Posted by Phil on September 4, 2003, at 7:09:13
In reply to Re: Insurance Obsession » Dinah, posted by fallsfall on August 30, 2003, at 22:08:48
fallsfall,
I work for the state and, of course, Texas had a 10 billion dollar defecit this year so, even though they currently pay for a single persons coverage, the butchered our plan.
We have a $50.00 copay on meds, per family member.
You have to buy 90 days supply at a time mail order and our copays all went up. When they had meetings to explain the lack of coverage, people walked out when a drug rep talked.
I had to see my pdoc for an hour recently because of a little slippage in my grip. $175.00 per hour. BCBS 'customary is $60.00 an hour; they reimburse you 60% of that. 40 or so for 175.00 appt.
When I spoke to them, it took 8, VIII, eight people before I could get a straight answer as to why I had 4 claims unpaid. I didn't have a referral from my primary care doc. Cut to the chase, I see out of network doc and it is self-referred, I never needed a referral. I usually try to avoid docs they list because 1. they are usually new docs that don't know sh*t from shinola. 2. They aren't taking new patients.
I told BC that their customary fees were adequate in 1956!
Formulary: Formulary is a sham and shouldn't even exist, for instance..Lexapro and Celexa are non-formulary. They just tell your doc to switch the patient to Prozac, Paxil, Zoloft or one other..they don't understand. I sent them two emails asking basically why they were so f*ck-- stupid.
Oh, since buying 90 days of meds at a whack was a burden, the state introduced a bill, no sh*t, to charter buses to Mexico for employees wanting to buy meds there. This happened while the feds were lying that overseas meds weren't safe.
They settled on: You can buy month by month at your local pharmacy for about twice the mail order price.
I could go on but I could write 20 pages on these losers. One other thing: Hospital and ER used to be a flat $75.00 co-pay. Now they are $100.00 a day PLUS 20% of the bill.
The med companies and insurance companies are huge contributors to, especially, Republican pols. Med companies have risen to 11th from 17th in largest contributors to pols in one year. Drug prices are driving these increases.
I feel for you and all the rest of us because this is the future and it will get worse.
So, Texas was broke so they go with Merck-Medco(avoid at all cost, they suck). Merck is not a Texas based company. So, they screwed local pharmacies to send the money, billions, out of state.
And they wonder why we go nuts.
Good luck. I feel like I've fallen into a snake pit. I'm afraid, before this is over, med ins. will be as bad as dental-you don't want to hear our dental plan! : )
One more: I paid my doc $175.00 for 1 hour. I found out that $100.00 goes towards my $500.00 deductible going by the treatment code my doc used. GOTCHA.Thanks for listening.
Phil
poster:Phil
thread:255647
URL: http://www.dr-bob.org/babble/social/20030829/msgs/256833.html