Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Old 02-26-2012, 07:21 PM   #21
Administrator
W2R's Avatar
 
Join Date: Jan 2007
Location: New Orleans
Posts: 38,827
Quote:
Originally Posted by eridanus View Post
Price transparency would help a lot with reducing US health prices. It would probably apply downward pressure to salaries, which is against the interests of health care professionals.
I couldn't agree more! I just had an example of that in my life, today.

My insurance no longer covers as much of prescription drug costs in 2012, as it did in 2011. Today I got my first prescription refills under the 2012 rates, and they had "only" gone up from $48 to $67. My best estimate had been about $90-$110 following what I had been told two weeks ago.

The only information received on paper directly from BCBS was a masterpiece of weasel-wording, self-contradiction, and meaningless fluff verbiage. Why must the patient be left completely in the dark on costs?
__________________

__________________
Already we are boldly launched upon the deep; but soon we shall be lost in its unshored, harbourless immensities.

- - H. Melville, 1851
W2R is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 02-26-2012, 09:01 PM   #22
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
NW-Bound's Avatar
 
Join Date: Jul 2008
Posts: 19,391
The medical billing in this country is totally messed up!

I have a friend who had a knee replacement recently. He said that the main surgeon was inside the network of his insurance company, while the assisting surgeon was not.

The result was that the assistant surgeon charged him about twice what the main surgeon did. And so, the insurance company refused to pay!

My friend said, hell no, he wouldn't pay more. So, in the end, the assisting surgeon had to reduce his bill, to the same as that for the main surgeon, if my memory serves.

Why was all the above billing detail not revealed to the patient? Didn't he have a choice in the matter? Who invited that assisting surgeon?

I guess in this country, we are all so used to the total bill being picked up by the insurance policy provided by the megacorp, and then when we are on Medicare, to be covered by Uncle Sam that nobody bothers to let the patients know anything anymore.

"Don't worry about it. You've got it covered." This just got me all worked up...
__________________

__________________
"Old age is the most unexpected of all things that can happen to a man" -- Leon Trotsky
NW-Bound is offline   Reply With Quote
Old 02-27-2012, 08:37 AM   #23
Thinks s/he gets paid by the post
 
Join Date: Oct 2008
Location: Naples
Posts: 2,161
Quote:
Originally Posted by W2R View Post
I couldn't agree more! I just had an example of that in my life, today.

My insurance no longer covers as much of prescription drug costs in 2012, as it did in 2011. Today I got my first prescription refills under the 2012 rates, and they had "only" gone up from $48 to $67. My best estimate had been about $90-$110 following what I had been told two weeks ago.

The only information received on paper directly from BCBS was a masterpiece of weasel-wording, self-contradiction, and meaningless fluff verbiage. Why must the patient be left completely in the dark on costs?
W2R, not saying my method of holding down drug costs would work for everyone but I reduced ours a lot starting last year. Suggestion: take any generic drug prescription to WalMart and check their prices. If the price is close, use WalMart since your cost will not count towards the donut hole. Remember, it's your cost PLUS the insurance companies cost that go toward the donut hole.

I take Plavix. No generic available for sale in this country, so I got it last year from a Canadian pharmacy. In 2012 I changed our Medicare Advantage plan to BCBS. Through their mail order pharmacy I was able to get a reduction in the cost of the Plavix to $135 for a 90 day supply by getting my doctor to complete a form called "formulary or tier esception". The form verifies that the doctor has tried all other options to Plavix and that nothing else is available. The generic available from the Canadian pharmacy cost me $85 for a 90 day supply. I'll pay the extra $50 to get the brand name. Now I have to be careful since BCBS paid $422 on the Plavix. That's a total of $557 toward the donut hole. That's why buying other drugs outside the insurance plan (see WalMart) is cost effective.
__________________
JOHNNIE36 is online now   Reply With Quote
Old 02-27-2012, 11:21 AM   #24
Administrator
W2R's Avatar
 
Join Date: Jan 2007
Location: New Orleans
Posts: 38,827
Quote:
Originally Posted by JOHNNIE36 View Post
W2R, not saying my method of holding down drug costs would work for everyone but I reduced ours a lot starting last year. Suggestion: take any generic drug prescription to WalMart and check their prices. If the price is close, use WalMart since your cost will not count towards the donut hole. Remember, it's your cost PLUS the insurance companies cost that go toward the donut hole.

I take Plavix. No generic available for sale in this country, so I got it last year from a Canadian pharmacy. In 2012 I changed our Medicare Advantage plan to BCBS. Through their mail order pharmacy I was able to get a reduction in the cost of the Plavix to $135 for a 90 day supply by getting my doctor to complete a form called "formulary or tier esception". The form verifies that the doctor has tried all other options to Plavix and that nothing else is available. The generic available from the Canadian pharmacy cost me $85 for a 90 day supply. I'll pay the extra $50 to get the brand name. Now I have to be careful since BCBS paid $422 on the Plavix. That's a total of $557 toward the donut hole. That's why buying other drugs outside the insurance plan (see WalMart) is cost effective.
Johnnie, my problem is not with the generics; it's with the one that isn't generic. My doctor does not want to try me on other options so I doubt that he would sign such a form, if it would even apply in my case (I have no information from BCBS about such a form even existing that would apply in my case). I'll ask him again. At any rate, I'm less worried now than I was since I don't have that $95 co-pay that I was warned was in effect, less than two weeks ago! That was the point of my post. As for the donut hole, I'm not on Medicare yet so I'm not quite sure what you are talking about but I'm sure I will figure it out one of these days.
__________________
Already we are boldly launched upon the deep; but soon we shall be lost in its unshored, harbourless immensities.

- - H. Melville, 1851
W2R is offline   Reply With Quote
Old 02-27-2012, 11:28 AM   #25
Moderator Emeritus
Bestwifeever's Avatar
 
Join Date: Sep 2007
Posts: 16,372
DH had a prescription change last week that isn't one of the $4/mo Target generics. He called the mail-order prescription insurance people to ask what it would cost just for grins as he has no choice not to have it filled--they told him they wouldn't know what the pills would cost until they actually filled the prescription. That same day.
__________________
“Would you like an adventure now, or would you like to have your tea first?” J.M. Barrie, Peter Pan
Bestwifeever is offline   Reply With Quote
Old 02-27-2012, 12:58 PM   #26
Thinks s/he gets paid by the post
 
Join Date: Oct 2008
Location: Naples
Posts: 2,161
W2R, sorry for the misunderstanding on my part. I guess when one is on Medicare for so long, you have a tendency to think everyone is. The form I'm talking about is "2012 Medicare Part D Formulary or Tier Exception".
I never heard about it until BCBS suggested I get my doctor to fill it out and fax it to them. The purpose is to have the doctor tell your drug insurance company that "patient must take this prescription drug and there are no others". I suppose the purpose is to tell your pharmacy that you deserve a break on the price because of the specific need. On the form it states that "this is a Medicare Part D form".

Interesting, but since it doesn't apply to your situation, maybe someone else can benefit from the post. I know it saved me a couple hundred bucks every three months. I never looked it up on the Medicare site because my insurance pharmacy led me through the process.
__________________
JOHNNIE36 is online now   Reply With Quote
Old 02-27-2012, 01:06 PM   #27
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Brat's Avatar
 
Join Date: Feb 2004
Location: Portland, Oregon
Posts: 5,913
My mail-order house is Medco. Their drug prices are on line. What fascinated me is that if your pharma insurance is Medco and you fill a script locally at a participating pharmacy the $ is more and it is the same price at all the participating pharmacies. I checked Costco, Pharmaca and Walgreens recently for the same medication.
__________________
Duck bjorn.
Brat is offline   Reply With Quote
Old 02-27-2012, 01:17 PM   #28
Thinks s/he gets paid by the post
 
Join Date: Oct 2008
Location: Naples
Posts: 2,161
Quote:
Originally Posted by Brat View Post
My mail-order house is Medco. Their drug prices are on line. What fascinated me is that if your pharma insurance is Medco and you fill a script locally at a participating pharmacy the $ is more and it is the same price at all the participating pharmacies. I checked Costco, Pharmaca and Walgreens recently for the same medication.
I had Medco when I was covered by my company provided health care. I used Medco, Prescription Solutions for the last two years and now PrimeMail. Guess they are all about the same. However, I don't use them for anything except 90 day mail orders. All the local pharmacies are part of the plan but I only go there for immediate needs and short term prescriptions. They will only issue a 21 day supply max. Costco is still the cheapest; however, if it is an antibiotic, Publix will provide them free of charge.
__________________
JOHNNIE36 is online now   Reply With Quote
Old 02-27-2012, 01:18 PM   #29
Thinks s/he gets paid by the post
 
Join Date: May 2006
Location: Largo
Posts: 1,945
Quote:
Originally Posted by JOHNNIE36 View Post
No wonder this country is so screwed up on the subject of health care. I'm not saying the doctors. I'm talking about the health insurance companies, the hospitals, surgery centers, etc. DW is going to have rotator cuff surgery (same day surgery as outpatient). We have a Medicare Advantage insurance plan which has been a good way for us to go until this surgery. And, we are new to Blue Cross Blue Shield this year. Same surgeon is in this plan as in our last plan. No problem there.

Question I'm asking is what is our copay or deductible at the facility. Can't find out. Why? According to BCBS, copay at a freestanding sameday surgery center is $265; however, the surgery center this group of surgeons uses is not covered by BCBS. The surgeons in this group are not licensed to use the facility that IS covered by BCBS. So, we opt for a hospital that is in our plan. BCBS says an outpatient surgery is 20% of the allowable cost but they can't tell me what that cost is. Pretty cut and dried on an overnight stay. That price is also $265 but you can't just opt to stay overnight. The guidelines in the coverage manual state that the type surgery dictates whether or not it is considered "same day surgery". Your surgeon could write an order for you to stay overnight but you would still be billed for "same day surgery", the 20% deal.

I went to the hospital to try to find out about the price. They couldn't tell me. BCBS can't tell me. Still got a couple feelers out there but I'm losing faith in the system. No wonder people are pi**ed at our health care in this country. This is just a little problem. Wait till a big one comes along.
I thought they could send a pre-approval/"request for quote/pricing" to your insurance company to have the insurance company price it prior to the procedure. I can't remember the correct terminology. Each location/entity would probably have to do it for you to get a complete picture. Worth the effort? Will the answer make you change anything?

What a waste of effort to the universe.
__________________
Buckeye is offline   Reply With Quote
Old 02-27-2012, 03:13 PM   #30
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Moemg's Avatar
 
Join Date: Jan 2007
Location: Sarasota,fl.
Posts: 10,031
Quote:
Originally Posted by JOHNNIE36 View Post
W2R, sorry for the misunderstanding on my part. I guess when one is on Medicare for so long, you have a tendency to think everyone is. The form I'm talking about is "2012 Medicare Part D Formulary or Tier Exception".
I never heard about it until BCBS suggested I get my doctor to fill it out and fax it to them. The purpose is to have the doctor tell your drug insurance company that "patient must take this prescription drug and there are no others". I suppose the purpose is to tell your pharmacy that you deserve a break on the price because of the specific need. On the form it states that "this is a Medicare Part D form".

Is your BC/BS a medicare advantage plan ? I just went on Medicare with regular BC/BS as my secondary so I wonder if it would apply in my case . I take several asthma inhalers that are not generic . I don't think they even make generic inhalers .
__________________

__________________
Moemg is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Second Thoughts on FIRE Bankerwithabrain Young Dreamers 26 03-09-2012 04:15 AM
save money on food? palomalou Other topics 104 03-06-2012 12:20 PM
cool bbc movie on nomads in USA mickj Other topics 16 03-04-2012 10:22 PM
Who has tried this? (Living on a fixed amount to prepare for retirement) Frugalityisthenewblack FIRE and Money 52 02-24-2012 02:44 PM
Wade Pfau on SPIAs Nords FIRE and Money 30 02-23-2012 04:13 PM

 

 
All times are GMT -6. The time now is 06:59 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.