hearing aid , glasses, wheelchairs, etc., should always have such necessities provided. Depression is often caused when someone cannot see or hear properly leading to more problems. My one sister was trying to call our mother incompetent, all that was wrong was her hearing was impaired. She almost convinced our mom. :scared:

[htuttle]

33. Is this the best we can do?

Look around
There's doctors down on Wall Street
Sharpenin' their scalpels and tryin' to cut a deal
Meanwhile, back at the hospital
We got accountants playin' God and countin' out the pills
Yeah, I know, that sucks – that your HMO
Ain't doin' what you thought it would do
But everybody's gotta die sometime and we can't save everybody
It's the best that we can do

Four score and a hundred and fifty years ago
Our forefathers made us equal as long as we can pay
Yeah, well maybe that wasn't exactly what they was thinkin'
Version six-point-oh of the American way
But hey we can just build a great wall around the country club
To keep the riff-raff out until the slump is through
Yeah, I realize that ain't exactly democratic, but it's either them or us and
And it's the best we can do
-- Steve Earle, Amerika 6.0

[Horse with no Name]

41. Very powerful.

Thank you.

[aint_no_life_nowhere]

37. See if you can find another insurance company - one that offers more coverage

There might not be any out there, but you owe it not only to yourself but to society to try to find one. We need to drive these types of companies out of business. Hopefully, some day we'll have full 100% taxpayer supported health care in this country and get the middle man's fingers out of our wallets. Until then, however, the average citizen should try their best to support the better HMOs or insurance companies and hopefully drive the more rapacious swindlers out of business through competition.

[Horse with no Name]

38. I'm uninsurable privately

The only way I can get insurance is on a group plan. I have asthma as well as a rare disease that is fairly expensive when it flares up.
Last month I took 14 pills that cost $2500.
Of course, that was on my other insurance policy. Heaven knows if I could even get them now.:scared:

[aint_no_life_nowhere]

43. I'm sorry to hear that

My cousin was uninsurable after he lost his job. He had very high blood pressure and heart problems. He ended up going down south to a very fine European-educated heart doctor in Mexico who cost only a small fraction of the cost of a doctor in the U.S. including all the testing and he ended up buying medication at a very low cost in that country from a reputable pharmacy. Fortunately, he lived in California at the time and the commute wasn't that bad. He had to do that for quite awhile until he could receive social security and medicare benefits here.

[Jokinomx]

40. My Family Feels Your Pain.....

We changed as of the first of January also. However, it was to get a better company that has lower co-pays. Our original jumped to $30 co-pays for prescriptions and with two diabetics and a wife with asthma we couldn't afford the medications needed. So we opted for a $25 a month increase to have our co-pays drop to $10.....

Incidentally, our old company refused to pay for my annual physical in December....I think they were upset to lose another customer. We finally got it straightened out...but not without a fight.

Good luck with your new company... so far ours has been treating us ok....

peace

[donco6]

46. And on top of that, be thankful you're not on Medicaid.

My nephew is paranoid schizophrenic. Every so often, some government agency makes him come in for an investigaton on why he's getting medication, whether he could be on something cheaper or taken off completely. So they dicker with his medicines and he has an episode and sometimes they put him back on the good stuff. We usually tell then, "The poor kid sits in the garage most of the day talking to his "friends." Just having a big ol' conversation." And they want us to prove he needs medication. Jeebus.

[Bjornsdotter]

49. I just love

...when insurance companies practice medicine. :sarcasm:

Cheers

[Zodiak]

50. I worked for Blue Cross/Shield of Kansas.

I lasted six months before I quit.

I watched them purposefully kill people to save money. Because I was "smart and know medicine", I was invited to some of their medical review board meetings. One doctor who doesn't practice was there making all of the decisions, and all of the decisions were "no".

I saw Blue Cross give an old lady the run-around on a $60,000 hospital bill that was most definitely covered (and her husband had died in the hospitalization). They refused to pay the bill because she didn't fill in one line on her claim correctly. They never mailed her a notice...just waited for her to call after the creditors had dug their claws into her. She died soon afterwards, and the execs were glad they didn't have to pay the claim in the end.

As far as I'm concerned, health insurance companies kill Americans....tens of thousands of them, but we don't declare war on them like we do Al Queda. Instead, we reward them with more power.

The funny thing is...when they hired me, I told them I was interested in helping people get the medical care they need. Do they think I lied?

[uppityperson]

51. Legalized gambling. They bet they can make much more than will ever pay out.

Insurance companies are in the business of making money. Period. If they happen to pass a bit of it back, that is their bad luck. Simply put, I hate them and wish there was a way to make them serve the people who pay into them.