Rant about my stupid stupid insurance company (aka WE NEED A NATIONAL HEALTH CARE SYSTEM)

[gollygee]

My 5-year-old daughter was at the doctor today because of a health problem and she needs a prescription.

So I go to the pharmacy to get it and I'm told my insurance doesn't cover it. It's $65. No explanation as to why. The pharmacist doesn't know.

We have money in our flex spending, so I try to buy it with that, and The Card Is Declined. The card for which I just got a statement saying we still have $400 in the account. The Card is ROUTINELY declined for no reason. NO REASON. ROUTINELY. Flex spending is the biggest rip-off on the planet. We will never put money into flex spending again.

Now, I have a couple of days' worth of samples, so I can try to find out what the hell is going on. And I have means to pay for this in other ways if I can't resolve it. And my daughter won't die or anything if she doesn't get this prescription, though she will be very uncomfortable. Did I mention she's only 5 years old?

What do people do whose insurance companies do this and who don't have money to pay for it in another way?

This is DRIVING ME CRAZY and I am very very angry.

[Lint Head]

1. That's how they make money to build new skyscapers.

The more they deny people that are paying them for insurance thy more they make. It's simple math. I am having the same experience.
:dem:

[InkAddict]

36. And buy addendums to hospital names

Columbus Children's Hospital will officially change its name to Nationwide Children's Hospital on Sept. 24, honoring the $50 million gift from the local insurer announced by the hospital a year ago.

http://www.dispatch.com/dispatch/content/health/stories/2007/06/22/childrens_logo.ART_ART_06-22-07_B1_2D737N6.html

[panader0]

2. The Lt. Governor of California was on MSNBC earlier.

He said the No, one job of insurance companies is to pay as little as possible and to take as long as possible to do it. (About the California fires)
I have no insurance at all. The best I can do is try to stay healthy. Money spent on insurance is thrown away. Check out who the insurance donated to for elections.

[in_cog_ni_to]

3. 50 million people have no insurance at all. Those who do and can't afford the meds or deductibles

go without.:(

Have you tried THIS???




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[gollygee]

4. Brilliant

I love Michael Moore

Yeah - as to the 50 million without any healthcare, that's my point. This is awful for me and I am financially pretty comfortable and have supposedly "great" healthcare. And look what I'm going through. If this is happening to me, things must be absolute HELL for people in that kind of position. For me, it is an annoyance, but for some people it's truly a life or death situation. What if this were a my daughter needed this or she'd die? What if I didn't have the samples? And again, that assumes I have insurance to begin with. It's a national nightmare, and it's much much better for me than most people.

[in_cog_ni_to]

9. I know. I've been there, done that! BC/BS refused to pay for a

colonoscopy I had even though the doctor who did it was a participating provider. The colonoscopy was done in his clinic....THE SAME FREAKIN' BUILDING HIS OFFICE IS IN, and BC/BS REFUSED to pay for it because "the clinic" was not a participating "hospital". Whoooeeeeee! Did that tick me off! We got stuck with the entire bill, which totally sucked. I even called BC/BS to make sure I would be covered even if he did the procedure in his clinic and was told yes by the lying little wench on the phone. I appealed the claim decision and LOST.:(

My heart goes out to people with no insurance. It has to be hell on earth.

[lovuian]

5. Insurance companies are commiting FRAUD

on a massive scale

Your Flex spending program was just another farce to hold back the nation from going to National Health

Healthcare is a basic right

and your seeing children are the most vulnerable

isn't this whole system unchristian uncompassionate and such a LIE

[Hondadriver]

10. While I may agree with

part of your post, where is it written that health care is a basic right?

I agree we ALL should be covered, but, its not a right.

[mmonk]

12. Nowhere but nowhere is it written

Blackwater is a basic right either or Haliburton contracts. Depends on where people think the commonwealth's money should go I guess. I vote healthcare instead of Dyncorp.

[Hondadriver]

13. As I said

I feel that all should be covered, but, its not a right. I have enough trouble with my own health ins LOL

My doc has put me on lunesta, but, its not covered so we tried ambien, I would have amnesia, my wife would call I and I would have no recollection at all. Its a pain because lunesta is EXPENSIVE so I live off of samples.

[mmonk]

15. Sorry to hear about that.

Any reason they give why they won't cover it?

[Hondadriver]

19. No reason

other than the fact that it is a brand new med and very expensive. If I remember correctly its 135 for a months supply and there is no way I can justify that cost, especially with 2 kids in braces.

[mmonk]

22. Yep, two kids with braces will hit the pocketbook.

Maybe something else is out there besides ambien that could help.

[islandspirit]

31. ordering drugs elsewhere

Go on internet & price what you need from an on-line canadian pharmacy. Any drugs we need are 60-75% less from Canada than their cost here in US.
As for right/privilege - i'm curious (your response) -what do you think is going on in every western country that makes them give health care as a right to their people? Personally, I think that they have risen to a higher form of civilization than we have in the US.

[geomon666]

37. I couldn't even get ambien for my insomnia.

I have medicaid and I couldn't get it. The doctor put me on temazepam instead and thankfully it works great.

[davekriss]

34. We the People get to declare what we as a nation...

...uphold as rights. There is no magic tablet at the earth's core that we can refer to and say, yes, we have these rights because it is written. No, we have to take responsibility for ourselves and declare what we will uphold as rights. You may not want to confer upon all citizens the right to universal healthcare, but the majority of U.S. citizens do -- who are you to say it's not a right? Would you retreat to legalese and say it's not inked in the Constitution so case closed (you'd welcome universal care but, alas, it's not a "right"), or would you join the chorus of the majority and insist that our representatives fix this problem so that it is, in legalese and desire and ethically and in fact a right of citizenship?

[Stargazer99]

17. Apparently you have good coverage or are healthy

One has a right to the basic needs of life. Those who do not think so are not hurting...read Rep/Con
People like you are part of the problem.

[Hondadriver]

21. Basic needs of life

are food, shelter, and water NOT health care.

Even when I did NOT have health coverage I still felt the same way, an I am not sick but I do deal with COPD, acid, bad knees, and the beginning stages of high blood pressure.

[gollygee]

24. Health care is more than just taking care of bad knees

Do you think it's a basic right to have a fire put out if your house catches on fire? Is it a basic right to have the police come if someone tries to break into your house? Then why isn't it a basic right to get treatment if you have a stroke? Or treatment to keep you from getting a stroke? I seriously disagree with you. Healthcare is a basic right and should be treated like anything else related to health and safety.

[Hondadriver]

25. I pay taxes

that pay for police and fire protection. As I have said more than once, I feel that everybody should have some sort of health care be it privately paid for, thru their job, or from the fed gov I just dont think its a basic right.

[gollygee]

27. How about if, instead of paying through our work, and instead of our employer paying to private

companies, we and our employers pay the same amount in taxes and we get actual useful health coverage?

I simply disagree and I think only someone who has healthcare and who hasn't had a child's prescription denied for no apparent reason would feel the way you feel.

[Hondadriver]

30. As long

as its not government ran, I deal with the VA and that is a nightmare, so bad that I refuse to go back to the Dayton VA Hospital.

I think that insurance companies deny way to many prescriptions for sometimes stupid reasons and THAT issue needs to be addressed especially for the OP.

I have a big issue with anything that is totally ran by the government. Government just screws things up with their buerocratic(sp) rules and the fact that some people get on a power trip and think they can play God with people's lives. Yes I know that insurance companies do the same thing, but, there is one difference. You can switch insurance companies.

[riderinthestorm]

32. Nope, you can't switch insurance companies

Pre-existing conditions will block switching: if you have a pre-existing condition such as arthritis or diabetes, you won't be covered.

And yes, insurance companies are absolutely HELL to deal with on prescriptions - you really think the private insurance companies are better than govt programs??! I have news for you, most people are thrilled with public prescription programs - even with their flaws.

And govt doesn't just "screw things up". Think Medicare and Medicaid - most people can't wait until they can get government medical benefits.

Sorry about your VA experience but IL VA is great with Tammy Duckworth (a Dem double amputee from Iraq) in charge. You need to lobby harder with your local VA to change those persons who are making decisions for you. Look at the REAL records of those who will represent you at your local VA. I would bet that your Dayton VA is/was run by people who don't give a shit about you and your health care. You need to become pro-active on those issues that impact you. I guarantee you that the Dems will be the most sympathetic.

Good luck.

[tammywammy]

33. You can go up to 90 days

(I believe) without insurance and not have pre-existing conditions held against you. So really, yeah I can cancel insurance through my work and buy it myself and still have everything covered.

[Stargazer99]

35. Sometimes healthcare is the difference between life or death

just like the air you breath. Apparently, you've not had it tough enough

[poiuytsister]

6. Out of curiosity, were you at Walgreen's?

They are notorious for declining flex cards.

[gollygee]

7. I have had the card declined at Walgreens for no reason

however I was at Meijer.

[mmonk]

8. Sorry to hear that. I got a notice today my family coverage is going up

over $188 a month starting in January. That will put my cost for health insurance @ over $991 a month. I think it's time to look into a health savings account plan.

[RB TexLa]

11. It is doubtful that your insurance company administers your FSA. Financial institutions administer

them. So that part is not the insurance company's fault. The drug being covered or not is the insurance company's fault in as far as who they offer prescription benefits from. Medco pretty much sets the standard, the others usually cover what they cover and exclude what they exclude. Very few health insurance companies operate their own prescription plan, if any.

[MiniMe]

14. Did you call your doctor?

He/she may be able to prescribe something different, or argue with the insurance company on your behalf to authorize the prescription.

[gollygee]

16. I'm going to start with the insurance co. and my husband's work HR dept.

if that doesn't work we'll talk to the doctor.

[yellowdogintexas]

18. who is the plan adminsitrator for your flex? By Federal Law

flex has to pay for it even if your account does not have the money in it right then, as long as you have not exhausted your benefits. As soon as you pay for the meds, fax that receipt right on over to them. Call the plan administrator for the flex and find out why they declined the dumb card, buy the drugs and turn in the receipt. You will get a check in full from your flex.

Those "debit" cards are a piece of work though. I have Conexis as my flex administrator and I hate the damn debit card. I quit using it because they still wanted the damn receipts for everything; so I just said to hell with it and sent in receipts instead. I used it very successfully with Walgreens and Target but Costco did not accept it because it was MasterCard linked and Costco does not take Master Card (go figure).

YOUR FLEX PLAN IS SUPPOSED TO PAY EVERYTHING YOUR MEDICAL PLAN DOES NOT COVER!!! Did you know over the counter stuff is now included, like aspirin, tylenol, ibuprofen, claritin, etc. I use the hell out of mine! In January, my spouse had hernia repair, and I turned in the hospital bill the minute the health plan completed it and received a check for the full balance my flex plan was set to accumulate for the entire year, even though I had only put like one installment in at that time. If I left the company the next week, they could not ask me for it back either. Federal Rules.

It is ridiculous for the pharmacy to not be able to tell you why the particular drug was declined by the prescription drug plan. If your meds are covered under a separate carrier you will need to deal directly with them. Mine is Medco, but there are several drug plans out there.

[gollygee]

20. When it's usually declined is when I'm trying to buy

claritin or tylenol. Or benedryl for the same daughter. SO yeah I know it's SUPPOSED to but it just doesn't. And it's usually like $5 and it's not worth bothering with. I'm sure they know that. So I just buy it with cash that time. And I've still got $400 in my account at the end of the year. I usually have some dental problem or another and my teeth have been great this year so I'd have extra in there anyway I suppose but still this is really bothering me. It's call insurance fraud if I play game with them (which I wouldn't do because I have MORALS) but they can play games like this with me and it's just business.

My flex spending and insurance are both through United Healthcare.

[yellowdogintexas]

26. sounds to me like your flex card is only programmed to work for RX items

which means you just need to submit the receipts for the OTC stuff. We have United Health for our medical and Medco for RX and Conexis for Flex.

Time to get new glasses or contacts? LOL, That is usually what I do with excess $$ if I have any in December, decide I need some new eyewear.

It's fraud if you try to make them think you have spent money on a covered item and it isn't really a covered item.

It's stupid that they are making it so difficult. I was fortunate once to have all my stuff administered by the same outfit and the out of pocket expenses automatically rolled over to the flex and within 10 days I had my refund check. I liked that much more that that dumass card.

[gollygee]

28. No, it isn't

I got all sorts of paperwork explaining how it works. And it said that if I go to Walgreens things will automatically be marked on the receipt if the card will work to pay for them. But I go to Walgreens and it doesn't. And it obviously doesn't at Meijer either.

I'm lucky to have good vision, as are my husband and daughter. I don't mind losing money if I just miscalculated. I didn't have tooth problems and I'm happy about that. If I'd needed a crown, the money would be there. I'm only upset about having to pay for things that card should pay for.

[SammyWinstonJack]

23. Why at the very least aren't we allowed the same health care insurance that we made to pay for our

elected officials? Sen Kerry addressed this issue during his presidential campaign. Aren't we the people good enough for at least what we are made too pay for our Congresscritters? If not, why not?

[riderinthestorm]

29. I am using health care as an irritant with Rethug relatives

Shameless but true: my husband has been diagnosed with Stage IV lymphoma (this is NOT a DU call-out for sympathy, please note - just an FYI). We have excellent health insurance so we are fine. But I have been shameless in milking this episode for my Rethug relatives and friends. They LOVE my husband, and I make sure that they understand that he would DIE if we didn't have the health insurance we have, and that there are MILLIONS of other Americans as deserving of the same health care as he is.

Flame me if you want, but I am enraged that if we didn't have health insurance, we would be fucked and it's now become a fucking MISSION to make sure everyone I know understands the ramifications of their lethargy towards universal health care.

I absolutely, 110% believe, that health care issues are so bi-partisan after my own personal experience, I am shocked that our Dem candidates aren't making this their #1 issue. It's a sure fire win. I can talk to Rush Limbaugh fanatics in the waiting room of an oncology ward, and they would vote for any candidate that promised better, universal health care - without regard to party affiliation.

Frankly, S-CHIP is our foot in the door. The rethugs are shown for the heartless bastards that they are when they vote against it. Health care is a universal concern and it WILL be the single most important issue in the next 10 years.

[1932]

38. Not as bad but still infuriating: I just spent 4 hours getting all my HCRA receipts together.

So, SHPS has had my money interest free for almost 11 months, and I have to spend a couple of hours of my time to get it back from them so that I can save a couple bucks in taxes.

If the government really believes that these expenses should reduce my taxable income then why make the system so complicated that a for-profit company gets to make money off of it, and why do I have to waste so much of my time to exercise my legal right to the tax benefit?