Now I'm Getting Real Unhappy! OMG

[OldLincoln]

Friday I received a letter from my medical insurance company (United Health Care) that my Durable Medical Equipment (DME) provider will no longer be under contract after November. I called the DME who I know pretty well and they were surprised although their headquarters is back east. They did say that Blue Cross sent them a letter stating DME reimbursements will be reduced 40% the first of the year.

Today, my wife was following up on an overdue prescription with our contracted Rx provider (Caremark) and after going through the chain I finally spoke with the pharmacist. He told me that they will no longer cover any brand of that class of medication. Just like that!

I fear it's really happening. Obamacare is already affecting the industry and more so the patients. It may be a preemptive move by the insurance industry to make America bleed before the election and get Obama out, but I doubt they are they sophisticated.

It sure as heck affect my family and I don't like it one bit. If I had a window that opened I'd stick my head out and shout like that movie did.

[LaP]

I hope this can somehow be resolved to your satisfaction. Please keep us advised.

[Rainman48314]

Friday I received a letter from my medical insurance company (United Health Care) that my Durable Medical Equipment (DME) provider will no longer be under contract after November. I called the DME who I know pretty well and they were surprised although their headquarters is back east. They did say that Blue Cross sent them a letter stating DME reimbursements will be reduced 40% the first of the year.

Today, my wife was following up on an overdue prescription with our contracted Rx provider (Caremark) and after going through the chain I finally spoke with the pharmacist. He told me that they will no longer cover any brand of that class of medication. Just like that!

I fear it's really happening. Obamacare is already affecting the industry and more so the patients. It may be a preemptive move by the insurance industry to make America bleed before the election and get Obama out, but I doubt they are they sophisticated.

It sure as heck affect my family and I don't like it one bit. If I had a window that opened I'd stick my head out and shout like that movie did.
Find out what the Rx appeal process is..there usually is one. If you want to send me some specifics by PM, maybe I can help with 30 years working for and against demon Inurance Companies, Blue Plans and HMOs.

Some questions I might ask:

What State are you in? Looks like CA

Is this a group plan or individual?

Is it a Medicare Advantage Plan (aka Medicare Choice or Part C plan)

How does Blue Cross have any involvement in the DME issue?

Have you asked United for the name of a new DME near you?

What prescription is it?

[OldLincoln]

Rain, I've been taking on the insurance industry politely for over 30 years as my wife's health has declined. I have excellent insurance through my retirement or she would have passed away when in a coma those 30 years ago. I can't believe the wonderful life we've had together all these years in spite of health issues.

I will escalate the Caremark issue trying to get some relief. Caremark has always played games in the forth quarter trying to boost earnings and they must be hurting this year as it's worse than usual, filling named Rx with generic and now this. They've been sued by several states attorneys general for this but it hasn't slowed them down.

I already have 2 candidate DME's and spoken with one. I'll interview them both before selecting. I just hate loosing the one I have as they are super fine people who always come through and know me and my equipment. But things change. I have to say I hope I get a call saying they worked things out and have resigned for next year. Not likely and it's not a killer thing like the pharmacy.

[CarlCyrus]

It is getting worse.

My brother is a family doctor and he indicates that the reimbursement rates are so low to front-line doctors that many are retiring or moving into HMOs and a fixed salary. Reimbursements are so low that only 2% of med school grads are going into family (front-line) practice. Most are headed to the big hospitals where they become specialists at a significantly higher reimbursement rate.

He claims the Government's plan is to replace all front-line docs with PAs and nurses. One will go through multiple layers of cheap PAs and nurses before seeing a more expensive doctor. That is how the Government plans to hold down some of the costs. So...yes you can continue to see your current doctor, until he gives up practice and moves into a big HMO/hospital. Then you won't even be able to pick your PA or nurse...you will see who the Government decides.

Have also heard through him that the big pharma corps are moving overseas where they can do the R&D and production at cheaper rates and avoid the class action suits. [We are the only country in the World where class-action suits are so prevalent and where the lawyers get most of the settlements (not those injured).] Government will decide which drugs get imported. Pharma will decide what drugs they even want to offer to Americans. Get used to the "Change You Can Believe In."

Carl

[O'Dell]

Lincoln, I'm sorry you're having these problem. Fighting with insurance companies is never fun. I don't know the situation in California, but I lucked out here in Georgia. I was with Kaiser before I turned 65, so I stayed with them with their senior advantage plan. I don't have much in the way of medical problems, but when I do Kaiser is very good. When the orthopedist said to get an MRI Friday before last, I was in the tube in less than 24 hours. The same would have been true for a CT Scan as they have both machines in their facility. The only thing I've found slow is dermatology. I called for an appointment yesterday, and couldn't get it until Dec. 2nd.

[WMD]

Health insurance rates for Mrs WMD and myself significantly increased since Obamacare was put in place. The government should not be dictating how health coverage should be working. This should be left up to the private sector. If the government would comlpetely back out of healthcare, you would see major, and very positive, reform in that arena. Healthcare is not the Governments job! As long as the Government has their fingers in this pie, we will continue to get hosed! :mad:

[OldLincoln]

I usually see the PA's for all but two docs and today my wife saw the PA. Even when not a PA, they have vitals people who take the oral history and do the workups. The doc comes in for about 3 minutes armed with their work to shake hands and give me the readouts. Big Deal.

I actually prefer PA's over docs until we get into surgery as they are less arrogant and willing to check things out better. Besides they are younger and cuter than the male docs. Makes the "bend over" part better too.

[jeepster09]

My doctor just quit the practice. I got a letter also saying "x brands" medications no longer will be covered......go Mr. O go! Persident Zero is sure fixing things for the country. :mad:

[muggsy]

A lot of doctors are not accepting new medicare patients. If you lose your doctor and you are 65 or over you may have a tough time finding another doctor. Way to go, President O.

[yqtszhj]

It is getting worse.

He claims the Government's plan is to replace all front-line docs with PAs and nurses. One will go through multiple layers of cheap PAs and nurses before seeing a more expensive doctor.



I just saw this for the first time at my local doc in the box. They are "selling" it as a highly trained medical professional with a masters degree, but you can see the "Dr." if you want to.

[Rainman48314]

Health insurance rates for Mrs WMD and myself significantly increased since Obamacare was put in place. The government should not be dictating how health coverage should be working. This should be left up to the private sector. If the government would comlpetely back out of healthcare, you would see major, and very positive, reform in that arena. Healthcare is not the Governments job! As long as the Government has their fingers in this pie, we will continue to get hosed! :mad:I do not support Obama and I certainly will not vote for him in 2012, however, there are several posts in this thread that blame Obama and are far from being correct.

If you had no changes to your healthcare rates during the Bush years, you are the lone person on the planet.

Hardly any of ObamaCare is yet in place. The parts in place, like being able to cover even married children up to age 26, has no one complaining.

[OldLincoln]

An old school chum of mine is a retired PA. She got her Masters then went to Stanford medical school to get her PA. From that she started her practice doing PA work for a couple doctors and a clinic with her own patient base aside from the docs. She loved it but became chronically ill and couldn't continue. Point is she really was highly trained, far beyond an RN.

[tv_racin_fan]

I do not support Obama and I certainly will not vote for him in 2012, however, there are several posts in this thread that blame Obama and are far from being correct.

If you had no changes to your healthcare rates during the Bush years, you are the lone person on the planet.

Hardly any of ObamaCare is yet in place. The parts in place, like being able to cover even married children up to age 26, has no one complaining.

If there are no complaints how do you explain all the waivers?

[Rainman48314]

An old school chum of mine is a retired PA. She got her Masters then went to Stanford medical school to get her PA. From that she started her practice doing PA work for a couple doctors and a clinic with her own patient base aside from the docs. She loved it but became chronically ill and couldn't continue. Point is she really was highly trained, far beyond an RN.I took a friend to a highly respected cardiologist for follow up and he saw a nice PA who spent much more time getting a history than the Doc would have.

There is a shortage of Primary Care Physicians in the U.S. In Michigan, their average annual income is around $178,000. Specialists earn around $385,000 with many earning twice that.

There are a lot of office calls that do not need a doctor (or even a PA) and this drives up insurance rates for all of us.

[Rainman48314]

If there are no complaints how do you explain all the waivers?I'm referring to the Age 26 provision, you are referring to organizations wanting to keep plan designs that are out of step with ObamaCare and they are planning ahead. The complaints, as you call them, are not about anything needed today (2010-2011).

[tv_racin_fan]

I'm referring to the Age 26 provision, you are referring to organizations wanting to keep plan designs that are out of step with ObamaCare and they are planning ahead. The complaints, as you call them, are not about anything needed today (2010-2011).

Out of step?

BUT BUT didn't President Obama say that I would be able to keep the plan I currently have if I liked it? Was that just some made up crapola?

They told the sheeple that only those making over $200K would get a tax increase to fund this.. only right there in black and white in the actual bill there is a tax on every plan. Ain't a nation on earth the funds a national healthcare plan thru taxation only on the top bracket.

[Rainman48314]

Out of step?

BUT BUT didn't President Obama say that I would be able to keep the plan I currently have if I liked it? Was that just some made up crapola?

They told the sheeple that only those making over $200K would get a tax increase to fund this.. only right there in black and white in the actual bill there is a tax on every plan. Ain't a nation on earth the funds a national healthcare plan thru taxation only on the top bracket.This is exactly how you keep the plan you have. These waivers are for companies or other plan sponsors( Including Taft-Hartley Trust Funds) who have very limited benefits, can't afford more and want to stay were they are now once 2014 rolls around. Often these so called "mini-med" plans are for workers in restaurants and retail. An example of being out of step is having a Lifetime Maximum of something well under $1M.

[tv_racin_fan]

EXACTLY!

In other words those people who wanted to keep their plan but work for a corporation who could not get a WAIVER can NOT keep their plan, contrary to what President Obama told them.

[O'Dell]

EXACTLY!

In other words those people who wanted to keep their plan but work for a corporation who could not get a WAIVER can NOT keep their plan, contrary to what President Obama told them.

Which from what I'm reading will eventually be about all of them. Obama lied to us? What a surprise!!!

[Rainman48314]

EXACTLY!

In other words those people who wanted to keep their plan but work for a corporation who could not get a WAIVER can NOT keep their plan, contrary to what President Obama told them.

No, that's not correct. Their plans, if limited in certain specific ways, will be upgraded. Let's say they had Lifetime Maximum Benefits of $1M (very common in group plans), they MUST move up over three years to $5M. This improvement is worth about $3 per month in rate increases to Singles, or about 6/10ths of 1%. If their plan met the federal standards, nothing changes.

[tv_racin_fan]

EXACTLY! President Obama did not tell the sheeple that. He told them IF you like your plan you can keep it... there is a huge difference in what he said and what is the truth.

[yqtszhj]

You can keep it IF your company still offers it. I work for a major corp that has already figured out and told the Financial media that they would save MILLIONS by paying the fine for not providing insurance and force the employees to go on the public plan. And I can tell you they WILL do that if they gte the chance.

[Rainman48314]

You can keep it IF your company still offers it. I work for a major corp that has already figured out and told the Financial media that they would save MILLIONS by paying the fine for not providing insurance and force the employees to go on the public plan. And I can tell you they WILL do that if they gte the chance.True. It remains to be seen which companies will suffer a talent drain when some competitors keep offering employee health benefits