Re: Insurance companies

[Guest guest]

Well, Mike, as far as not being able to blame the insurance company for

following the guidelines, that was not what I was doing. I suppose I was

complaining about the guidelines themselves.

And yes, for another $340. per month, I could have opted for a lower

deductible, but who knew out-patient things could be redefined in such a way

to wind up being in the hospitalization deductible. Silly folks like me

just figure logically that " hospitalization deductible " means just that, a

deductible for medical procedures and treatments done to one while one is

hospitalized. I would be more than happy if the diabetes education course

in question would sell me the class for the discounted price they sell it to

the HMO, rather than the full $800. if I have to pay. The HMO's price is

something like $326. if they pay for it

The lower deductible policy doesn't make sense, since it would cost more

than the difference in the deductible to purchase the lower deductible. And

the synopsis they furnish at each enrollment period does not really cover

every possibility. I am sure there is a book/policy somewhere that covers

every possibility, but we don't get it.

And not to be argumentative here, Mike, but I certainly do blame insurance

companies for all of this. I don't know how old you are, but I am 52 and

can remember a time when most people did not have medical insurance, except

for hospitalization. And we could afford our dr. visits and procedures as

they were pretty reasonable. And then the insurance companies grew and

grew, and convinced everyone they needed complete coverage, and they

basically, in my opinion, drove the prices up, all the while making record

setting profits for themselves.

Now, no one is happy (except the insurance companies). The very poor and

working poor do not have access to insurance, and can no longer afford

medical care. Employers and their employees are having to pay more and more

each year for insurance, and many employers are opting not to offer it at

all, leaving more people uninsured. I personally know many middle class

hard working families that are one hospitalization from bankruptcy, praying

that they and their kids stay healthy. Kind of a middle class Russian

Roulette, because if you can't find a group, coverage prices for families

are hideously high.

And don't get me started on the city, state, and federal employees with

their inflated benefits paid for by the taxpayers. Our governor just vetoed

a bill that our state legislators were trying to slide by as the last bill

for this session that would pay for their and their families health

insurance for the rest of their life after serving their 2 terms. If

passed, that bill would have cost Louisiana taxpayers $10,000. per year for

every state legislator, current and future, for the rest of their lives.

Mercifully the news got wind of it, reported on it, and the governor's

office was flooded with calls from constituents raising the roof. So she

vetoed it. But who knows, once they try something like this, they keep on

plugging until they get it.

Gee, I have worn myself out!

Laurie,

Getting off of her soapbox

[Guest guest]

> And not to be argumentative here, Mike, but I certainly do blame insurance

> companies for all of this. I don't know how old you are, but I am 52 and

> can remember a time when most people did not have medical insurance,

> except

> for hospitalization. And we could afford our dr. visits and procedures as

> they were pretty reasonable. And then the insurance companies grew and

> grew, and convinced everyone they needed complete coverage, and they

> basically, in my opinion, drove the prices up, all the while making record

> setting profits for themselves.

Laurie,

I'm almost 49, so not too far behind you. Insurance companies have no

interest in seeing medical costs rise. In fact, they do all they can to

keep costs down, by contracting rates with hospital groups, and (in the case

of HMOs) attempt to controll utilization. Also a large number (but not all)

Blue Cross Blue Shield plans are non-profit organizations, and can only

build reserves in expectation of future claims. Then there are the mutual

insurance companies who are owned by their members (umm.. that would be the

policy holder). ;-)

Insurance companies make easy targets, as they are the entity who says they

aren't paying for something (or aren't paying enough)... they are also

targeted by doctors and hospitals who complain about reimbursement. But we

don't talk much about doctors who think nothing about having annual incomes

of $200,000+ or the hospitals and doctors that have to have fancy building

space and decorations...all of the money spent on art for lobbies and

waiting rooms, not to mention the costs of malpractice insurance driven by

lawyers who want to make more than the doctors or the lawyers clients

looking for the road to easy street. Of course, there are the politicians

in bed with both sides for the financial support to buy their next term.

Then we have the drug companies who figure that if they change the design of

the packaging their medicine comes in, they can extend the patent protection

another 8 years to keep someone from producing a generic, when the packaging

has nothing to do with the effectivness or delivery method of the

medication.

Not to forget the employers out there, many of which would prefer to put all

employee benefits (including insurance) into their pockets and lobby against

any legislation (state or national) to require companies to provide

healthcare benefits for all employees.

Yes, I remember growing up without insurance... it was something farmers

didn't have (or if they did, it was only hospitalization). Yes, prices were

less for doctors services back then... but gas was only 35 cents a gallon

too! You could drive up to full service and get $3 of 'regular' and leave

with almost a half tank.

From the time I graduated, I've always managed to have a job that provided

insurance benefits, and always made sure to sign up for them when they were

available. I've been very fortunate that way... and I've also made many

dinners from Raman noodles to afford that insurance.

I look at it this way. Without insurance companies, there would only be the

'free market' to keep costs in check, and we know what happened to the

phone, cable, airlines, etc. when they were de-regulated and dumped into a

'market' economy. Prices went up and services went down.

Handing Laurie back her Soap Box :-)

Mike

[Guest guest]

Mike,

Just one question. Why are the premiums for insurance coverage

for health so high (for some people costing about $300 a month

often more for many others like some friends of mine whose

insurance is $1000 a month)?

If there are some insurance plans such as some BCBS plans that

are non-profit by having that reserve it means that they can say

it's ok to charge such ridiculous prices for premiums which then

they bring the cost on to us making it harder to pay them. This

is kind of the same principle that ties in to the Post Office

when they hike the prices of first class stamps (which will be

done again next year).

Don't get me wrong I'm glad we have it so far but I worry (as

does my mom) that the cost may be so prohibitive that we may end

up without insurance some day. I'm just glad I was able to have

my surgery now (to check the status of my endometriosis) b/c I

don't know what the insurance situation is going to be like next

year.

My insurance is thru the feds due to special circumstances with

my mom's help but the output of the premium for a monthly basis

is affecting her pension in a not so nice way. Most insurance

companies raise prices b/c of concerns about the shareholders

(not saying that this is necessarily true with BCBS as you

mentioned). It's a monopoly much like the thing you gave with

the thing of the phone and cable companies and the way that they

charge. If they are so concerned about lowering costs then why

is it that a surgery such as my laparoscopy should cost $21,000

and that's including the meds and the anesthesia. It should be

a lot less if they are trying to reduce prices.

The HMO that used to service federal employees in this area of

FL where I live only services the Southern portion of the State

now and people who are getting it are paying $800 a month for

coverage. HMOs won't service federal employees in this area:

not retired ones anyway and I don't understand why. There's one

that I would love to have come here b/c it's closer to the HMO

we had back in the 1990s and in to part of the 2000s but they

won't come here and I would love to know why.

I just hope I have a job soon so that I can help take care of

paying some of the bills so that it's not so hard on my mom.

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________

[Guest guest]

>

> Just one question. Why are the premiums for insurance coverage

> for health so high (for some people costing about $300 a month

> often more for many others like some friends of mine whose

> insurance is $1000 a month)?

>

> If there are some insurance plans such as some BCBS plans that

> are non-profit by having that reserve it means that they can say

> it's ok to charge such ridiculous prices for premiums which then

> they bring the cost on to us making it harder to pay them.

Kristy,

Ok... here goes ;-)

There are several things that can be involved with a $300 policy vs. a $1000

policy. One of the greatest impacts is whether or not it is a group

policy. The reasoning? If you go out and buy a single policy, you are

probably doing so because you know you will need it. However, with a group

policy, the main thing is that it includes people who don't 'need' insurance

along with those that do. This is controlled in one of two ways, either

coverage is mandatory and everyone is paying a premium (or the company who

you work for is paying it), or the requirements to join the policy are such

that if you don't take advantage of it when you are first eligible (i.e.,

when you are hired, or at the end of a probationary period or some other

company established time), you can either not ever get it, are required to

undergo a physical or other 'underwriting' or are required to pay a slightly

higher premium (or a portion that you would not have had to pay had you

joined right away). What the insurance company figures is if they have

healthy people paying a premium, they can lump all of these premiums

together and charge less for the less healthy individuals.

There is an interesting concept people have about insurance companies. They

seem to think that there is unlimited funds to cover every claim filed...

but don't consider where the money comes from. If your policy is $300 a

month, but your expenses cost $350 (even at 80%) a month... how long do you

think an insurer can cover you? Or what about someone who pays $1000 a

month, but has a heart attack and in one month has expenses that top

$50,000. That's certainly more than 1 years worth of premiums. That's why

individual policies are generally quite high in cost and why group policies

are formed, so that they can get those $300 a month people who may have

medical expenses of $200 a year for an office visit when they get a cold and

a single Rx for cough syrup. Things can balance out like that with a group.

To offset that $1000 a month guy who has a heart attack, rates need to be at

a point where two things happen. First, the policy is competitive with

other insurers and second, enough money can be collected and put into

reserves to handle anticipated future claims.

Maybe it is a little like your Post Office scenario... but I don't see where

that is a problem. The insurer's reserves are calculated on the policies

enforce, the amount of claims compared to premiums and projected changes in

the number of insured. All states have rules requiring these types of

calculations be filed with the insurance commissioner and they also require

that the insurance company have adequate reserves (reserves can't be touched

for anything but paying claims) to keep operating. This is your protection

that your covered services actually get paid.

Well, insurance companies are not monopolies, as the very nature of a

monopoly is a company who is the only company that operates in a field or

region of the country that does not have competition against it and is able

to set their prices without regard to market pressure. This simply is not

the case with insurance companies. I believe most (if not all) states also

have policies and regulations regarding rate increases that insurers have to

follow as well. They aren't free to do as they please (even if it may look

like it from our point of view sometimes). By the way, my comments

regarding phone companies and airlines etc... were to illustrate what

happens when regulation is removed and the 'free market' principles are

applied... which you hear a lot about from politicians... let the market set

the price... what generally happens in these cases is that prices go up and

service declines. Without the insurance companies stepping in an

contracting with hospitals and physician groups for 'fee schedules' on most

services, your coinsurance would be much higher than it is... so this saves

you money.

Insurance companies are always trying to reduce costs. Every once and a

while, you hear of a hospital or physician group that refuses to sign a

contract with a local insurer... it doesn't happen often, but when it does,

it's always because the insurer is trying to reduce (or keep from raising)

what it pays for individual services or groups of services. You'll hear the

physicians and the AMA complain that they don't get enough money from

insurers, Medicaid or Medicare... (Medicare is in a unique position as it's

rates are regulated by congress).

HMOs are a unique animal. You see many HMOs that offer coverage for things

that are not typically covered by insurers (glasses, massages, etc.) but

what you don't see is that you are limited in the physicians you see.

Generally with a HMO, a physician gets paid 'x' dollars a month to provide

services for a pool of beneficiaries (those who have elected him as their

'primary care' physician). This doctor gets a flat rate for you...

regardless of how many time you see him each month. The co-pay amounts are

put in place to help minimize the number of trips you make to the office.

This physician is then the gatekeeper and generally they get rated on how

well they control costs for the HMO. So you have pros and cons with this as

well (make sure needed care is given to prevent more costly illnesses, but

make sure you don't spend more on the care of this patient than you make,

and make sure you don't give unnecessary referrals that cost the HMO

needlessly).

I know it's hard to believe at times, but insurance companies really are in

business to pay claims. If they didn't pay claims, they would soon run out

of people who would buy their policies. They are working to fulfill legal

contracts that have specific details of what is covered or what is not

covered. Sometimes an insurance company can be a big bureaucracy. I won't

deny that. They may be slow to react and there could be individuals that

you deal with that are just wrong. Sometimes you have to go to battle with

them... so don't think I'm just defending them.

I'm simply trying to present a fuller picture so next time you pay a premium

you don't feel like you are being taken advantage of. Sometimes we all feel

the part of the victom when we deal with an insurer. But it's not the

case. Everything you are entitled to have paid should be covered in your

policy. Sometimes this coverage (or coverage restriction) is written in

broad terms... but if push comes to shove, you can always go to the state

insurance commissioner or if the dollar amount is large enough contact a

lawyer. Yes, I agree you shouldn't have to, but not every person who is in

a decision making position is perfect. Generally you can find the right

person to help if you make a few calls (or enlist the help of your

physicians billing department, it's in their interest to get things paid

accurately too!).

Hope that helps,

Mike

[Guest guest]

Mike,

It helps some. Does the State Insurance Commissioner's Office

regulate a plan in a State such as mine: FL if it's thru the

federal government (which mine is, my mom and I are classified

as a family) when it comes to prices? So for other families

that fall in to a federal plan here in FL they will most likely

pay $300 a month.

I still am not sure how they can figure (maybe I need to look at

the breakdown some more) that the total cost of my surgery is

$21,000. No wonder sometimes insurance is confusing.

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________

[Guest guest]

>

> Mike,

>

> It helps some. Does the State Insurance Commissioner's Office

> regulate a plan in a State such as mine: FL if it's thru the

> federal government (which mine is, my mom and I are classified

> as a family) when it comes to prices? So for other families

> that fall in to a federal plan here in FL they will most likely

> pay $300 a month.

>

> I still am not sure how they can figure (maybe I need to look at

> the breakdown some more) that the total cost of my surgery is

> $21,000. No wonder sometimes insurance is confusing.

That is a good question. If the insurance is a federal plan, what is

typically called 'FEP' I'm not sure. The reason I say this is there could

be federal legislation that allows for these types of policies that may

override state law. If you have concerns, your state insurance

commissioner's office would be the place to start. If they don't have

jurisdiction, they should be able to direct you to the appropriate agency.

The insurance company probably isn't the one saying your surgery cost is

$21,000... it's probably the hospital. (Actually the hospital is probably

saying it cost more than $21,000 and the insurance is saying that $21,000 is

all that the hospital is contractually entitled to).

There will probably be more bills to come. The hospital will have bills for

the surgical suite, the accommodations (if you had an overnight stay), and

the costs for supplies involved in the surgery, recovery room and

disposables in the room. You will probably receive a separate billing from

the anesthesologist and yet again from the surgeon. If your family/GP

doctor visited you in the hospital, you will probably get a bill separately

from him as well. Not to mention if there were a requirement for physical

therapy, or other specialized care, and tests, the 'technical' aspects of

this would be billed through the hospital, but the 'professional' aspects

would be billed by the individual doctors or therapists involved. Unless an

x-ray is performed entirely in an doctors office, it will generate two

charges. One from the facility for the 'technical' aspects (the equipment

use and materials) and one for the 'professional' component (the actual

reading of the x-ray by the radiologist).

Mike

[Guest guest]

Quoting Mike schappaugh@...>:

> Not to forget the employers out there, many of which would prefer to put all

> employee benefits (including insurance) into their pockets

The company I work for recently dropped health insurance benefits for employees.

When these employees applied for coverage through the same company that had

been providing coverage, only two employees were approved. They had two things

in common---they had no health problems and were normal weight!

>

> Yes, I remember growing up without insurance... it was something farmers

> didn't have (or if they did, it was only hospitalization). Yes, prices were

> less for doctors services back then... but gas was only 35 cents a gallon

> too! You could drive up to full service and get $3 of 'regular' and leave

> with almost a half tank.

I remember those days. At 59, older than both of you. We also made a lot less

back then. BTW, our family doctor charged my parents $5 for an office visit no

matter how many of their 9 children they took in, including penicillin shots, or

$2 for enough pills to treat everyone. His office was in his house and he had

NO office help.

Handing Laurie (and Mike) back the Soap Box :-)

Kitty

[Guest guest]

>

>

> The company I work for recently dropped health insurance benefits for

> employees.

> When these employees applied for coverage through the same company that

> had

> been providing coverage, only two employees were approved. They had two

> things

> in common---they had no health problems and were normal weight!

>

>

> I remember those days. At 59, older than both of you. We also made a lot

> less

> back then. BTW, our family doctor charged my parents $5 for an office

> visit no

> matter how many of their 9 children they took in, including penicillin

> shots, or

> $2 for enough pills to treat everyone. His office was in his house and he

> had

> NO office help.

>

> Handing Laurie (and Mike) back the Soap Box :-)

Climbing back on the soap box (and rubbing my knees from all fo this

climbing!) ;-)

Kitty.. yep, it sounds like the employees who didn't get coverage were

'victoms' of underwriting. When the policy was dropped by the employer and

basically the coverage became 'individual' instead of 'group' each

individual is rated on their own for benefits. My guess is that the package

that was in effect was offered at a modified rate for those who met

their underwriting requirements. I would bet that the others who didn't get

covered *could* get a policy with that insurer, but the benefits would be

different or the rates would be different than what they offered to the two

who were accepted.

Unfortuantely, with all of the different insurance plans and Medicare,

Medicaid and the number of potential companies you would have to deal with

to file the claims... a doctor probably couldn't manage to run an office by

himself these days. Choice and competition are great for some aspects when

we look at prices and benefits.....but all of those choices mean that

doctors have more and more paper work (to become 'members' and participating

physicians with each and every health plan) various billing requirements

that are required from different insurers (this is improving with HIPAA...as

standard code sets and electronic formats are being required across the

board for private insurers and Medicare/Medicaid).. but still there is so

much more time involved. As patients, many times we expect our doctors to

know what our insurance plan covers and not to do things that will cost us

money, so that means either the doctor (or staff) has to make calls... deal

with 'pre-admission' approvals some policies require and jump through the

hoops (or even look up what hoops have to be jumped through!) with maybe 20

different insurers and HMO's, not to mention the multiple products each of

these insurers or HMO's may offer.

Ahh... for the 'good ole days' ;-)

Mike (climbing back down from the soap box, kicking it a little cuz it hurt

his knee and then heading for the door for some 'shopping therapy') ;-)

[Guest guest]

Thanks Mike. And yes my BCBS is an FEP insurance.

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________

[Guest guest]

Mike schappaugh@...> wrote:

" I would bet that the others who didn't get

covered *could* get a policy with that insurer, but the benefits would be

different or the rates would be different than what they offered to the two

who were accepted. "

My very good group BCBS plan of Georgia plan did not get converted to

individual plans, but when my COBRA ran out, they wouldn't insure me for any

price. In Georgia I was considered an " assigned risk " and the office of the

insurance commissioner assigned me to an insurance company who, by law, had to

insure me at rates determined by the state. It was still more than I could

afford, as by this time I was on disability and waiting for my SSDI to kick in.

Then it was another 2 year wait for my Medicare to kick in. I was so anxious

for all that time and couldn't afford medications, so couldn't really take care

of myself. Now with the Medicare and the Medicare Rx plan, I can pretty much

manage, but it's still a struggle. No matter what, access to health care is our

nation's achilles heal.

__________________________________________________

[Guest guest]

>

>

> My very good group BCBS plan of Georgia plan did not get converted

> to individual plans, but when my COBRA ran out, they wouldn't insure

> me for any price. In Georgia I was considered an " assigned risk " and

> the office of the insurance commissioner assigned me to an

> insurance company who, by law, had to insure me at rates determined by the

> state. It was still more than I could afford, as by this time I was

> on disability and waiting for my SSDI to kick in. Then it was another

> 2 year wait for my Medicare to kick in. I was so anxious for all that time

> and couldn't afford medications, so couldn't really take care of myself.

> Now with the Medicare and the Medicare Rx plan, I can pretty much manage,

> but it's still a struggle. No matter what, access to health care is our

> nation's achilles heal.

,

I agree, healthcare is our nation's Achilles heal. In many aspects it is

one of our greatest strengths too. Unfortuantely, the strengths don't

outweigh the weakness when talking about being able to afford care. But

that isn't necessarily the fault of insurance companies, as they function

within the framework prescribed by law. I'm not sure if it's state or

federal laws that allow for a total exclusion of coverage for high risk

individuals, and the designation of an 'insurer of last resort' to cover

those individuals. While some proposed changes (which I believe to be

local) that would establish local 'insurance pools' to obtain group rates

for individuals (this practice is also done with some professional

organizations), it doesn't change the fact that the bottom line (no pun

intended) is that the expenses that an insurance company pays out (i.e.,

claims paid) can't exceed the premiums received. So while it's unfortunate,

it is understandable. It's a simple math equation, and while reserves cover

short term situations where claims covered exceed premiums received; that

situation can only exist for a finite amount of time before the insurer is

bankrupt.

I don't know what the answer is because someone somewhere has to pay for

care provided (be it through insurance premiums or taxes paid to the

government). Unless, somehow, there are caps put on what can be charged for

a medical procedure, and limits put on the amount of profits drug companies

can make...one way or another we will pay (through insurance premiums or

taxes). The reality of the matter is that our political climate will never

be to a position where we will impose caps on profits that doctors,

hospitals or drug companies can make, or where coverage of all individuals

is mandated through employer groups or government sponsored programs. On

one side of the political spectrum are endorsements for tax credits for

coverage, but that only goes so far, and the other side endorses government

sponsored programs. Unfortunately there is a vast gap in the middle that

will continue to fall through the gaps, and those on the fringe that are

simply overlooked.

Even with insurance some people have struggles. For instance, I have a $25

co-pay for an office visit (if during one month seeing my cardiologist,

internist and podiatrist that's $75). My prescriptions are covered at 80%,

but I have to pay for them in full up front... and file for reimbursement

(which takes about three weeks). So many times, I'm floating a couple

hundred dollars waiting to be reimbursed on a credit card hoping to get my

check before I have to get my refills. It can make for a challenging

bookkeeping process at times! Yes, it would be nice to have a better

policy, but I know it's much better than having *no* policy.

Mike

[Guest guest]

There are also plenty of negatives about the Canadian system

just like there are positives. The same is true for the system

that is currently in this country.

I know that I would personally not want the system used by the

Canadian and English governments and the reason is b/c the

surgery that I just had to check the status of my endometriosis

I would be waiting months for (meaning even longer than what I

was hoping to have to hold out for until pain decided that I

couldn't do it anymore). Also, the wait times to get in to

gynecologists (as an example) are even longer with that system

which is often not a good thing for a woman with endo. One who

doesn't have this problem may not have a problem waiting a long

time to see a gyn. This is also why some women with endo in

Canada come to have surgery here in the U.S. and I don't mean

just with the specialists considered tops for the treatment of

endo but with some of the other drs that also know a lot about

endo but aren't as recognized as the top like the others.

I like the fact that with my gyn if she thinks my situation is

bad enough (I am prone to infections b/c of my endometriosis and

one of my other female problems) to be worked in to the schedule

after I make a call to tell the symptoms I'm having that the

staff will do just what she tells them to do.

I'm just showing for my own personal feelings that even though

there are faults with the system here I would rather have this

one than the one in Canada or in England.

(And yes we have discussed this very issue before about 2 months

ago, what goes around comes around)

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________

[Guest guest]

Kristy Sokoloski sokokl@...> wrote:

There are also plenty of negatives about the Canadian system

just like there are positives. The same is true for the system

that is currently in this country.

Kristy,

I understand there are problems with the Canadian system -- whenever health

care is rationed, but whatever means, there are going to be imperfections. I

was commenting, though, on the price of drugs, which can be purchased for much

less in Canada than in the US -- up to 50% less.

Kristy,___

---------------------------------

Sneak preview the all-new Yahoo.com. It's not radically different. Just

radically better.

[Guest guest]

,

I found out that a medicine that I need for one of my problems

(and is sold OTC up there b/c it is no longer a prescription

medicine) thru one of the Canadian pharmacies was $22 for one

tube. If I wanted a 3 month supply it would have been about

$70.

Also, for some Canadians who get prescription coverage the

prices have been a bit spendy b/c some of them also have private

insurance b/c of the problems with the health system there.

Health Canada has had something to say about this as well and I

don't know what they are doing right now in that regard. They

have been concerned about those that are on the Canadian Social

Security system. There are quite a few problems with it, quite

similar to the system down here.

I would love for my insurance coverage to offer flex spending to

annuitants of the federal government to help reduce some of the

cost of our scripts even further. One of my other meds this

year went up by $7. Last year that medicine (yes the

prescription) was $19 and now it went up to $26 for this year.

For the medicine I'm going to do again for my endometriosis I

have to pay a co-pay for it which will be $35 for a 90 day

supply (the script was originally written for one shot only with

one refill which means I would have had to pay $35 each for each

shot and that wasn't going to happen so I made sure that they

did the script for the 90 days b/c then we only have to pay the

price one time). When I did this medication last time (I was on

an HMO then) I didn't have to pay a co-pay for the medication.

Just the co-pay to the office for the visit.

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________

[Guest guest]

In a message dated 6/25/2006 10:42:28 P.M. Eastern Daylight Time,

greytsmiles@... writes:

My blood pressure meds are a non-preferred brand, Lotrin, though it's been

around awhile. It costs me $56 a month. I take 10 drugs and only 3 of them are

generics. It's not easy, but I'm better off than before.

Hi ,

Have you talked to your doctor to see if he/she can switch your meds to

those on the preferred list for the pharmacy you are using?

I've done this for myself and my mom. Also, asked his doctor last year

to switch one of his meds.

hugs

Eunice

[Guest guest]

Kristy,

Yes, Rx drugs are a problem for everyone. There was a time when my Rx drugs

would have cost me $1300 a month, but I sure couldn't afford that. I got by the

best I could with only taking some things every other day or so, and by getting

samples from my doctor. For one year I was lucky to be able to get assistance

from the drug companies for almost everything I took.

Now, with my Medicare Rx plan, I pay a deductible for a 30 day supply of

drugs. There are 3 tiers of co-pay: $5 for generics, $28 for preferred, and $56

for non-preferred. My prescriptions still cost me almost $300 a month, but at

least I can squeak by and get what I need. I'll have a difficult time once I

reach a certain amount, wherein they will not pay until my out-f pocket

expenses exceed $3000 some. That time is quickly approaching. I will have to

pick and choose what I can afford and try to get samples for the other things.

Kristy Sokoloski sokokl@...> wrote:

,

I found out that a medicine that I need for one of my problems

(and is sold OTC up there b/c it is no longer a prescription

medicine) thru one of the Canadian pharmacies was $22 for one

tube. If I wanted a 3 month supply it would have been about

$70.

Also, for some Canadians who get prescription coverage the

prices have been a bit spendy b/c some of them also have private

insurance b/c of the problems with the health system there.

Health Canada has had something to say about this as well and I

don't know what they are doing right now in that regard. They

have been concerned about those that are on the Canadian Social

Security system. There are quite a few problems with it, quite

similar to the system down here.

I would love for my insurance coverage to offer flex spending to

annuitants of the federal government to help reduce some of the

cost of our scripts even further. One of my other meds this

year went up by $7. Last year that medicine (yes the

prescription) was $19 and now it went up to $26 for this year.

For the medicine I'm going to do again for my endometriosis I

have to pay a co-pay for it which will be $35 for a 90 day

supply (the script was originally written for one shot only with

one refill which means I would have had to pay $35 each for each

shot and that wasn't going to happen so I made sure that they

did the script for the 90 days b/c then we only have to pay the

price one time). When I did this medication last time (I was on

an HMO then) I didn't have to pay a co-pay for the medication.

Just the co-pay to the office for the visit.

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________

[Guest guest]

,

Even $28 for preferred for a monthly medicine is too much for

someone on Medicare. No wonder so many seniors run in to a

situation where they have to choose whether or not to keep the

meds going to maintain the problems with their health or eat.

And then with all the confusion about the Part D I don't know if

that will ever be cleared up.

I hope so.

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________

[Guest guest]

You don't have to tell me it's still too much for someone on Medicare --

especially when there's not much more income than what I get from Social

Security (I can earn up to $522 extra a month, which I need, so I work a few

hours a week). When I got sick a couple of years ago, I lost my job, my

retirement, savings, and finally my house, so it's been rough going for me both

physically and financially. I am just so happy that I have the Medicare and

especially the Part D so that I can get my drugs. My blood pressure meds are a

non-preferred brand, Lotrin, though it's been around awhile. It costs me $56 a

month. I take 10 drugs and only 3 of them are generics. It's not easy, but I'm

better off than before.

Kristy Sokoloski sokokl@...> wrote:

,

Even $28 for preferred for a monthly medicine is too much for

someone on Medicare. No wonder so many seniors run in to a

situation where they have to choose whether or not to keep the

meds going to maintain the problems with their health or eat.

And then with all the confusion about the Part D I don't know if

that will ever be cleared up.

I hope so.

Daughter of Type 2 Insulin Dependent Diabetic,

Kristy

__________________________________________________