insurance vent----

[55dznypal]

Ive been trying to get my chelstrol # without meds and for the last

year and a half Ive slowly gotten them down

until last month when it went up 60 points

doing nothing different--dr is even stumped--sent me for an NMR test that

shows more then the standard test--get the EOB and insurance denied it

saying its new and investagional?!!!!

talked to insurance and they see no reason to have that test

(dr is the one that went XX many years to med school but its the insurance that calls the shots?!!)

so now dr is writing a letter so we can appel it!!!

gotta love thw insurance?!!!

Im really looking forward to see what happens next

 

[Frye7127]

Ive been trying to get my chelstrol # without meds and for the last

year and a half Ive slowly gotten them down

until last month when it went up 60 points

doing nothing different--dr is even stumped--sent me for an NMR test that

shows more then the standard test--get the EOB and insurance denied it

saying its new and investagional?!!!!

talked to insurance and they see no reason to have that test

(dr is the one that went XX many years to med school but its the insurance that calls the shots?!!)

so now dr is writing a letter so we can appel it!!!

gotta love thw insurance?!!!

Im really looking forward to see what happens next

I think this is the test my dad has to have ever so often, expensive and his insurance refuses to cover it. It burns me up when the insurance company overrides a doctor on what is necessary and appropriate. They tried to change one of my son's medicines at the pharmacy when I picked it up, saying they would not cover X, but would cover Y, and they were two totally different meds. I was furious. I would appeal!

 

[akcire]

Ive been trying to get my chelstrol # without meds and for the last

year and a half Ive slowly gotten them down

until last month when it went up 60 points

doing nothing different--dr is even stumped--sent me for an NMR test that

shows more then the standard test--get the EOB and insurance denied it

saying its new and investagional?!!!!

talked to insurance and they see no reason to have that test

(dr is the one that went XX many years to med school but its the insurance that calls the shots?!!)

so now dr is writing a letter so we can appel it!!!

gotta love thw insurance?!!!

Im really looking forward to see what happens next

I can beat that. I am pregnant and needed to take progesterone for one month. I paid cash $171 when they denied the claim.

In two weeks CVS Caremark sent me two letters.

One explaining how they do not cover progesterone for infertility treatment--I think great, I am already pregnant. So I call them.

The next letter they send me states that CVS only covers the drug for infertility and that it is an off label usage during pregnancy.

They then tell me they will approve a "different" medication, but I can only get it from the specialty pharmacy--which will take 5 days (keep in mind this is a 30 day prescription and I am nearly done with the prescription). Moreover the drug they want to approve is more expensive, and contra indicated with some of my other medical issues.

My doctors did multiple appeals--all to be told no.

My doctor is so upset (I can afford the $171, but many people could not) that she is compiling data to see if this has effected enough people in IL to justify a class action lawsuit. She also has contacted a large law firm to make certain they would take the case. I am being kept in the loop, because I would end up being named in the lawsuit.

Gotta love insurance companies.

 

[ssawka]

When are people going to realize that we are at the mercy of big business? It is the insurance companies, oil companies, etc. that control this country and have the politicians in their back pocket. This is most visible in the health care industry where medical decisions are made by businessmen and not by doctors. Health insurance companies do not care about your health, all they care about is dollars and cents. If they can get away without paying for something, they will not pay for it. It's that simple! And, any plan to change the status quo will be fought against by expensive lawyers and corrupt politicians, you know the same guys that turn around and tell you that they are working in your best interest.

Ok, I'll get off my soap box now!

 

[cm8]

When are people going to realize that we are at the mercy of big business? It is the insurance companies, oil companies, etc. that control this country and have the politicians in their back pocket. This is most visible in the health care industry where medical decisions are made by businessmen and not by doctors. Health insurance companies do not care about your health, all they care about is dollars and cents. If they can get away without paying for something, they will not pay for it. It's that simple! And, any plan to change the status quo will be fought against by expensive lawyers and corrupt politicians, you know the same guys that turn around and tell you that they are working in your best interest.

Ok, I'll get off my soap box now!

This is so true

 

[powellrj]

I have been on Celebrex for years. I went to have it refilled only to be denied because the insurance said it wasn't needed. OK, I have arthritis and degenerative disk disease and I take it because it works. Over the years I have tried other drugs, but none worked as well as celebrex. They told me the only way they would cover it was if I had a bleeding ulcer from the other drugs. I am now on the generic Mobic which does nothing so I am back to painful joints and numb legs and feet.

Gotta love'em.....

 

[Muushka]

While I can't get into the bad insurance aspect, the test you had (the NMR-nuclear magnetic resonance) is actually a very beneficial test, but it has not been around for a long time (company started in the late 90's and the first time I heard about NMR was around 2000), so some insurance companies do still call it investigational. It just has not become a well know test, so I guess insurance companies are hesitant to add it to their list of approved tests.

The company that performs the test (right here where I live) is Liposcience. http://www.liposcience.com/.

I could get into the virtues of how great this new technology is, but it might be boring.
By the way, did you get your results back yet?

If your insurance refuses to pay for it, you might try contacting Lipomed and see if you could work something out. I just tried to look up the prices of the NMR, but couldn't find them. When I researched this company a few years ago, I was surprised that the test was pretty inexpensive (I think I remeber around $80).

 

[Purseval]

If the test is so good why not pay for it out of your own pocket and if the insurance company covers it that is just a cherry on top of the sundae?

 

[55dznypal]

thanks for the replies--

insurance is so fustrating!!

the dr is sending in the appel for us--hopefully he can so something

I did get the results back but to me all it is is alot of letters and #S

the dr is still waiting for something from the lab--Im not sure what though

I asked him for a range--like from this to this is good

this to that is borderline but all I got from him was he said in reviewing the results cholesterol is good and the LP IR score that I was so worried about since mine was so low is terrific

he said that means Im insulin sensitive I found the range for that one on the interent

so I guess this is all good

good luck akcira how are things going for you

yes I sure know were at the mercy of big business--

I dont how all this happened-and no one does anything about it

just let the business screw the little guy

 

[hanutedmansionmomma]

I'd love to add something here about health insurance...

was always on HMO until it got too expensive that increases outweighed any pay increase (or no pay increase, last several years), so switched to High Deductible.

Now I pay up front for everything 'till I hit $5K for family.

Dr. prescribed brand name pill for DD, went to pick up and was $177 for 30 pills.

called and had him switch scrip to generic please and new pill, same ingredient was $17 for 30.

WT?????????????????????????????????????????????????????

thanks for letting me hijack a bit...no wonder health care is out of control. I never knew how much things cost when I "just" payed copays. I worry about folks who aren't researching and asking questions and just opening their wallets or handing over their credit cards.

 

[Tink-aholic]

I'm pretty sure that this will be the future of health insurance for most of us: HSAs and FSAs matched with high-deductible catastrophic plans.

I teach Medical Coding and Billing (among other things) and the average US family pays $17,000 for premiums and out-of-pocket medical costs per year.

 

[Muushka]

thanks for the replies--

insurance is so fustrating!!

the dr is sending in the appel for us--hopefully he can so something

I did get the results back but to me all it is is alot of letters and #S

the dr is still waiting for something from the lab--Im not sure what though

I asked him for a range--like from this to this is good

this to that is borderline but all I got from him was he said in reviewing the results cholesterol is good and the LP IR score that I was so worried about since mine was so low is terrific

he said that means Im insulin sensitive I found the range for that one on the interent

so I guess this is all good

good luck akcira how are things going for you

yes I sure know were at the mercy of big business--

I dont how all this happened-and no one does anything about it

just let the business screw the little guy

I'm glad your test came out good. That is the value of the NMR. It does not look at just Chol/HDL/LDL numbers but gets into the actual composition (not sure if that would be an accurate word for this). In other words, you can have someone with a 250 chol who is actually at less risk than someone with a 175 chol. Looking at the chol/hdl ratio is helpful, but the NMR brings it to a new level.

And with NMR, they are finding more tests that use this technology to get even more information about other chemistry analytes (like glucose for example). With your LP-IR score, it sounds like you were also tested for this. So the $$ might be more.

Back to insurance. I think that a lot of our medical cost problems stem from people (myself included) wanting insurance to cover everything. It opens up a Pandora's box for over-testing. This is what they have created in us. But when you think about car insurance, it does not cover oil changes or blown head gaskets, it just covers accidents. Equating that to medical insurance, if it was set up that it just covered catastrophic illnesses, the mess would be greatly improved. I know people who went to the doctor because (on our last ins which I miss very much) it was free, no copay. And how many people would think twice about running to the doctor for a head cold if they knew it would cost them $90?

My sister once had a blood test (experimental, gene study) to the tune of $2800.00 to rule out a condition that she has. The test did absolutely nothing as far as how she was treated for it. In fact, her condition is not treatable. It was just a rule out type of thing. The insurance company ended up paying for it (why, I will never know).

If they overhaul the way insurance is provided, it will improve.

PS I do hope the insurance company pays for your test.