Biggest Medical Rip Off?

[jaybirdsmommy]

I have crohns disease and one of my meds was lialda. The copay for one months worth of pills (4 pills daily)was $1000...for one month. When I told my doctor I couldn't afford $1000 per month her jaw dropped and she said 1)it does not cost remotly close to that much to make and 2)it's cheaper to buy it out of pocket for 1/2 the cost ($500 a month). Sill $500 a month is not affordable for us.

Neither are my infusions at a copay of $2,000 every 6 weeks. My insurance refuses to approve it anymore even though it is the ONE DRUG that has me in remission. They want me to go back onto a drug that I'm allergic to and almost killed me...

This makes me mad. Same thing happens to my husband regularly. He finds a drug that works for his autoimmune arthritis and after a few months the insurance refuses to cover it anymore and wants him to go back to something cheaper that doesn't work. Why does the insurance company have more of a say in what meds someone gets to use than that person's DOCTOR does?

 

[Dakota731]

That's because I'm also paying a pretty high monthly premium. There was a time when having insurance meant those costs were covered.
I have to pay full price for all my Rx's and lucky me they don't count towards my deductible. So yeah I kind of think it's the end of the world, you can cancel your cell phone and cable but some just can't really do that with m

But no one ever does cancel their cellphone or cable subscriptions. Just saw on the news today that 90% of teens in this country in this country have cellphones, and I’m sure tv ownership is even higher. My point was how can we compare our health to entertainment? What can be more important yet some people think every cent of their healthcare should be paid for by insurance.

 

[JacknSally]

Went to the eye doctor for a new glasses prescription. Eye doctor recommended me to a specialist because she suspected my astigmatism was actually a worsening corneal disease. Went to the specialist, and the suspicion was confirmed. So now I'll have to go to a different eye doctor who makes specialty contact lenses specifically for this disease, since glasses will never be able to get me to see well/comfortably. With the contacts, I'll actually see 20/20 again, which I haven't done in a decade.

The initial eye doctor visit had to be filed through my vision insurance, which used up my one eye doctor visit for the year. The specialist was covered under the medical insurance. Because I've used my one eye doctor visit, I'll have to pay out of pocket for the eye exam at the new eye doctor's office. Once I've had my eye exam, if he agrees with the specialist's diagnosis, then he'll argue with my insurance that the contacts need to be covered by medical insurance. Hopefully he can convince them, because I'll be looking at ~$1000 for the contacts. My dad also has this corneal disease (it's genetic) and his isn't as severe as mine, but his insurance would only cover one pair of contacts. Any future pairs will have to be out of pocket, even if his prescription changes.

There's also a procedure the specialist recommends I do ASAP, because it basically stalls the progression of the disease. There's nothing to correct it, so this procedure is the best chance to keep my vision from worsening. As it is, I won't go completely blind, but eventually the condition would worsen to the point that I need a cornea transplant, which is invasive eye surgery. This procedure would basically freeze the progress at the point it is whenever I have the procedure done.

There's no insurance that covers this procedure, because no insurance deems it "medically necessary", because I won't go blind, and there's an alternative solution (the invasive surgery)... Nevermind that my eyesight would just continue to worsen until it reaches the point that the surgery is medically necessary. The procedure is ~$3500 per eye, not counting days missed from work for recovery/check-ups, and not including any complications that could arise.


Yeah, that procedure isn't happening any time soon.

 

[kymom99]

Went to the eye doctor for a new glasses prescription. Eye doctor recommended me to a specialist because she suspected my astigmatism was actually a worsening corneal disease. Went to the specialist, and the suspicion was confirmed. So now I'll have to go to a different eye doctor who makes specialty contact lenses specifically for this disease, since glasses will never be able to get me to see well/comfortably. With the contacts, I'll actually see 20/20 again, which I haven't done in a decade.

The initial eye doctor visit had to be filed through my vision insurance, which used up my one eye doctor visit for the year. The specialist was covered under the medical insurance. Because I've used my one eye doctor visit, I'll have to pay out of pocket for the eye exam at the new eye doctor's office. Once I've had my eye exam, if he agrees with the specialist's diagnosis, then he'll argue with my insurance that the contacts need to be covered by medical insurance. Hopefully he can convince them, because I'll be looking at ~$1000 for the contacts. My dad also has this corneal disease (it's genetic) and his isn't as severe as mine, but his insurance would only cover one pair of contacts. Any future pairs will have to be out of pocket, even if his prescription changes.

There's also a procedure the specialist recommends I do ASAP, because it basically stalls the progression of the disease. There's nothing to correct it, so this procedure is the best chance to keep my vision from worsening. As it is, I won't go completely blind, but eventually the condition would worsen to the point that I need a cornea transplant, which is invasive eye surgery. This procedure would basically freeze the progress at the point it is whenever I have the procedure done.

There's no insurance that covers this procedure, because no insurance deems it "medically necessary", because I won't go blind, and there's an alternative solution (the invasive surgery)... Nevermind that my eyesight would just continue to worsen until it reaches the point that the surgery is medically necessary. The procedure is ~$3500 per eye, not counting days missed from work for recovery/check-ups, and not including any complications that could arise.


Yeah, that procedure isn't happening any time soon.

I hope you are able to find a way to have the procedure. My mom had double cornea transplants and it's nothing to hope for. That will cost your insurance far more than $7000, too.

 

[JacknSally]

I hope you are able to find a way to have the procedure. My mom had double cornea transplants and it's nothing to hope for. That will cost your insurance far more than $7000, too.

Thank you! The transplant is definitely nowhere near my list of things I'd ever like to do in life, haha.

 

[Hikergirl]

But no one ever does cancel their cellphone or cable subscriptions. Just saw on the news today that 90% of teens in this country in this country have cellphones, and I’m sure tv ownership is even higher. My point was how can we compare our health to entertainment? What can be more important yet some people think every cent of their healthcare should be paid for by insurance.

I don't think anyone here has claimed that their insurance should cover every cent.

And how do you know nobody cancels their cell or cable, or their land line, or cut back anywhere else to be able to afford those $1000 a month prescription copays? Have you even read the budget board, people are always looking for ways to cut back on those expenditures.
My kids have phones, the 3 of them combined cost less than one month of my health insurance premium. My cell service cost $100 a month, but I can get it down to $75 a month working some magic, and that is for 4 lines.
Not every house is full of $1000 iphones and $300 a month cell phone bills you know, or $200 cable bills. Some of us have insurance premiums to pay

 

[MillauFr]

I was shocked when I saw how much Kaiser was going to charge for a circumcision for our son. They don't deem it medically necessary and so don't cover it. I quickly decided against the procedure.

 

[CalDisneyMomof2]

I was shocked when I saw how much Kaiser was going to charge for a circumcision for our son. They don't deem it medically necessary and so don't cover it. I quickly decided against the procedure.

I was surprised at how little my sons' cost. It was our only bill for both labor/ deliveries etc. of both boys. $300. What was Kaiser going to charge?

 

[kymom99]

I was shocked when I saw how much Kaiser was going to charge for a circumcision for our son. They don't deem it medically necessary and so don't cover it. I quickly decided against the procedure.

I paid one $10 copay for all my maternity care and hospital/delivery. And my insurance was completely paid for by my employer. That was in 1999.

 

[Dakota731]

My kids have phones, the 3 of them combined cost less than one month of my health insurance premium.

And why would your health insurance premium be less than your cell phone bill? Health insurance can pay up to a million dollars in some cases with extended cancer treatments. I just think priorities have sometimes gotten off track when so much money is spent on frivolous things, but when anyone has to pay a portion of life saving treatments then it’s a ripoff. I have a friend who won’t get a flu shot because her insurance won’t cover it! Yet she’s spends thousands a year on trips and clothes. It’s just a question on what’s important to you.

 

[Hikergirl]

And why would your health insurance premium be less than your cell phone bill? Health insurance can pay up to a million dollars in some cases with extended cancer treatments. I just think priorities have sometimes gotten off track when so much money is spent on frivolous things, but when anyone has to pay a portion of life saving treatments then it’s a ripoff. I have a friend who won’t get a flu shot because her insurance won’t cover it! Yet she’s spends thousands a year on trips and clothes. It’s just a question on what’s important to you.

First of all, it is the cost of my kid's 3 phones that were less than my health insurance premium, although my monthly service is too.
My point is that just because someone has something doesn't mean they are making it a priority cost wise over something else. I spend the minimum on things I feel are needed for my family, and IMO that includes cell phones.
I certainly don't think what I do is what everyone does, just as what your friend does is what everyone does either.
The point of having health insurance is so that the costs of medical care for people is affordable. You pay a premium, your insurance company works out deals and you pay a small portion of what it costs. That isn't the case anymore these days. We still pay a premium, but now we also have to pay OOP up to a certain amount before we can pay that small portion. The people (I know) that are complaining are doing it because they are still paying thousands of dollars to their insurance companies but not getting things covered. Not to mention that those insurance companies are raking in the profits. It's a fair complaint and it has nothing to do with priorities, it has to do with being ripped off, which is the subject of this thread

 

[BLAZEY]

I have crohns disease and one of my meds was lialda. The copay for one months worth of pills (4 pills daily)was $1000...for one month. When I told my doctor I couldn't afford $1000 per month her jaw dropped and she said 1)it does not cost remotly close to that much to make and 2)it's cheaper to buy it out of pocket for 1/2 the cost ($500 a month). Sill $500 a month is not affordable for us.

Neither are my infusions at a copay of $2,000 every 6 weeks. My insurance refuses to approve it anymore even though it is the ONE DRUG that has me in remission. They want me to go back onto a drug that I'm allergic to and almost killed me...

That why my sister and BIL moved back to Canada. BIL has crohns as well and moved to SF for work moved home to Canada after less than a year . The amount he was paying for insurance premiums, copays and hospital admissions for the remicade infusion it was way more out of pocket and taxes than here.

 

[lookame]

That why my sister and BIL moved back to Canada. BIL has crohns as well and moved to SF for work moved home to Canada after less than a year . The amount he was paying for insurance premiums, copays and hospital admissions for the remicade infusion it was way more out of pocket and taxes than here.

Its really bad. At one point I resorted to taking expired pills that someone else had because the copay and price out of pocket was WAY to much. If I wasn't taking expired pills that was someone else script I was taking less of the prescribed amount in order to stretch the meds. My dr took me off them because entyvio was working very well and my other script was only $5 but now my dr and insurance company are fighting over whether I truly need entyvio...meanwhile I'm starting to see a huge increase in symptoms...some I haven't seen in a few months.

I'm not saying my meds should be paid 100% but when infusions are costing more than my husbands monthly paycheck and pills are 1/2 his monthly pay and then I'm flat out refused the drugs that have me in remission and told I need to go back to meds that I am deathly allergic to because its cheaper for the insurance company....something is wrong...

When I had my daughter my iron had dropped to 6.9 (normal range is 12 for a woman)...at thatpoint I needed a blood transfusion and I was denied because it was just to expensive for the insurance company

 

[BLAZEY]

Its really bad. At one point I resorted to taking expired pills that someone else had because the copay and price out of pocket was WAY to much. If I wasn't taking expired pills that was someone else script I was taking less of the prescribed amount in order to stretch the meds. My dr took me off them because entyvio was working very well and my other script was only $5 but now my dr and insurance company are fighting over whether I truly need entyvio...meanwhile I'm starting to see a huge increase in symptoms...some I haven't seen in a few months.

I'm not saying my meds should be paid 100% but when infusions are costing more than my husbands monthly paycheck and pills are 1/2 his monthly pay and then I'm flat out refused the drugs that have me in remission and told I need to go back to meds that I am deathly allergic to because its cheaper for the insurance company....something is wrong...

When I had my daughter my iron had dropped to 6.9 (normal range is 12 for a woman)...at thatpoint I needed a blood transfusion and I was denied because it was just to expensive for the insurance company

Sorry to hear that. I think the course of treatment should be what gives the patient the best results and care, not what the insurance company wants to pay. We are very lucky to live in Canada where universal healthcare is available to everyone.

 

[Sagginit]

My OBGYN was in network but I found out a few weeks before delivery that the hospital she delivers out of is out of network, but both same healthcare system. I think the total they charged our insurance for my labor/delivery/and 48 hr stay with my son was 150K. We just had co-pay but our insurance notified us recently as just an FYI that the hospital is still trying to get more money out of them for my son's stay and he is 18m. I believe the split was I was 120K and he was 30K. I had a vaginal delivery too so even if I was in labor for 36 hours or so I can't see why it cost sooo much. We never got an itemized bill as we didn't want to get into it but I did get a summary and they charged for the anesthesiologist twice. Once when I got the epidural and then the same cost for him to come back and turn it back on (they turned it off for me to push, which the nurse is allowed to do but even with him having it all set up there was a lockbox to turn it back on that only he had access to). Amazing how it costs the same for him to set up the epidural as it does for him to unlock a box and hit a button.

 

[Patches Lee]

$800 room charge for an ER visit that I was left in the hallway entire time. Had to do chest x-ray, then EKG in full view of everyone. Husband had to hold up jacket for me to remove bra and block at least some view.

 

[luvthemouse71]

This is why we should be trying to live as healthy as possible. In this country, we’re focused on treatment, not prevention.

Obviously, this doesn’t apply to accidents and such. But, things like high cholesterol, high blood pressure and some kinds of disease can be prevented for most people.

 

[Dakota731]

This is why we should be trying to live as healthy as possible. In this country, we’re focused on treatment, not prevention.

Obviously, this doesn’t apply to accidents and such. But, things like high cholesterol, high blood pressure and some kinds of disease can be prevented for most people.

Agreed. Younger and younger people are on all kinds of prescriptions than ever before. Not all conditions can be prevented but many can. Unfortunately there is not one easy answer to this issue. Insurance companies are paying more than ever for high cost treatments some that are chronic. Hospitals have to pay for many patients who have no coverage at all so the costs are raised to cover those people. Contrary to belief in this thread, health care professionals and insurance companies are not evil entities who set out to rip off patients.

 

[Dakota731]

The insurance company is heavily regulated. Insurers that sell individual and small group health insurance coverage must spend at least 80 percent of premiums on medical claims and quality improvements for members. No more than 20 percent of premium revenue can be spent on total administrative costs, including profits and salaries. Most insurance companies make profits in the single digits. I can guarantee you corporations like Apple and Google make a heck of a lot more than that. As far as their CEOs making large salaries, they are not out of line for other companies of the same size. You can’t recruit an experienced company leader for minimum wage! Health insurance must make a profit or they won’t exist then you will be paying the total costs for your healthcare, so I’m grateful for my company’s $500 a month $6000 deductible plan!

 

[Jaime4004]

I paid one $10 copay for all my maternity care and hospital/delivery. And my insurance was completely paid for by my employer. That was in 1999.

Almost 15 years ago I paid one $5 copay for all my maternity care and hospital/delivery. Times have definitely changed. I just paid $700 just for labwork to check a few things on my son who is growing less than expected (all was normal, thankfully).

My other pet peeve is going for mammograms annually. Last few years they see "something." End up going back for another view. Then for an ultrasound. Then recheck in 6 months. Since we have a high deductible plan (I so miss that $5 copay from yrs ago), I have to pay 100% of all these follow ups. Rinse and repeat the next year. Of course I know i'm lucky that nothing is ever found and that someone is concerned enough to keep checking. But I still cringe at the bills.