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wow thank goodness for insurance!

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Ulcerative Colitis
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Posted 6/17/2011 1:01 AM (GMT 0)
I was recently diagnosed (last week) and I'm slowly coming to terms with it and just being happy that they finally figured out what was wrong (in addition to Celiac Disease which I've had for 3 years but never caused symptoms like this). I just picked up my prescription for Lialda and my insurance saved me $841! Wow! I am SO glad I have insurance, but now I worry about times in the future when I won't have it...
Posted 6/17/2011 1:14 AM (GMT 0)
Be glad that your insurance covered it.  My insurance would not cover Asacol 80HD and it was $700 a month out of pocket. They had to switch medications and my son did not respond to the regular Asacol 400mg and had a relapse.   He just had his first Remicade infusion yesterday.  The price of just the medication alone for first two infusions(not including infusion center costs or doctor) was $5180.00.  Yes, thank goodness for insurance,  but it is still a sin what the insurance and pharmacy companies get away with charging us.  I too, worry about the future.

 

Posted 6/17/2011 2:25 AM (GMT 0)
Yes, thank goodness for insurance, but it is still a sin what the insurance and pharmacy companies get away with charging us.

Agree, agree, agree.
And how unfair that people who cannot afford insurance have to pay the highest rates for Rx drugs and any medical care.
This is my highest priority when I step in the voting booth.
I've paid for my own health insurance my whole life but there but for the grace of God go I...
Posted 6/17/2011 2:42 AM (GMT 0)
I can completely relate. I've had issues with not having insurance and then getting it... was without for about 6months once.. tried applying to get insurance and was denied because now having UC it is a pre-existing condition. Luckily, I ended up getting a job which had medical benefits. Then was let go and pushed onto COBRA, which is not cheap but covers remicade, etc. really well. Oh the burden of having UC.
Posted 6/17/2011 3:06 AM (GMT 0)
I'm in a difficult situation since my last flare up.
Oxford denied me when I applied again due to a pre-existing condition too. It's so hard paying my GI appointments, pentasa, canasa, etc out of my pocket. But Humira is covered through PAP so I got lucky.
I'm still looking through to get insurance ugh. Get everything out of your insurance coverage while you can!
Posted 6/17/2011 3:40 AM (GMT 0)

MotherofTeenwithUC said...
Be glad that your insurance covered it. My insurance would not cover Asacol 80HD and it was $700 a month out of pocket. They had to switch medications and my son did not respond to the regular Asacol 400mg and had a relapse. He just had his first Remicade infusion yesterday. The price of just the medication alone for first two infusions(not including infusion center costs or doctor) was $5180.00. Yes, thank goodness for insurance, but it is still a sin what the insurance and pharmacy companies get away with charging us. I too, worry about the future.

I'm aware that some uninsured Americans have trouble paying for their meds (they have fully free care in my wife's hospital), but that there exists insurance companies in the United states that decline to cover basic meds! It's not only a sin but a crime. I'm not even going to ask how in the hell do you manage to cope.

I never really paid any attention to the insurance until we've forced to change the insurance company. We're still 100% covered, with a small copay for clinic visits and medications. Regardless, the insurance company wants to make our life as difficult as possible.

So, I've learned in a year what, I guess most Americans know, that some meds, procedures and hospital visits are expensive.

Like the OP, I was flabbergasted to learn that my VSL#3DS costs over $500 for the insurance company, not to mention the charges for a ER visit (kidney stone), hospital stay (kidney stone) or endoscopy and colonoscopy.

Then again, the insurance company have lots of people whose brain does not function very well. Once they out of blue declined to continue to approve a pre-approved cheap med. I had to make an appointment with my GI doc ($450) and have a bunch of tests done ($600) to get the medicine again. They cause me to waste their money.

Indeed, thank God for the insurance.
Posted 6/17/2011 6:08 AM (GMT 0)

KiWi44 said...
Like the OP, I was flabbergasted to learn that my VSL#3DS costs over $500 for the insurance company, not to mention the charges for a ER visit (kidney stone), hospital stay (kidney stone) or endoscopy and colonoscopy.


What?? How the hell does VSL 3 DS cost $500??? Are you getting more than one box at a time?? You can get the equivalent amount of one box of VSL 3 DS in one and a half boxes of the standard stuff, which will only run you about $100 if you get it cheap through Costco. And that's out of pocket with no insurance. Even if you paid full price off their website, the equivalent amount of standard stuff to one box of DS wouldn't cost more than $120-130.

I really, really hope you are getting more than one box, or your insurance company is getting HIJACKED by the pharmacy!

I remember reading that another HW member found out that the pharmacy had charged her insurance company nearly $8,000 for a transdermal LDN prescription that out of pocket only costs $50! We had a big discussion on whether it was a clerical error of some kind or not, because that is just WAY off target. This is the original post:

"I just checked my BlueCross account details. The LDN cream costs over $7800.00 for a two month supply. The pills when I had them filled for a month were $3989.00. I thought it was supposed to be a cheap medicine? That costs me more than the Humira. I won't be able to take it come January when my deductible starts over. Wow. Not cheap."

I wonder if pharmacies uber-charge insurance companies just because they can. Are we looking at the very dark underbelly of the medical industry, or is there something going on here we don't understand?
Posted 6/17/2011 11:16 AM (GMT 0)
I despise all insurance companies.
Posted 6/17/2011 11:38 AM (GMT 0)
the Asocol I have to take every day would be over $600 a month without insurance. Seems pretty out of whack, I know these companies have research costs, etc, but they are also making obscene profits.
We all have to have these drugs, it's not like we have a choice. The drug companies have huge lobbying budgets, which puts most politicians in their pockets -Who's fighting for our rights?
Posted 6/17/2011 11:51 AM (GMT 0)
The VSL#3 DS cost my insurance company $249.89 for three boxes of 20 sachets (60 sachets total) and my cost was $30.   They wouldn't cover Asacol 800HD at all, not even under an appeal process (and my son's GI pushed for this med)  We lived on samples he got from his pharmaceutical rep for the first month.    Then they switched us to Asacol 400mg.   The cost to the insurance company for a 90 day supply of the 400mg was $805, my cost was $125.00.   Within a week of getting this prescription filled, I received a letter that they would no longer cover the Asascol 400mg.  AND they wouldnt cover it under the retail pharmacy when I initially filled it, only under the mail-in 90 day prescription.  A month after starting the 400mg, my son was taken off it.  So I paid for 2 months of a med that he can't take.

I am starting to think that Government run health care is the way to go.  I have a friend in Sweden and she told me that she doesnt pay anything for health care and the Government pays for everything.

Posted 6/17/2011 1:25 PM (GMT 0)
I was flabbergasted to learn that my VSL#3DS costs over $500 for the insurance company

It does not cost the insurance co. $500 or anything like it. The $$ figure they print out is the jacked up retail price that no one except an uninsured person would pay. Health insurance companies pay a low low negotiated price to pharmaceutical companies behind the scene.

It's a scam and one that needs to be stopped. We need to cut out the middleman (the insurance company), have prices made realistic, allow Americans to get their RX wherever the price is best (Canada anyone?) and have reasonable health insurance costs that don't bankrupt working people.

Medicare works for senior Americans why can't non-seniors have the same medical plan? Common sense.
Posted 6/17/2011 2:07 PM (GMT 0)

badslinke said...

KiWi44 said...
Like the OP, I was flabbergasted to learn that my VSL#3DS costs over $500 for the insurance company, not to mention the charges for a ER visit (kidney stone), hospital stay (kidney stone) or endoscopy and colonoscopy.


What?? How the hell does VSL 3 DS cost $500??? Are you getting more than one box at a time??

[clip]

I receive 6 boxes, 120 sachets of VSL#3DS per month. The $500 is the amount that is printed on the label, and that was what I was told by my pharmacy I need to pay if my insurance won't cover it when we're fighting the insurance company. Well, my insurance covers it and I think I only pay $25 dollar copay.
Posted 6/17/2011 2:17 PM (GMT 0)

imagardener2 said...
I was flabbergasted to learn that my VSL#3DS costs over $500 for the insurance company

It does not cost the insurance co. $500 or anything like it. The $$ figure they print out is the jacked up retail price that no one except an uninsured person would pay. Health insurance companies pay a low low negotiated price to pharmaceutical companies behind the scene.

[clip

Naturally you're correct, but 120 sachets of VSL#3DS is not cheap. The only way to get it is to have a script from your doc in addition to all sorts of explanation why this patient needs that particular 'medicine.'

If memory serves, I initially tried the VSL#3 capsules (60) that cost me about $40. I think I get a lot more VSL with my $25 copay now.

Thank God for insurance companies.
Posted 6/17/2011 2:17 PM (GMT 0)
$11,000 for remicade soup to nuts at my Dr's. office, no way could I pay that on my own.
Posted 6/17/2011 2:18 PM (GMT 0)

Dsm4life said...
I despise all insurance companies.

I'm with you.
Posted 6/17/2011 2:32 PM (GMT 0)

MotherofTeenwithUC said...

I am starting to think that Government run health care is the way to go. I have a friend in Sweden and she told me that she doesnt pay anything for health care and the Government pays for everything.

I've lived quite a few years overseas, Sweden included. Their system is based on preventive care, and it appears to work well in small countries like Scandinavian nations. It's great to have a three-year paid maternity leave, etc.

I'd not like to wait a year for an operation, a knee replacement, for instance. Here, if insured, you get under the knife within two weeks if you're not in a hurry. Getting an appointment for a specialist there takes months. Ask our Canadian friends.

Swedes pay huge taxes for their system, so it's not free. Sweden is a great place to live, no doubt about it. If I had to choose another country than US, I'd go for Norway or New Zealand.

With insurance USA is the best country in the world, at least out of the 75 or so I've visited or lived in.

Think whatever you want of government run health care, it would not work in the United states.
Posted 6/17/2011 2:36 PM (GMT 0)
Yes, we all need to start standing up and voicing ourselves over health insurance and medication costs. My company went to a high deductible health insurance plan, and the employees, after being on it for about six months, are now starting to find out how costly it is and some have stopped taking medication and going to the doctor. Even the routine exams like breast or paps that we were told would be covered still have some sort of $$ attached to them. One gal told me that she was charged because she mentioned "hormone therapy" to her doc during her annual exam. The insurance company said it wasn't part of the exam. I'm so very lucky that for the time being I'm on my husband's plan. Our meds would be very costly.

Posted 6/17/2011 2:36 PM (GMT 0)

MotherofTeenwithUC said...

I am starting to think that Government run health care is the way to go.

Believe me, it's no panacea. I was living in Canada when I first came down with U.C. and the waiting lists were outrageous. I was deathly ill with pancolitis (undiagnosed at that point) and I was told it would take 8 months to get in to see a Gastroenterologist! Luckily my wife is a nurse, and she pulled some strings to get me in to see a Doc she knew. Who knows what would have happened otherwise.

The care I have received in the U.S. has been far superior to what I got in Canada, but I do agree that drugs are way overpriced here in the states. It's the crazy patent system that is the main problem IMO. Patents are too broad and too long lasting. Greedy ambulance chasing lawyers don't help either.

Based on my experience I will personally resist any attempts to create a government system down here in the states. Been there done that. I would rather reform the current system. Unfortunately Obamacare is going to be a disaster. Some good ideas in it, but a lot of stuff that obviously just isn't going to work. The details of how it works are starting to trickle down to the health care industry and some of the stuff is just mind bogglingly stupid. For example, hospitals and doctors will avoid any patients with difficult to treat health issues, because if the least little thing goes wrong, the government will now refuse to pay (for medicare patients, and for patients with "Obamacare" type insurance).
Posted 6/17/2011 3:12 PM (GMT 0)
When I was diagnosed, my GI doctor gave me samples of Lialda to try first. Then he tried me on Apriso samples. They have these discount cards that go with each medication that he would give me to present to the pharmacy. It is $500-$600 a year savings. You would get a discount per month until you max the discount. I have government insurance and it doesn't cover any of these drugs either. It makes them cheaper, but not like all my other medications since there is no generic available. You might want to call your GI doctor's office and see if they have the discount cards available? Or if they could give you a month's worth of samples when you are low on funds. Many doctor's here do that for patients that have to have the medications but cannot afford them. Hope this helps.
Posted 6/17/2011 3:14 PM (GMT 0)
If we're discussing extortionist drug prices, I think we can identify two culprits. The pharmaceutical companies want to make obscene profits, of course, but then that's typical of American businesses these days. It's become all about the shareholders, not the quality or value of the product.

I think we also need to give some credit to the product liability lawyers. If you don't believe me, just watch television during the day or late at night. Had a baby with cleft lip? Took an anti-epeliptic drug? You can sue the drug company and get big money! While I agree that a birth defect is tragic, I also know that the potential was listed in the information sheet given to the patient every time she filled the presription, as well as the fact that the drug is not approved for use during pregnancy.

We do need to be protected from damage, but we also have to take responsibility for ourselves. I know so many people who have never read the information from the pharmacist, and then are shocked when they get a side effect from a drug.
Posted 6/17/2011 3:31 PM (GMT 0)
 

$11,000 for remicade soup to nuts at my Dr's. office, no way could I pay that on my own.

$11K for one infusion?   I was told by the Specialty Pharmacy that approved my son's Remicade that the medication alone  (enough for the first two infusions and not including infusion center or doctor) was $5180.00.     I was told that a total of three infusions was the loading dose, so now I have to go back and have the third infusion preauthorized.  Makes no sense to me.   I  pay over $650 a month in insurance premiums for a family of two, plus high deductibles and a max out of pocket of $6000 per person (which I met by February). 

So when you break it down...$650 X 12 = 7800.00 per year in premiums,  $6000 out of pocket X 2 in family= $12000, plus every copay for doctor and prescription (probably another $3000 per year easily) for a total approximate cost of $22,800.00 per year...out of pocket!   How is a single parent supposed to be able to afford this?  

No wonder so many people are in foreclosure and can't pay their bills.   If it comes down to paying your mortgage or paying for meds and doctors...what would the choice be?  Pretty obvious.

 

Posted 6/17/2011 6:28 PM (GMT 0)

C_G_K said...
Believe me, it's no panacea. I was living in Canada when I first came down with U.C. and the waiting lists were outrageous.

Most Americans have no idea how socialist health care works.


C_G_K said...
Unfortunately Obamacare is going to be a disaster.

It's already affecting companies AND employees - higher premiums for employees, in addition to bigger deductibles, co-pays and out-of-pocket expenditures, etc.

Well, those who voted for the One will get what they voted for.
Posted 6/17/2011 7:11 PM (GMT 0)
I personally can`t wait for the Affordable Health Care Act to go into effect.
People should try to keep their politics to themselves.
Posted 6/17/2011 10:37 PM (GMT 0)
yes insurance for my prescriptions is a life saver... and I must say it was due to this condition and THIS FORUM that I came to appreciate the free health care we receive in Canada!!!! I feel bad when other posters (Americans and others.. ) mention the cost of procedures. I can't imagine paying to see my GI, or to get a scan, colonoscopy. or blood work done.

I do love Canada!
Posted 6/18/2011 3:09 AM (GMT 0)
I completely agree with imagardener2! Healthcare is my first priority when stepping into the voting booth! Medicine should not be big business. I am lucky to have decent insurance but I feel for the people that do not. There should never be a time anyone should go without health care due to finances. During my teen years, both my parents were very sick so I had to handle all their insurance issues because back in those days, I had to hand file every claim. I learned to hate insurance companies with a deep passion since they found any little reason to deny a claim. Things are better now but until every person can get affordable care, I will never be satisfied.
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