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When the going gets tough...

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  • JohnInCarolina
    JohnInCarolina Posts: 30,971
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    "I've made a note never to piss you two off." - Stike
  • JohnInCarolina
    JohnInCarolina Posts: 30,971
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    "I've made a note never to piss you two off." - Stike
  • lousubcap
    lousubcap Posts: 32,369
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    How sweet it is...
    Louisville; Rolling smoke in the neighbourhood. # 38 for the win.  Life is too short for light/lite beer!  Seems I'm livin in a transitional period.
  • JohnInCarolina
    JohnInCarolina Posts: 30,971
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  • nolaegghead
    nolaegghead Posts: 42,102
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    ______________________________________________
    I love lamp..
  • JohnInCarolina
    JohnInCarolina Posts: 30,971
    Options
    "I've made a note never to piss you two off." - Stike
  • JohnInCarolina
    JohnInCarolina Posts: 30,971
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  • lousubcap
    lousubcap Posts: 32,369
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    Time to declare victory and move on right there.  Hopefully he has a 24 hr driver. 
    Louisville; Rolling smoke in the neighbourhood. # 38 for the win.  Life is too short for light/lite beer!  Seems I'm livin in a transitional period.
  • JohnInCarolina
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    "I've made a note never to piss you two off." - Stike
  • JohnInCarolina
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    "I've made a note never to piss you two off." - Stike
  • fishlessman
    fishlessman Posts: 32,754
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    I'm holding out to see if the price drops on eliquis before the patent runs out, then wait to see what ins does with it. Looks like three card monte right now
    fukahwee maine

    you can lead a fish to water but you can not make him drink it
  • Botch
    Botch Posts: 15,483
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    Does anyone know what the insulin industry is doing now?
    The administration got them to lower their prices for seniors, and then one of the 3 or 4 monopolized manufacturers promised they'd lower the cost for ALL customers.  I figured then that the other 2 or 3 would either have to drop their prices too, or just abandon the market.
    But I've not heard anything more about it.  :confused:  
    _____________

    Remember when teachers used to say 'You won't have a calculator everywhere you go'?  Well, we showed them.


  • HeavyG
    HeavyG Posts: 10,348
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    I'm holding out to see if the price drops on eliquis before the patent runs out, then wait to see what ins does with it. Looks like three card monte right now

    Can't always assume the price will significantly drop when the patent expires. BigPharma often plays games in cahoots with manufacturers of generics to keep the price high for at least a few more years.

    Will be interesting to see what the Medicare negotiated price for Eliquis becomes. With My Medicare C plan I only pay about $80/month (for a 90 day supply) for my Eliquis. If the price drops fine, if not it's not that big a deal. However, I know some folks do pay much higher so any price break would no doubt be welcome.

    Or we could be like the Republicans in Texas...



    “Reality is that which, when you stop believing in it, doesn't go away.” ― Philip K. Diçk




  • fishlessman
    fishlessman Posts: 32,754
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    For 90 days it's 450 on my blue cross,  2300 without. Was supposed to go generic next year but it's now 2028 I think
    fukahwee maine

    you can lead a fish to water but you can not make him drink it
  • nolaegghead
    nolaegghead Posts: 42,102
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    For 90 days it's 450 on my blue cross,  2300 without. Was supposed to go generic next year but it's now 2028 I think
    Usually those kinds of warts go away on their own….🤪
    ______________________________________________
    I love lamp..
  • fishlessman
    fishlessman Posts: 32,754
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    For 90 days it's 450 on my blue cross,  2300 without. Was supposed to go generic next year but it's now 2028 I think
    Usually those kinds of warts go away on their own….🤪

    ins is nutz nowadays, just getting the pills i was denied by ins. the reason,  they said the pharmacy wouldnt supply them to me even though they carried them. we had a discussion on how a pharmacy can and will count out 30 pills. then they said they would get the pharmacy on the line for a three way conversation, that never happened.
    fukahwee maine

    you can lead a fish to water but you can not make him drink it
  • nolaegghead
    nolaegghead Posts: 42,102
    Options
    For 90 days it's 450 on my blue cross,  2300 without. Was supposed to go generic next year but it's now 2028 I think
    Usually those kinds of warts go away on their own….🤪

    ins is nutz nowadays, just getting the pills i was denied by ins. the reason,  they said the pharmacy wouldnt supply them to me even though they carried them. we had a discussion on how a pharmacy can and will count out 30 pills. then they said they would get the pharmacy on the line for a three way conversation, that never happened.
    That doesn’t make any sense….maybe there is some policy around off-label drug use that’s causing the issue?
    ______________________________________________
    I love lamp..
  • fishlessman
    fishlessman Posts: 32,754
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    For 90 days it's 450 on my blue cross,  2300 without. Was supposed to go generic next year but it's now 2028 I think
    Usually those kinds of warts go away on their own….🤪

    ins is nutz nowadays, just getting the pills i was denied by ins. the reason,  they said the pharmacy wouldnt supply them to me even though they carried them. we had a discussion on how a pharmacy can and will count out 30 pills. then they said they would get the pharmacy on the line for a three way conversation, that never happened.
    That doesn’t make any sense….maybe there is some policy around off-label drug use that’s causing the issue?

    i believe nowadays they just deny first, then come up with the why. eliquis is more money than warafin (rat poison) but warafin needs multiple doctor visits and blood testing every few weeks. eliquis is the cheaper option down the road so there was no need for the denial. my yearly statement is mostly denys, then eventually approvals. im debating with them now about a consultation i had with a surgeon to remove the gallbladder, right now its a debate about if it were an emergency, an emerging problem, or a non emergency. well thats why i saw the surgeon in the first place and it was initially approved. now denied a month later.
    fukahwee maine

    you can lead a fish to water but you can not make him drink it
  • dbCooper
    dbCooper Posts: 2,081
    edited September 2023
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    For 90 days it's 450 on my blue cross,  2300 without. Was supposed to go generic next year but it's now 2028 I think
    Usually those kinds of warts go away on their own….🤪

    ins is nutz nowadays, just getting the pills i was denied by ins. the reason,  they said the pharmacy wouldnt supply them to me even though they carried them. we had a discussion on how a pharmacy can and will count out 30 pills. then they said they would get the pharmacy on the line for a three way conversation, that never happened.
    That doesn’t make any sense….maybe there is some policy around off-label drug use that’s causing the issue?
    @nolaegghead @fishlessman
    Possibly it is more sinister than that for health insurance in general and denials.  A recent personal example is instructive... in 2015 I had my first colonoscopy.  It was considered a preventive procedure and my employee health insurance picked up the tab.  Polyps were found so I was scheduled for a return in 2020.  In 2020 I was retired with private health insurance, polyps again found and they picked up the tab with a scheduled return for 2023.  Have a different insurance carrier now than in 2020 and they won't pick up the tab, because due to prior polyps it's a "diagnostic" procedure, not preventive.  Understand that it was also "diagnostic" in 2020, once you have polyps there are no more preventive colonoscopies.  
    Here is where it gets kind of crazy, a preventive and diagnostic colonoscopy uses the same doctors, the same equipment and same procedure, they just have a different insurance code.  Medicare (which I'm not eligible for until 2027) covers either code, as do some private insurance, but not my current provider.  So I've been in the appeal process for months and am convinced it's a rigged game with the hope the insured just gives up.
    A recent article leads me to believe my impression is correct, which motivates me even more.
    "I Set Out to Create a Simple Map for How to Appeal Your Insurance Denial. Instead, I Found a Mind-Boggling Labyrinth."
    *edit to also flag fishlessman
    LBGE, LBGE-PTR, 22" Weber, Coleman 413G
    Great Plains, USA
  • lousubcap
    lousubcap Posts: 32,369
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    @dbCooper appreciate you addressing your personal situation.  The follow-on linked article is a good read about how dang near every one who is involved sees the bottom-line as the main driver (I will exempt patient focused medical professionals from the prior but that community reads like a dwindling population.) Presents a bleak picture. 
    Health insurance is right there with social security as a hard wired third rail in this country. 
    Louisville; Rolling smoke in the neighbourhood. # 38 for the win.  Life is too short for light/lite beer!  Seems I'm livin in a transitional period.
  • JohnInCarolina
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  • HeavyG
    HeavyG Posts: 10,348
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    Suddenly, everybody loves a snitch.


    “Reality is that which, when you stop believing in it, doesn't go away.” ― Philip K. Diçk




  • lousubcap
    lousubcap Posts: 32,369
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    Another , how sweet it is. 
    And the band plays on!
    Louisville; Rolling smoke in the neighbourhood. # 38 for the win.  Life is too short for light/lite beer!  Seems I'm livin in a transitional period.
  • caliking
    caliking Posts: 18,731
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    dbCooper said:
    For 90 days it's 450 on my blue cross,  2300 without. Was supposed to go generic next year but it's now 2028 I think
    Usually those kinds of warts go away on their own….🤪

    ins is nutz nowadays, just getting the pills i was denied by ins. the reason,  they said the pharmacy wouldnt supply them to me even though they carried them. we had a discussion on how a pharmacy can and will count out 30 pills. then they said they would get the pharmacy on the line for a three way conversation, that never happened.
    That doesn’t make any sense….maybe there is some policy around off-label drug use that’s causing the issue?
    @nolaegghead @fishlessman
    Possibly it is more sinister than that for health insurance in general and denials.  A recent personal example is instructive... in 2015 I had my first colonoscopy.  It was considered a preventive procedure and my employee health insurance picked up the tab.  Polyps were found so I was scheduled for a return in 2020.  In 2020 I was retired with private health insurance, polyps again found and they picked up the tab with a scheduled return for 2023.  Have a different insurance carrier now than in 2020 and they won't pick up the tab, because due to prior polyps it's a "diagnostic" procedure, not preventive.  Understand that it was also "diagnostic" in 2020, once you have polyps there are no more preventive colonoscopies.  
    Here is where it gets kind of crazy, a preventive and diagnostic colonoscopy uses the same doctors, the same equipment and same procedure, they just have a different insurance code.  Medicare (which I'm not eligible for until 2027) covers either code, as do some private insurance, but not my current provider.  So I've been in the appeal process for months and am convinced it's a rigged game with the hope the insured just gives up.
    A recent article leads me to believe my impression is correct, which motivates me even more.
    "I Set Out to Create a Simple Map for How to Appeal Your Insurance Denial. Instead, I Found a Mind-Boggling Labyrinth."
    *edit to also flag fishlessman
    I deal with this daily at work, and your assessment is spot on.

    I maintain an archive of publications/papers re: current standard(s) of care for various conditions. During "peer to peer" telephone conversations for insurance approval for different things, I first politely request that I speak with a peer, not a nurse or pharmacist, and that they can call me back whenever one is available. If they deny approval after I've sent them the info about current standards of care, I ask for documentation of their denial of treatment, despite being informed of current standards. I usually win. 

    #1 LBGE December 2012 • #2 SBGE February  2013 • #3 Mini May 2013
    A happy BGE family in Houston, TX.
  • JohnInCarolina
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    "I've made a note never to piss you two off." - Stike
  • JohnInCarolina
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  • lousubcap
    lousubcap Posts: 32,369
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    The only people benefiting from this legal-ese are the lawyers.  The people getting hosed (and appear to be glad to be taken for a ride by the grifter in chief)  are those contributing to the CHEETO defense fund (called by some other name).  Sad state of affairs. 
    Louisville; Rolling smoke in the neighbourhood. # 38 for the win.  Life is too short for light/lite beer!  Seems I'm livin in a transitional period.
  • JohnInCarolina
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  • HeavyG
    HeavyG Posts: 10,348
    Options
    “Reality is that which, when you stop believing in it, doesn't go away.” ― Philip K. Diçk




  • HeavyG
    HeavyG Posts: 10,348
    edited September 2023
    Options
    “Reality is that which, when you stop believing in it, doesn't go away.” ― Philip K. Diçk