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Obamacare

kerley

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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?
 

TexasBred

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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.
 

True Grit Farms

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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.
 

Clodhopper

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True Grit Farms":2gkzdyfu said:
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/
 

kerley

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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.
 

hurleyjd

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kerley":2x0sw86s said:
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.
 

hurleyjd

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kerley":1bmtzg3h said:
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
 

crop/hail

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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!!
 

kerley

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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.
 

callmefence

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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.
 

farmerjan

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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.
 

backhoeboogie

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kerley":2cb5q8yh said:
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
 

Bestoutwest

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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.
 

boondocks

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farmerjan":10junxvd said:
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.
 

ddd75

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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..
 

True Grit Farms

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ddd75":q4ptczsw said:
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..

I've often wondered why more folks don't have their kids at home. We enjoyed having our kids at home. My daughter was a little tricky because her umbilical cord was wrapped around her neck. I told my wife to push and she said she wasn't having a contraction, I told her what was up and Andrea almost hit the floor coming out she pushed so hard.
 

Farm Fence Solutions

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Obamacare. It only works if you don't. We have a policy, but it's worthless unless something serious happens. My wife is a vet tech, sooooo we're covered. lol
 

farmerjan

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@boondocks don't know about the morbidly obese and no I don't think it covers smokers but I don't remember. Try the dreaded google for Liberty health share and see what you think.
The prolotherapy has definitely helped the pain in the left knee but it was not so bad as the other. It is not doing much for the ankle but it is really bad. We are now thinking stem cell which is in the neighborhood of 5,000 but is a one time deal. At present I am doing the right knee and the left shoulder and it's only been a couple of weeks. The shoulders are just starting to hurt quite a bit so not as damaged as the knees or the ankle. I want to do any/every thing I can before I go the serious surgery route, and since the ankle will most likely be a fusion, I am doing anything there is to stave that off. Knee replacement is not as "serious" as the ankle replacement and since they only do the "top joint" in the ankle and you have 3 joints, replacement would be only partially beneficial anyway. My biggest problem is being on concrete for work, I think I would see more improvement if I could just off the concrete.
 

Workinonit Farm

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farmerjan":1o0a51xu said:
My biggest problem is being on concrete for work, I think I would see more improvement if I could just off the concrete.

You would/will be amazed at the difference, in how you feel, if/when you can get off that concrete! It takes a little bit of time, but what a difference.

Good luck with all your joint issues, not fun.
 

danl

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:idea:I just met with the insurance agents for the renewal at work. My job includes taking care of the insurance. Yay. Not.
We had a good plan that is ending oct. 31 due to not enough enrollees.
The only people left are 50 plus years old. The young ones are invincible or on Obama care. The remainder are on their spouses plan. For a 2500.00 deductible with 5000.00 maximum out of pocket it is going to be 651.00 a month. 30.00 office visit and 15/25/50 drug copay.
I'm actually pretty happy with, just hope the owner goes along with it. He thinks we should have a 10000.00 deductible. Only thing is, he has it we don't.
One of the plans offered was Anthem was over 1400.00 per person, the owners wife asked what was so good about that plan. They said it isn't better but it's Obama Care compliant. We are exempt, but they have to offer.
 
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