Obamacare

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kerley
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Obamacare

Postby kerley » Wed Feb 15, 2017 6:40 pm

Anyone having problems receiving their Medications through Medicare/ private Ins.
When I was diagnosed with RA my MD. ran a blind test on me and determined that I needed Celebrex and Embrel. My Insurance Co. [PERS] informed me that the two drugs would have to be approved by Medicare because of the Obamacare rules. The battle began. Finally, after much debate, the drugs were approved but at a higher deductible. Through PERS, our deductible is decided upon your rank at retirement. At retirement, the deductible for me was $10. for a ninety day supply of each script. When Obamacare began the deductible jumped to $25. for a thirty day supply of each script [Celebrix and Embrel] Last month I was notified that my Deductable would be $50. per thirty day supply. When Kathy inquired why she was told by PERS that Obamacare was the reason. Kathy filed a grievance and now we are told that I no longer qualify for the prescribed Medication unless I pay the $50. per month for each. Are any of you folks having this problem with your Insurance Companies?
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TexasBred
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Re: Obamacare

Postby TexasBred » Wed Feb 15, 2017 7:39 pm

I've had no real problems. Have medicare and prescription coverage through Humana. Only have 3 prescriptions and they send a 90 day supply each time. Two have no charge and the third is $6.95.
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True Grit Farms
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Re: Obamacare

Postby True Grit Farms » Wed Feb 15, 2017 8:13 pm

I had problems with BCBS approving the prescriptions my doctors said I needed. The BREO or Atrovent was costing me $315.00 a month out of pocket. That added to a few other things ended up costing us $400. A month. So I just said screw it and I'm rolling the dice. I haven't taken any drugs, prescription or otherwise including my blood pressure medicine since December. I'm trying to watch what I eat, no more cakes, candy, ice cream, or potato chips. I think the whole medical system is nothing but a racket.
Diet and exercise has worked for me so far, maybe it'll work for you also. FYI, do not follow the diet guidelines on the American Diabetes website, there sponsored by the drug companies and are in cahoots together.
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Clodhopper
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Re: Obamacare

Postby Clodhopper » Thu Feb 16, 2017 6:45 am

True Grit Farms wrote:I had problems with BCBS approving the prescriptions my doctors said I needed. The BREO or Atrovent was costing me $315.00 a month out of pocket. That added to a few other things ended up costing us $400. A month. So I just said screw it and I'm rolling the dice. I haven't taken any drugs, prescription or otherwise including my blood pressure medicine since December. I'm trying to watch what I eat, no more cakes, candy, ice cream, or potato chips. I think the whole medical system is nothing but a racket.
Diet and exercise has worked for me so far, maybe it'll work for you also. FYI, do not follow the diet guidelines on the American Diabetes website, there sponsored by the drug companies and are in cahoots together.

I'm no nutrition expert, but look at the glycemic index of foods. It's a scale relating to the digestion and absorption of sugars by the body. http://www.glycemicindex.com/
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kerley
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Re: Obamacare

Postby kerley » Thu Feb 16, 2017 1:20 pm

My wife "Kathy" called Medicare this morning, they told her that in the Obamacare rules, the only Medications approved are the Genetic. My Enbrel is not available in the Genetic form so I'm S..T out of luck, but if I want to pay the higher deductible I may be able to get it. I wish Obamacare would have left people that provided their own Health Insurance and were happy with it alone.
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hurleyjd
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Re: Obamacare

Postby hurleyjd » Thu Feb 16, 2017 1:53 pm

kerley wrote:My wife "Kathy" called Medicare this morning, they told her that in the Obamacare rules, the only Medications approved are the Genetic. My Enbrel is not available in the Genetic form so I'm S..T out of luck, but if I want to pay the higher deductible I may be able to get it. I wish Obamacare would have left people that provided their own Health Insurance and were happy with it alone.


Did you mean generic.
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hurleyjd
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Re: Obamacare

Postby hurleyjd » Thu Feb 16, 2017 2:01 pm

kerley wrote:My wife "Kathy" called Medicare this morning, they told her that in the Obamacare rules, the only Medications approved are the Genetic. My Enbrel is not available in the Genetic form so I'm S..T out of luck, but if I want to pay the higher deductible I may be able to get it. I wish Obamacare would have left people that provided their own Health Insurance and were happy with it alone.

My wife is on the three oral drugs described in this article and is doing pretty well on them.
http://nationalpainreport.com/generic-r ... 20381.html
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crop/hail
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Re: Obamacare

Postby crop/hail » Fri Feb 17, 2017 12:38 pm

I'm not old enough for medicare but I have BCBS for me and the family and it has been a total nightmare. thanks to good ole bronco bama!! just before the end of the year, our premiums went up from 620 to 930 per month. I got online on the healthcare exchange and got another plan that has lower deductibles and premiums (as long as I have enough deductions this year and the tax man can keep me under six figures).!!! Anyway they never dropped the other plan and were billing me for both plans, so I called (spent an hour on the phone pushing 1 for this and 3 for that) and had them drop the previous plan. A couple days later my wife looks online and discovers that they dropped BOTH plans. I have now spent about 3 hours on the phone with numerous phone calls and they cant seem to figure out what happened and cant reinstate the policy but were hesitant about refunding me the money for the last 2 months that we were uninsured. I will be so glad when I will be able to just walk into a local insurance office and get healthcare like before. WE have been forced into sorry, no good, worthless insurance and don't have a choice to get anything else.
Local companies wont even talk to you about healthcare insurance all they will tell you is to go online and wish you the best!!
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kerley
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Re: Obamacare

Postby kerley » Mon Sep 11, 2017 10:53 am

I was billed online for September 2017's Embrel, four injections $6099.99, what a rip-off. And hurleyjd, Yes I ment Generic, thank you for correcting my spelling [Genetic] and please forgive me for my horrible error.
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Re: Obamacare

Postby callmefence » Mon Sep 11, 2017 11:35 am

I posted a picture of my bcbs bill back sometime ago. In two years it went from 700.00 to 1500.00.
Except for a castrophic plan that kicks in at around 30 grand I'm now proudly self insured.
It's actually not to bad. You just tell them your paying right now. You don't need to send me a bill. Here's my American express.
My doctor just did 275.00 worth of blood work
For around 80 bucks. They're tickled to death to actually get paid without dealing with insurance companies or deadbeats that skip on the bill.
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farmerjan
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Re: Obamacare

Postby farmerjan » Mon Sep 11, 2017 12:54 pm

For anyone that is of christian beliefs, try Liberty Health Share. They DO NOT require a church membership as Medishare does, and the rates I have been quoted are pretty decent. One of the farmers I milk test for has switched to them when his ins went up from like 600 mo to over 1500 month. He says they have been pretty good. I was in line to lose my full time status so was going to switch to them, but now I have gotten more farms since a tester quit so will limp along. Bad thing is it won't cover any of my prolotherapy treatments, but Liberty will after a year of no treatment. Plus we went from a 1500 deductible 4 years ago to a $6000 deductible now so I will never qualify unless I have a catastrophic disaster....don't take any medication and am also trying to watch what I eat and all.
My Liberty quote was $275. mo; should have been $180. but I am overweight for my height. Still cheaper than what my company pays but as long as they are still carrying me, I am staying on it. Went from BCBS to Aetna though. And yes many doctors will give a better rate if you tell them up front that you will be paying cash and they don't have to deal with insurance claims.
My dentist gives a 10% discount on any prepaid stuff and then will still file ins after that and then refunds the money back to me that ins pays them. It doesn't earn enough for me to have a problem with prepaying then waiting to get the refund. Got over $500 recently when the ins reimbursed for a crown that I had prepaid. So the 1100 crown less 110 cash payment was 990 then 500+ back made it 490 or so. My dental ins costs me about 22 a month and covers 2 cleaning/checkups a year and x-rays every so often...can't remember exactly. What I pay in dental ins covers the costs of 2 cleanings a year so it is a wash, but the other is a real bonus.
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Re: Obamacare

Postby backhoeboogie » Mon Sep 11, 2017 5:00 pm

kerley wrote:I was billed online for September 2017's Embrel, four injections $6099.99, what a rip-off. And hurleyjd, Yes I ment Generic, thank you for correcting my spelling [Genetic] and please forgive me for my horrible error.


Maybe I need to pal up with a good vet
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Bestoutwest
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Re: Obamacare

Postby Bestoutwest » Mon Sep 11, 2017 5:35 pm

I know a lot has happened since Obamacare, but there's also a lot more available to people. For instance, there's a lung cancer drug that may possibly lengthen a person's life by 1 yr. According to an article I read it's a 50% mortality rate and 50% success rate. It costs $150,000 for the treatment. With my foot, my IV drugs that I was on for 9 weeks, were $8,300 per week. I was talking to a pharmacist about this and he was saying it's b/c of the people that don't have insurance and won't/can't pay for it. Then you have medical imaging, unwarranted surgeries (ie weight-loss) and warranted ones (joint replacements) that weren't done to the degree they are now compared with even 15 years ago. Yes, Obamacare is part of the problem, but paying for a bunch of other medical advancements and frivolity have caused all of us to pay more.
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boondocks
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Re: Obamacare

Postby boondocks » Tue Sep 12, 2017 12:10 am

farmerjan wrote:For anyone that is of christian beliefs, try Liberty Health Share. They DO NOT require a church membership as Medishare does, and the rates I have been quoted are pretty decent. One of the farmers I milk test for has switched to them when his ins went up from like 600 mo to over 1500 month. He says they have been pretty good. I was in line to lose my full time status so was going to switch to them, but now I have gotten more farms since a tester quit so will limp along. Bad thing is it won't cover any of my prolotherapy treatments, but Liberty will after a year of no treatment. Plus we went from a 1500 deductible 4 years ago to a $6000 deductible now so I will never qualify unless I have a catastrophic disaster....don't take any medication and am also trying to watch what I eat and all.
My Liberty quote was $275. mo; should have been $180. but I am overweight for my height. Still cheaper than what my company pays but as long as they are still carrying me, I am staying on it. Went from BCBS to Aetna though. And yes many doctors will give a better rate if you tell them up front that you will be paying cash and they don't have to deal with insurance claims.
My dentist gives a 10% discount on any prepaid stuff and then will still file ins after that and then refunds the money back to me that ins pays them. It doesn't earn enough for me to have a problem with prepaying then waiting to get the refund. Got over $500 recently when the ins reimbursed for a crown that I had prepaid. So the 1100 crown less 110 cash payment was 990 then 500+ back made it 490 or so. My dental ins costs me about 22 a month and covers 2 cleaning/checkups a year and x-rays every so often...can't remember exactly. What I pay in dental ins covers the costs of 2 cleanings a year so it is a wash, but the other is a real bonus.

I've been curious about how these plans work for awhile. I assume they don't cover smokers, for example. Do they take, say, morbidly obese people? Or people who already have preexisting conditions, such as, say, cancer or muscular dystrophy? I know they keep prices relatively low and I've just been curious as to how they manage that.
I was curious as to what prolotherapy is so I used the dreaded google. Do you think it helps? I have an aunt who is out of her head with back pain, won't take painkillers.
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ddd75
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Re: Obamacare

Postby ddd75 » Tue Sep 12, 2017 7:23 am

even though we pay around 1000/month for insurance.. we just had a child at home with a midwife since its now 8500 to have a child in the hospital (with insurance). But it was 1000x better experience at home then at the hospital anyway.

its just another poor people tax.. now we have to pay for them to eat, sleep, go to the ER.. get all their pills..etc..
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