Gotta love those insurance companies

I won’t mention which one I use for my health insurance but I’d sure like to have a day in company’s upper echelon
with a ball bat.

I have copd and suffer from afib. For several years I’ve enjoyed meds that work on both fronts together but this year the insurance, in their infinite wisdom, decided to not support my primary inhaler so I had to hit up the doc for a replacement. This same doc suggested I use a “rescue” inhaler after the first “rescue inhaler I used, and it worked beautifully for me, was dropped from coverage a couple years back and I ended up with major league allergies to it. This most recent replacement inhaler, containing the same identical drugs as the other that caused issues, was one that was suggested by the company as a replacement. While at the doc for the first visit she suggested I start a statin as a maintenance med for cholesterol. My cholesterol wasn’t in the bad numbers yet but nearing it on one side so I said why not.

I got started with this new crap and after two days noticed a light , itchy, rash on my forearms that evening. By morning my hands had begun to swell and that rash had spread to my back and front of my thighs and my hands were so sore that I could not open a bottle of water. So off I go to the good doc again but I can’t see my primary so settled for another.

I had a nice visit and left with a heavy dose of prednisone by prescription along with sleep aide since prednisone tends to keep me up all night. Third day in on a twenty-day prednisone treatment and I can move my hands enough to work in the shop. The rash as all but gone and the tightness in the tendons has taken its leave, thank God. Damn, one doesn’t realize just how debilitating it is not have hand function without pain enough to bring tears to your eyes just picking up a friggin fork, until it actually happens to you. Now I need to go back and start a search for new meds that will actually work for me again. All this because some ignorant friggin buyer at the insurance company likely took a nice vacation and got a few thou stuffed in an envelope to use Mr. X’s new and improved inhaler and to drop one that actually worked.

This little episode probably cost the insurance company three times as much money as the idiots think they saved when all the blood work and office visits get tallied up. I had 7 very large vials of blood drawn and four of those had to be sent to specialized testing areas and I am sure that the testing wasn’t cheap.

While I despise government intervention, I would give anything to see these insurance companies get their nuts put in a vise and some serious pressure applied. Of course, that won’t happen since the pharmaceuticals and insurance companies are owned by the idiots [both sides of the friggin fence!] in Washington.

God I hate insurance companies and the older a person gets, the more they fk with you.

Jimmy i know that doctors can write an exception/or for better words explain why you need this particular med.

i personally dont no how well these turn out, but worth a shot……maybe!

In the Medicare space prescription tier and formulary exceptions are filled out and approved pretty often. You can ask your doctor to fill one out for you.

I know that it is frustrating when formularies(drug lists) change, but it is often done as a cost saving measure for the insurance company and consumer. Less cost for the insurance company should help with premiums as well.

If you have individual or a Medicare drug plan, you could look into changing your insurance carrier to get the drugs covered.

I personally had multiple doctors prescribe multiple ointments, inhalers, and pills to solve a skin rash. Finally one doctor pinpointed a chemical in my house that I was allergic too. The whole process was so frustrating. It’s good to hear that you identified the cause of your allergy so you don’t have to keep chasing the symptoms.

Doctors can in many cases write what is called a Prior Authorization, which is the physician’s reasoning to the insurance company as to why a patient should get approval for a medication that insurance may otherwise deny.
While the physician may not always win, keep in mind that the doctor almost always has the support of Big Pharma on their side – doctors are essentially their biggest salesmen. Even the deep-pocket insurance companies tend to avoid opposing the advice of a doctor supported by Big Pharma.
Lay out your case to your doctor, explaining the agony and suffering that you endured, and request a Prior Authorization be written on your behalf for a new medication.

Good luck, and I do hope you get relief soon.

My middle one had asthma pretty bad as a kid, her daily corticosteroid that we finally found that worked also went off the coverage list for our insurance. The specialist said they would send in a letter describing the circumstance and not long after they decided to cover it again. Thank goodness bc to buy it outright would have been $400 per inhaler.

Hope the health stays well for you.

Jimmy as others have said try to get a tier exception. Since you have a history of a pervious inhaler working and the new one not working due to side effects there is a good chance you will get it. If the tier exception doesn’t work file an appeal. Usually the appeal process is explained in the tier exception rejection letter.

Note: I have to request the tier exception every year but simply call Humana (my drug insurance company) to request it, they do the rest. It took one of my 90 day cost for a med from $1500.00 every 90 days to $5.00 every 90 days and no side effects like the other meds they tried.

since were on the subject of meds…… i take trulicity once a week. optimax RX informed me that my usual dosage was not in stock AND no idea when it will be.

long story short i’m getting a lower dosage but in the 2 conversations i’ve had with the local pharmacy…..apparently trulicity is the new weight loss med. pretty damn expensive to. like 1200 a month. i got good insurance so….

i asked the pharmacist why doctors a prescribing it, he said good question…..its not approved for weight loss. somehow there manupulating something from docs online?

That really sucks and it’s irritating these insurance companies do this crap! Hoping it works out for you. My wife ran into similar for ozempic for her newly diagnosed diabetes. Denied because the celebs use it for weight loss. Finally approved this week. My mom needed an EpiPen for food allergies and never could afford them so we gave some to her which she had to use a couple times. They never figured out what she was allergic to but her throat swelled shut. It was stupid expensive for her on Medicare. This stuff is life saving and these companies charge a fortue.

The health insurance/coverage situation in this country is a joke.

As Mojo referred to…… your doctor will need to do a Prior Auth…. In the Prior Auth world a new insurance may require a trial of their formulary med which it sounds like you have done. Now that you have failed that med, the Prior Auth should go through.

While I agree with all of the sentiment on insurance companies, especially those that operate for profit (UHC for example). If big pharma wasn’t allowed to charge what ever they want then insurance companies would not have to be “picky” in their formularies or take money from certain ones to cover their products. I’m not for government intervention in much, but the money is so great that big pharma operates with now, that they hold our whole system hostage.

you guys talk about meds that cost you $1200 like that is a lot…… We got an order a couple weeks ago for a new drug that comes as a prefilled syringe for a once every 3 month injection… our hospital’s acquisition cost for 1 syringe was $119,000….. yes you heard me $119,000….. now we need to bill the patient/insurance with a slight mark up…….. now tell me that the insurance company is the bad guy.

I had an infection that was threatening to get into the calf bones of my leg and I was in the hospital, in bed, getting IV antibiotics twice a day for four days that cost $25,000.00 for a four-ounce bag. Ridiculous costs but I am damned glad they worked. I was one day from losing my right lower leg.

big pharma preys on the sensitivity of your situation…

for 28 years i welded stainless and built stainless vessels….alot for pharmaceutical companies……its staggering what they cost especially when electro polished.

i also got to hear about the cost of these drugs…crazy. but talking the customers and inspectors made me understand it. there an awefull lot that goes into that final product!

Don’t be fooled Glenn…….. most of these drugs’ R and D are paid for in the first quarter of sales let alone the first year… Everything after that is insane profit….

joe-winter wrote:

Don’t be fooled Glenn…….. most of these drugs’ R and D are paid for in the first quarter of sales let alone the first year… Everything after that is insane profit….

oh i know!!!!!!! we made a veesel for some shampoo company once….the inspector said that first batch outta the tank would pay for the tank cost plus some!!!!!!

Big pharma is comparable to the devil.

They fund almost half of the FDA’s budget, the same organization that regulates them The more we get sick from all the chemicals and additives in our food the more pills we have to buy. After going to Europe it is eye opening and worrisome.

Tons of room for a political retort but will pass.
The missus works for one of the big ones processing claims.
We have no idea just how bad it is. Makes you wanna get in a vehicle and make somebody pay. Nothing short of criminal what’s going on in this country with this “business”

Sorry to hear that Jimmy! Health Insurance here is an absolute embarrassment, and these types of stories are all to common and terrible. Hope you get a quick resolution!

Umy wrote:

Tons of room for a political retort but will pass.
The missus works for one of the big ones processing claims.
We have no idea just how bad it is. Makes you wanna get in a vehicle and make somebody pay. Nothing short of criminal what’s going on in this country with this “business”

I agree and I honestly think it doesn’t even need get political, at least in the sense that we’re used to. It’s an issue, a current event topic. I think things usually get political when people start getting defensive because an issue is from “their side,” aggressive because it’s something “their side” wants, or someone just gets a case of “whataboutism” and flips the script to something non-related. I even figured I’d catch some flak for my post that health insurance/coverage in this country is a joke.

I really wish our country could get unified behind better health coverage. If nothing else, find a way to get anyone under 18 free medical coverage. I absolutely hate the thought of a kid not getting treated, or preventative care for something because a parent has to consider how much it’ll cost. That could ultimately lead to them dying or living the rest of their life with a condition that should’ve been taken care of. Feel free to call me a liberal socialist sheep snowflake for that opinion, whatever, we spend money on much dumber stuff than our future generations.

If our politicians – ALL OF THEM – had to have the same insurance as us and only for as long as they were IN office and there were term limits – this S-it would change in a heartbeat.
Moderna- over 1000%^ increased profits in one year due to COVID vaccines?! Thisis the kind “incentive” that keeps things from getting better for us peons

Like anything, health insurance has become almost exclusively political.

From the socioeconomic standpoint, middle class workers get hammered more than anyone as a % of their income on insurance that may/may not be decent in most instances.

Politicians will never change and them being in bed with big Pharma and insurance companies won’t either. Pray for good health and plan for the worst. Maximize your healthcare-related account contributions of all types, bank PTO like mad if it’s a part of your job compensation package, and save money for rainy days. We refuse to assume the government will do anything with health insurance or managing access to drugs now or at any point in the future.

Big pharma and corporate medicine are unknowingly (for the most part) complicit in the democide of – “Maintain humanity under 500,000,000 in perpetual balance with nature”.

Dr.’s are very good at getting a diagnosis from. That’s very important to have an accurate diagnosis. They are also good at cutting things out. Stainless Steel scalpels are also non-GMO.

Learn which medicinal herbs can address issues your family has and then grow as many as possible and learn how to use them.

I was born with asthma and had to go to the ER several times before I was 16. The old Primatine Mist inhalers that were banned for destroying the ozone layer worked great and helped millions of people. 10 years later the formula approved is about 1% as effective as the original, essentially useless (and 4 times as expensive). For asthma I now mainly use a tincture of Mormon Tea, Mullein Leaf and Lobelia. It works every time within 15 seconds of drinking the tincture. I have tincture formulas for all kinds of things like allergies and another for headaches, etc. Best thing is it doesn’t matter what happens to our supply chain or power grid, I can still deal with these issues for my family.

I’m glad you found some relief for your hands. You might try to find out what plants those meds were derived from. In the asthma example above, the Primatine Mist main ingredient was ephedrine which naturally is found in Ma Huang and Mormon/Brigham Tea.

I used to hate insurance companies too. And I probably still do. But 11 months ago I had a heart attack and emergency Open Heart Surgery ( triple by-pass). That bill would’ve over $200,000 without good insurance. My out of pocket so far hasn’t been $5-6000. But I do agree Big Pharma needs to be reined in.

wkw wrote:

But 11 months ago I had a heart attack and emergency Open Heart Surgery ( triple by-pass). That bill would’ve over $200,000 without good insurance. My out of pocket so far hasn’t been $5-6000.

Hope all is well with you now.

Going good Jimmy. I’m 69 so things take longer to heal. The real good news is I haven’t had (or wanted) a cigarette yet.

wkw wrote:

The real good news is I haven’t had (or wanted) a cigarette yet.