Insurance woes
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Today I bought a prescription that I have used for 12 years. Normally my insurance pays all but $25.00 of a one month supply for these pills. This has gone up from $7.00 that I was paying 12 years ago. Not bad right? It eats at the pocket book for sure, especially if it isn’t the only Rx you take on a regular basis. But it was okay. Today, I was charged $131 dollars for the same said prescription. I called the insurance company to find out why. I was told that as of 07/01/2008 this particular prescription was no longer covered. I could choose one of the cheaper prescriptions available and it would be covered. I’ve tried the cheaper Rx’s and they don’t work. I need this prescription to avoid more serious problems but there is no way that I can afford $131.00 per month just for this one Rx.
After doing some research, I have found - Cleve Killingsworth, president and CEO of Blue Cross Blue Shield of Massachusetts, ended 2007 with total compensation of more than $3.6 million.
Killingsworth’s $3.6 million take-home included a salary of more than $935,000, more than $1.8 million in bonuses and over $789,000 listed as “other compensation,” including unrealized retirement benefits. That was up from a total pay package of $3 million in 2006.
Source: http://boston.bizjournals.com/boston/stories/2008/02/25/daily60.html
And that’s just the CEO of Blue Cross Blue Shield of Massachusetts.
“The 18 percent pay raise for the insurer’s top brass comes as Blue Cross and Blue Shield of North Carolina’s profit and membership continues to grow.
Blue Cross, the state’s largest health insurer, came under fire last year for its increasing rates, its high profits and corporate spending on trips to the Caribbean and the U.S. Open. Last week, it reported that its profit increased 7.5 percent to $167.6 million in 2005.”
“Aetna CEO John Rowe had total compensation of $30.6 million and Cigna CEO H. Edward Hanway received $12.3 million. That includes millions of dollars in stock compensation. Meanwhile, the president of Cigna HealthCare of North Carolina made a total of $279,526 last year.”
Source: http://www.newsobserver.com/104/story/416559.html
This same source will tell you that the high cost of insurance premiums is not due to wages. I don’t believe it.
We are paying more and more for insurance premiums and receiving less and less. While the CEO’s get rich, we are having health problems.
The good news, is that I learned that my doctor can perhaps fight this particular issue that I’m having and win. We are giving it a try. But it seems that most every major as well as some minor issues that I have come up against has been a major fight to get the insurance company (supposedly good insurance) to pay.
I have a real issue with the CEO’s making this kind of money, while those of us with health issues can’t seem to afford medication that we need in order to survive. And what happens if because I can’t receive my medication due to cost, I develop a more serious problem? Will they refuse to pay for more serious problems as well?
Are others having these issues? Please voice your opinion.
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Comments
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0 OP - did the insurance company give you a clear reason why they discontinued the medication? It aggravates me to no end when companies do this because a product no longer contributes double digits to the bottom line. They figure a percentage of people are going to purchase the drug no matter what, and price accordingly to gouge those who need it.
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0 0 Anonymous - The insurance companies do not want to cover because there are other similar medications that are cheaper, one of which is going generic in the months to come. They are apparently trying to move everyone to this other Rx because once it goes generic, it won’t cost as much for them to cover it. However, as the doctors I’ve spoken to have stated, the cheaper brand works for some, not for others. I happen to be one of those it doesn’t work for. And yes, I’m very irritated.
Idahohie; yes, I think it’s time that we join the single-payer system. In fact, I think it’s past time.
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0 0 I had the same problem about a year or so ago with some monthly medication I’m taking. Everyone says that generics have the “same active ingredients” in them as the brand names, but they are not the same. More often than not there is less of the actual active ingredients in them than in the brand names. Mainly because generics are made overseas and are not regulated by anybody. Say you have a 10mg drug in the brand name, most of the time the generic only has 7-8 mg’s of the active ingredient in their drug as opposed to the full 10mg that the brand name has. (and that’s a generous example, often times it’s less than 7 or 8 mg’s)
Point is they tried the exact same thing on me and I raised hell. I spoke to everyone I could at the insurance company and everyone I could with my prescription plan until they finally got tired of me calling them. They ended up telling me to have my doctor write on the prescription “brand name” necessary and they’ve covered it ever since. I never use generic drugs and I shouldn’t have to. I pay out the @ss for my insurance and the least they can do is cover my medications.
Your best bet is to get on the phone and stay on the phone. Constantly call people until they’re so sick and tired of hearing from you, they will give in. I can almost promise you that.
Good luck and let us know what happens.
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0 0 Good advice from Guest House - thanks. We had a problem with an insurance company who initially approved coverage for a set of drugs for my wife, then denied our claim once they found out the purpose (after we’d paid for them, naturally). We had a friend call up and ask about coverage for the same drugs and we recorded that call. They again said the drugs were covered. That recording and the threat of a lawsuit did the trick.
But it is an embarrassment to us as a nation that sick people have to do things like what we did, or what Guest House went through, just to get our medical care. What other civilized nation would put up with it? Why do we as a nation continue to allow the insurance industry to have such control? Perhaps we should start electing politicians who represent people rather than industries.
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0 0 Yes good advice Guest House. Between big business and insurance companies it’s a wonder anyone can survive in today’s world.
Insurance companies have total and complete control over your health or lack thereof. I’d like ot hear from small business owners what exactly the cost of their health insurance is, if they can afford it at all.
There are many insurance companies that won’t even cover an office visit. Something has to give.
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0 0 My opinion (as someone else mentiones) is that you HAVE to fight the insuiranceco. If you have a good doctor he will be more than willing to help. he fought for a prodecure for me and the medication to go woth to the tune of almost $3000
FIGHT FIGHT FIGHT and don’t give up. at some point they will get tired of hearing from you and you r doctor and will give in!
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0 0 Guest House is absolutely right. I’ve had the same problem in the past with medication I was taking for years and then one day they just up and decided they weren’t going to pay for the brand name anymore. (meanwhile my coverage dwindled and co-pays and deductibles rose on a regular basis)
Without insurance my brand name medication was just under 550 dollars a month, as opposed to the 90 dollar generic. I don’t like generics either. Sure they have the same active ingredients, but GH is right in saying they aren’t as potent as brand name medications. I fought for a week straight calling the insurance company every day 4 or 5 times a day. I wasn’t rude to them, but I held fast and was firm but polite to them. I wouldn’t accept no for an answer. Eventually they told me the same thing they told GH, have your doctor write “Brand Name Required” on the prescription and they finally gave in and covered it. It’s sad that we pay so much for insurance and still have to fight so hard just to get the basics covered. But like the others have mentioned, don’t give up and don’t take no for an answer. They make money by you accepting no for an answer and the thing is, most people will just accept it move on, and that will be that. The insurance companies are banking on your doing this, instead of getting tough with them and insisting on coverage or payment or what have you. Granted, I’m sure there are some instances where this tactic won’t work, but when it comes to your prescriptions, I say don’t give up. Most of the time when you call your insurance company, you’re going to speak with a lowly customer service rep. Bypass them and ask for their manager. If that doesn’t get you anywhere, ask for THEIR manager, and so on. And than continue to hound them until you get satisfaction. Also, have your doctor contact them as well. Sure it’s tireing and frustrating, but when the price difference is hundreds of dollars a month, whats an hour or so out of your day to fight for what should be yours to begin with? To me it was worth it and it paid off in the end.
Best of luck AOK and let us know how it turns out.
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0 0 I take 3 meds regularly, and with 2 of them I take the generic and am glad to do so. One of them I pay the extra amount to get the name brand, only because both the pharmacy and the dr say the generic versions are not regulated to guarantee the exact same dosage with the exact same delivery capability.
Since it’s more sensitive for me, I choose the name brand which costs me double out of pocket.
But at least my insurance still covers it for now. If they drop it I would throw the same kind of fit y’all are recommending.
And, I agree with what many of you are saying, it’s just WRONG that in this wonderful country, only the rich (and maybe the very poor) get good health coverage…your ability to pay should have something to do with whether you can get good health coverage?
As loud-proud-hippie has said, big Pharma really makes a killing (so to speak) off us citizens who depend upon their products for daily health. They have a vested interest in not having a single payer system, and they have a vested interest in us being dumb sickly and stupid about our health in general.
I always wondered why insurance companies wouldn’t cover birth control (or in my case, they won’t cover birth control for my children) but they cover births, no problem. Why? They need more citizens who will need more medication so the big guys and the investors can make more bonus money.
I’m not necessarily a conspiracy nut, but I’m firmly convinced something is wrong with this picture.
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0 0 as someone who works inthe midicine industry, I have to disagree with those of you who claim that the generic does not contain the same active ingedients than that of a name brand. They do. Each drug has 3 names- one is the chemical make up and is referred to by that name by the chemists and manufacturers of said drug, the second is the generic name, i.e. ibuprofen, and the third name is the brand name, i.e. motrin, advil, etc. now even though they may be shaped differently, or coated differently-they are in fact the exact same drug.
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0 0 Some are, some aren’t.
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0 0 No offense to any one, Trax, but that is kinda borderline on the subject. Please dont turn this into a game of trying to prove others wrong or right. 
Sorry to all who have been having issues with insurance companies. I don’t forsee it getting any better either. Not only with prescriptions, butwith healthcare in general. The insurance provided at my place of employment doesnt cover well child visits or childhood immunizations. Its basically only a sickness and accident policy-with crappy prescription coverage. And just recently they dropped the dental and vision off, but the monthly out of pocket premiums remained the same-Oh and the deductables increased to double what they were before.
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0 0 Your right, Sorry to anyone I offended.
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0 0 Childhood immunizations are available through state funding. You shouldn’t have to pay for it if you go to District VII.
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0 0 hi Trax,
I actually thought your comment was great and directly on point……
hmmm, I don’t think you understood Trax’s comment: generic for a particular drug is, in fact, the exact same drug. At far less cost.
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0 0 Yes I understood and responded.
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0 0 okay, but your response indicated that generics aren’t always the same as the name brands. The fact is, they are exactly the same. That’s why I was puzzled by your “some aren’t” comment.
Maybe I misunderstood what you were trying to say. . .
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0 0 No really, some aren’t. But you’re free to believe what you choose. 
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0 0 hmmm, no need for nastiness!
I think trax and I are just saying when your doctor okays a generic substitution, you are getting the EXACT same product for a lot less: as trax mentioned, it may look a little different but is the exact same formulation….
Are you thinking of herbal remedies or something? Or can you give us the name of a specific drug you believe wasn’t exactly the same as its name-brand counterpart?
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0 0 btw, for those who are interested….here is the website for the FDA which gives an overview of generics and the rules which apply to the same:
http://www.fda.gov/cder/consumerinfo/generics_q&a.htm
I guess the only problem is that the drug companies still have plenty of unexpired patents on the “designer” meds and thus generics are not yet available for every prescription….yet.
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0 0 Aiy easterner, how was that nasty? Please don’t pick fights by accusing me of something I am not guilty of.
If you look at name brand and generic and less expensive brands you will find that most have different formulas. I say most not all. You’ll find they have varying structural formulations as well. This is why some of the generics and less expensive drugs do not work as well as some of the name brand products.
Ever try to use generic laundry detergent on heavily stained clothes? One of the reasons they don’t work as well as your name brand products is because they aren’t quite the same.
Do some comparisons. I just did one on a prescription that I use regularly and it isn’t the same.
If you prefer to believe they are all exactly the same, please do. I’m not here to argue the issue.
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0 0 no, but hmmm you are mixing apples and oranges….generics MUST contain the same ingredients and work equally as well as their pricier counterparts, or they cannot be sold by pharmacies (nor prescribed by doctors) as “generic equivalents”.
The thinking, “well, it is just like store-brand laundry soap. . . ” is what leads many people to insist on the pricey name-brand drugs.
The analogy doesn’t work (i.e., laundry soap is not a “generic equivalent” regulated by the FDA )and the only one who profits from this common misconception is the drug company. I just hate to think of people being ripped off because the truth about generics is not being spread as well as it should.
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0 0 p.s. this isn’t a “belief” of mine; take a look at the FDA site.
HAGN everyone
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0 0 Easterner, I digress, the comparison I made was between Nexium and Prilosec. Prilosec is said to be the “same as” Nexium, but it’s not. It is however, far cheaper. I know several people are having problems with this one.
If I compare Dyazide to the generic Triam/HCTZ, the ingredients listed on the former are so unclear (by the links I’ve found) it’s hard to say if they’re the same.
But, I am happy for you that you were able to prove yourself right with your FDA link. Hagn 
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0 0 This is what I mean by nastiness….hmmm, I am not trying to “prove” anything to you or anyone for some ego-driven purpose….I only worry that people are unnecessarily paying too much for medication because the drug companies certainly want everyone to think that generic equivalents are inferior products when, in fact, the active ingredients, by law, are exactly the same. That’s all. Your snarky, “I’m happy for you that you were able to prove yourself right” is nonsensical and certainly an attempt to turn this into a pissing contest, which it shouldn’t be.
Please, just relax a bit and stop looking for reasons to take offense with everyone, okay?
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0 0 Easterner, you responded to post # 18, please let it go already.
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0 0 gladly….hope you get to relax a bit today hmmmm; you are being pretty defensive all over this site.
Have a good night.
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0 0 The truth is that some controversy still exists over the efficacy of generic drugs for some types of prescriptions. Yes, they are supposed to be bioequivalent but there are studies that show some have a different medical impact upon the patient…
As I said before, one of my Rx that I take is the name brand only, because both the medical professional and the pharmacist told me that the generic version was not as trustworthy…if they (practical users of this drug) don’t know better, who would?
But I do take two daily generics, and they work well for me. So I’m happy to have them at the reduced cost (and apparently since the Evil Empire has reduced what they charge for many generics, so have the other pharmacies made some reductions in prices…)
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0 0 re: comment 10. nobody said generics didn’t have the same “active ingredients”. I myself said that often times they aren’t as potent as the brand names. It’s been proven and being in the “medical industry” you should know this. I’ve taken both the brand and the generic of the same medication and have felt the difference for myself. 20/20 also did a story on generics and how their made overseas and are not regulated, and most of the time have “less” of the active ingredients in them. You can take that any way you like it, but I know what I know.
Have a great evening!
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0 0 I think the problem here is that saying “generics” (like those made overseas or in Mexico) is NOT the same as saying “generic equivalent”.
Maybe that is where the confusion lies: true “generic equivalents” are strictly regulated by the FDA and, as trax pointed out above, are just a different shape, name, etc, than the pricier name brand. “Generic equivalent” is a term of art used by pharmacists and doctors to mean exactly that. . . the term “generics”, I guess, could mean anything.
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0 0 Prilosec is a name brand, and Nexium is also a name brand. They each have there own generic form, but to say that one is the generic for the other is way off.
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0 0 Well, because this is my first child, I wasnt aware until after my sons most recent immunization appt that I could go to dist 7 for them. Do they do Well Child Visits too?
Anyway, the point to my original post-was that I HAVE insurance and I pay the monthly premiums, which cost me around a $200 per month, for what-I still have to pay for most things because it doesnt cover. Kinda makes you wonder why you have insurance.
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0 0 Melon, that’s very true in a lot of cases. I don’t know if they do well-child visits or not. I’d give them a call though. Good luck!
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0 0 Easterner, I think I can add to this discussion in such a way that will help you to know what the fears are.
There are issues that are legitimate when it comes to generic equivalent drugs. One of those is the dose delivered (both in terms of time taken and amount able to be used) issue, which can vary from one manufacturer of a generic product to another manufacturer of the same generic product, and both of these can be different than the original patented product. Yet both generics meet the criteria of being equivalent and both can pass FDA guidelines.
Per my pharmacist, they don’t always buy from the same source each time they make a bulk purchase for their customers’ needs. Therefore, if a particular generic does not work for you this time, it may or may not work for you next time, depending upon the new manufacturer (if there is one). But who is willing to keep taking chances, when they know the brand name does work?
Another problem with this is some medical conditions don’t respond well to subtle differences. In those situations, the original name brand product (which you would hope would remain stable in dose and delivery, as it was made to the same specs) is probably the better choice.
As I said several times, I take 3 meds daily. Two are generics that are pretty general action, and I’ve had no problems yet. The third is more delicate and per recommendation of both the pharmacist and the medical professional, I take only as name brand.
My OTC drug choices are almost always generic, as they work very well for me.
It’s not always black and white, and if someone pays the extra money to Big Pharma by choice, that’s the good old American Way!
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0 0 Trax are you new here? I ask because that issue was already addressed. Also because you stated you are in the medicine industry but spelled medicine wrong. I’m just curious, not trying to pick a fight.
Everyone had good responses. I especially appreciate Nemesis responding and clearing up some issues that seem to have been regarded as a personal slight. I didn’t see it but am sort of new here as well.
I have tried the cheaper, the generics and the name brand on the prescription drug I refer to in the article. I don’t know if the generics were the equivelant or not but my body sure doesn’t seem to think they are equal to name brand.
Idahogie, I didn’t respond to your question earlier sorry. I am on Blue Cross.
My doctor did submit a letter to them stating my health issues and that he wants them to honor his prescription for name brand. Wish me luck!
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0 0 aok- I do apologize for the typo, I wasn’t aware that people in my profession were not allowed to make mistakes. So please excuse my spelling error.
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0 0 trax, nice response
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Sorry you’re having this problem A-OK. I hope that you and your doctor work it out. I think we’ve all been in a similar situation, where the doctor winks and says that if he writes up the diagnosis in a certain way, then insurance will cover it.
You didn’t mention whether you were on the new Medicare Prescription program - the one that the pharmaceutical and insurance industries wrote and that the GOP forced through using strong-arm tactics.
America will eventually either self-destruct or join the rest of the civilized world and go to a single-payer system. And it will be the large employers who force the issue, as they see that they can’t compete in the global economy with our exorbitant health care expenditures. I just hope that the conservatives come around sooner rather than later, because in the meantime, people like you are suffering.