Anthem Blue Cross/Shield: What an Evil Institution

[jj28west]

I have Anthem Blue Cross/Shield preferred tier and have been experiencing chronic pain for years. I would go to walk in centers or my GP and get an RX for a anti inflammatory, muscle relaxer,etc to manage the pain. I finally went to see a specialist (Neurologist) who did several tests on me as well as blood work etc and by process of elimination documented I had Fibromylgia and prescribed Lyrica which I have used and worked great. Neurontin was like a sugar pill in comparison.

Fast forward....I get denied by the insurance company because they stated that the drug is only prescribed for specific diagnostics (Lyrica being one of them). I corrected them and told them that is what exactly was specified by the doctor! My doctor is then told he must fill a letter of authorization stating I tried all these different medicines to no avail.

I then still get rejected because I did not report pain for 3 months. Are you efn kidding me. My doctor basically said screw them and he is is giving me as many sample bottles as I need.

I am still going to fight this but this is the third occurance where the insurance company has rejected me with other drugs.

Here a licensed practicioner prescribes a FDA approved drug for this specific diagnosis and I still get rejected.

Sorry to vent but the patient is really the victim. I wish there was a way to fight this but what a way to create a black market.

[HHMuse]

Insurance companies are up there with bankers, lawyers, and politicians. It's self righteous, offensive, and in no way, shape or form showing any kind of compassion to the clients they supposedly represent.

Dispicable.

[brdss]

Insurance companies are not there to make you get better. They are there to make money. If they deny 100 customers medication that they need and that is properly prescribed, and only 60 of them fight it and get them to pay for the drugs, then they come out ahead because the other 40 just suffer the pain or try a cheaper drug. It is a win/win for them! After all, they are not suffering the pain!

[jj28west]

I took this up with the human resource department at work. They contacted their Insurance rep who stated that the Insurance company is protecting me from side effects of the drug and that it is not about the money.
I love how there is this appointed board that gets to look and reject these cases. Its like they are protecting me from myself.
I told them that I am willing to sign a waiver with my lawyers letterhead to free Blue Cross/Blue shield from all responsibiity since they educated me a bout the potential dangers of this drug. I am now hearing crickets but I am sure I will hear something.
I pay along with my employer approx $850 a month for this. Just a sign of the times...

[Jeremy Fisher]

@jj28west, insurance companies are some of the worst institutions out there. Boy would I like to have an efficiency expert study some of the large ones.

Preventative $ should always be spent. Better to pay for birth control than a baby, stuff like that. I should have a better example but I don't.

My current issue is my insurance company will pay for diflonec (prescription anti-inflammatory pill) but not the diflonec cream (voltaren). The pill is systematic, the cream is topical and local. For me that is always better. Less stuff I have to make my stomach, kidney, and liver deal with, the better. But NO, they say. No cream FOR you.

I need to fight them. Still have 1/2 a tube of the cream though. It may just be that I have tried so many different things, they think I am going to keep 'buying' all of them.

And the price of this stuff w/out insurance is INSANE!!! Someone posted a source for the cream and I can get a script so might do that this next time as it takes forever to get a reversed decision from the insurance company.

Fire

[Gambit979]

I'm giving your doc a vicarious thumbs up via your post. Mine's really awesome about holding onto samples and vouchers from drug reps for me as well. Hang on to him/her. Even though you have a shitty insurance company at least you have a good doc.

[betsky]

I had to drop Bc/bs after my husband past away. I just couldn't afford the family premiums on my own. I am.able to get my kids covered rather cheaply but for me not so.much. my medicines monthly cost is outrageous which is why a fourum like this is so valuable

[Jellyfish]

I pay along with my employer approx $850 a month for this. Just a sign of the times...

I can't believe anyone, in 2012 has to pay that per month, just to get through their daily lives.
@Fireplaces I was prescribed Diclofenac, but that stuff is real harsh on your stomach, not to mention liver/kidneys/elsewhere where you can't actually feel it doing any damage.

I couldn't take it anymore, asked for something (anything else) and was told by the doc, to basically "make do" So, now I have 100 of these things a month, for the past 18 months, that get thrown in to the back of a cupboard, where I pull out the odd box for a friend or relative who is in need.
But I daren't not collect my repeat, for fear of them thinking I wasn't willing to try all methods before giving me something that actually works, and doesn't shred my stomach lining.

[betsky]

My family's. Insurance was $904 a month and did not include prescriptions.My scripts before iop's was $720/month. I actually save money nonlinear.

[Jeremy Fisher]

I am not sure but I think what we pay for insurance, even through employers is tax deductible for last year. I use Turbotax, and kind of skimmed past that; was trying to get a general idea of what we owe or get back. We get back $ so that is good. Anybody know the answer to if insurance $ paid through employer is deductible?

@Jellyfish, ask your doctor for volteran cream which is diflonec med in cream form. It could work for you; it works for me. I have a cervical fusion c5-c6 from 15 years ago and a deteriorating disc underneath. My neck and upper back are problem areas. c5-c6 is where one's arms connect so it impacts what I can do w/my arms if I want to avoid a flare up.

Anyway, try to get script for cream instead.

Fire

[Jellyfish]

I think my other half has had that before, for sciatica..is it the stuff that smells REAL strong?
He uses that deep heat stuff (or used to) but he's not allowed to sleep in the bed if he does lol..that stuff smells baaaaaaaaaad.

[Carter]

Health care costs in the US are insane. The way the system works is insane.
Per Capita US health care spending is ~twice as much in the US as it is in the other industrialized countries, yet we don't live longer, have lower birth death rates.... I really don't understand what Obama care will do starting in 2014 (probably nothing except create more bureaucracy and resulting cost), but I can't say for sure because I haven't read the 3000 plus page Bill that was passes by our Senate and House and signed by the President 'O'. I doubt if any of them read it either.

I googled "per capita health costs by county" and picked a link: (there's lot's of others and they all reflect similar data, but may have different written information to read)

Comparing U.S. Healthcare Spending with Other OECD Countries - Seeking Alpha



I've looked at all this before, and it driveds me nuts that 16% of our (US) GDP goes to health care, ~twice the costs/person and twice as much of the other counties GDPs.

I am lucky enough that I get "subsidized" medical insurance (still about costs me 400 dollars a month, and it's not the best, but it is OK) when I did an early retirement but it doesn't cover any depenedents (a change that was made the year before I retired) and what I pay just went up about $50 month at the beginning of the year. Also since I retired out of private industry (a megacorp) vs. the Govt., there is no guarentee it won't be eliminated before I hit 65. Here's the real kicker, prescription coverage was ~$2200 per year more (no thank you I said - I'll just order my meds off the internet..., it's alot cheaper - which it has been to date).

I don't have any answers/solutions....and our Govt. doesn't seem to either. Too many behind the seen people getting rich....it is evil.

Off my soapbox

I feel for all those who don't have, can't afford insurance, and people driven into bankruptcy because of needed medical care.

[Jellyfish]

God Bless our NHS..sure, it has problems, but the costs i'm seeing in this thread amounts to more per month, than what most would pay on their mortgage here.

I had a bit of a moan yesterday, my other half has been quite ill, with an infection in his upper airway, it ruptured yesterday morning, and he was coughing up blood.
That was at 7.00am, by 10.45, he'd been seen by a doctor, and have a prescription for 100x40mg DHC, and a 10 day course of Erythromycin, plus a sick note which he refused.
This came to about £14.
I went off on one, because I was certain that, here, we only pay one prescription charge, no matter how many items are on the script (which I later found out, only applies if it's several boxes of the same med)
Anyhow, I looked on the back of the slip, and saw that you can pay something like £110 for the YEAR, that covers anything and everything, with no maximum limits..to save paying out the £8.25 per item.
To see that the £110 would barely cover someone in the US for a weeks worth of basic coverage, not even including prescriptions leaves me truly gobsmacked.
I don't consider myself nearly as educated enough to join in on subjects such as these, and I don't know what the solution is, but anyone can see that there is something really wrong with that.

[smokinjoe]

Insurance companies are a racket, to make money. One has to be hard nosed when dealing with Insurance/crooks. Right out of the gate you have to play hard with the insurance/crooks.They use fine print in agreements/contracts as a well honed tool.
Several years ago I took a trip to ST.Croix in the American Virgin Islands I was taken aback by a 600ft+ lux ship docked at a small obscure villa,on its hull it bore a blue shield
The locals there told me it was owed by blue cross/blue shield,and used top exes for stress relief{?] Hell with meds give one of those.

[betsky]

Insurance companies are a racket, to make money. One has to be hard nosed when dealing with Insurance/crooks. Right out of the gate you have to play hard with the insurance/crooks.They use fine print in agreements/contracts as a well honed tool.
Several years ago I took a trip to ST.Croix in the American Virgin Islands I was taken aback by a 600ft+ lux ship docked at a small obscure villa,on its hull it bore a blue shield
The locals there told me it was owed by blue cross/blue shield,and used top exes for stress relief{?] Hell with meds give one of those.

I save so much money annually with online meds.I would love a copy of that photo to post on Bc/bs websites

[jeepdude8]

I didnt have time too read threw everyones posts, Im sure someone else already mentioned it. Im on testosterone injections which i desperately need, bottle is only $90 cash price for 2 month supply, not even expensive.. So my insurance filled it once or twice, then denied the next month... I had too call my doc too get him too cal insurance too tell them its the only drug that works, Afterwards every month doc had too call insurance too do prior approval on the same next script, then call pharmacy with P/A number before i can go pick up med... Always was a major Pain in the ass exp cause my docs office only has one girl who does P/As twice a week, She spend HOURS on the phone doing almost every patients approvals.... So a few times i ran out of test, while waiting days before they called.. Luckily now I finally got a year P/A approved for my script, cause i switched too new insurance company who allows that, instead of calling every month.. I assume your doc did this with your health insurance provider? My pharmacist told me the other day insurance comp's are even now starting too deny people for rx'd aspirin and cheap stuff like that, making it a pain in the ass, too save money. I guess some people will just pay cash, exp if there out of there meds... Shit, I did it one of the times.


This whole thing started too prevent corrupt pharmacy's for billing insurance company's for meds they didn't dispense. It was a big thing a few years back, in the papers... So this is there way too prevent fraud and save money, Only hurts us... Exp cause some docs will just put you on another med, that may not work good for you, cause some docs are cheap and dont wana hire another employee too do P/A's... It takes full days too do them, each one takes 15 mins on the phone with insurance company

[billyboy1965]

Also since I retired out of private industry (a megacorp) vs. the Govt., there is no guarentee it won't be eliminated before I hit 65.

Yup. And people need to understand they can't rely on their employers to cover that cost, during or after retirement.

You don't have any idea how often I've heard "I don't need to plan for that, my company will take care of me." Right.

I will play devil's advocate for just a minute, and obviously I agree with you and everybody about the entire subject ~ but, people need to take care of themselves because nobody else is going to do it.

I have no compassion for smokers. And unfortunately, and this will no doubt piss people off, obesity issues will take over in the next few decades as far as medical costs. Don't ask me for a source, it's my opinion.

You don't need to smoke. You don't need to be obese, in most circumstances. Medicaid is still the best coverage plan out there and I don't like paying for it.

*This post was auto-merged. The following text was added 6 minutes after the last post:*

Anybody know the answer to if insurance $ paid through employer is deductible?

If it's paid through a compensation package, it generally is not excluded from income. Big help, huh? If it is excluded from income, it might need to fall under the 7.5% of adjustment gross income floor, or 10% if alternative minimum tax.

"You should always consult with your tax adviser."

[RedDaisyLady]

@Fireplaces- If I understand your question correctly, you are asking if you can tax deduct your out of pocket cost for insurance. This would be the amount that comes out of your check each pay period.

I'm not a tax expert, but I can tell you that yes, we do take that deduction each year. You can actually deduct any out of pocket health care costs i.e. prescription costs, co pays, hospital stays, just about anything your insurance did not cover. You can also deduct the cost of traveling to the doctor each visit i.e. gas, etc. (Note: You must keep up with the mileage for that. Also it's helpful to have reciepts.)

You can get a printout from your pharmacy telling how much you spent in RX's this year. My insurance (the very crappy BC&BS) only covers 80-90% depending on the service. I can deduct my out of pocket costs to the doctors office.

They do limit how much you can deduct. It is a percentage based on your annual income. Basically, if you use a program like Turbo Tax, you just put in everything you spent. The program will then figure how much of that is deductible. Of course, this is only deductible if you itemize your return. That is, not take the standard deduction. The good thing about the programs like turbo tax is that it will figure out which way will get you the most return.

Again, I'm not a tax expert. These are just item's I've deducted in the past. We recently got audited over some stocks and investments. (Basically etrade didn't report our buying and selling of stocks correctly.) We got that all taken care. Nothing was ever mention about the medical deductions for that year. I'm guessing if there was a problem with it, it would have come up in that audit. Of course, I do have all of our reciepts, Dr Bills, etc.

Just thought of another thing, if your insurance costs are covered under an umbrella such as, Aflac, then the rules change. You will want to contact a tax expert about that.


Edit: Here's a link explaining all of the info about medical expense. From what I understand, you may not be able to deduct the insurance premium amount this year. This would be the amount that comes out of your check. (It looks like the rules have changed from years past. More will change at the end of 2012.) However, if you are self employed, then those premiums may be deductible. Medical Expenses are still deductible even if you have insurance. Also, you will still want to go to your pharmacy, and doctors offices for your printout of costs this year.

http://www.irs.gov/taxtopics/tc502.html

[C_Dub]

You can also deduct the cost of traveling to the doctor each visit i.e. gas, etc.

Good info RedDaisyLady!

I just wanted to add that there is a standard amount per mile to and from your doctor that is determined each year. I think it was around $.50/mile last year, and that really adds up to a lot if you are like me and have to pick up scripts from your doc 1 - 2 times a month and the office is 15 - 20 miles away.

I mapquest.com my address to the doc's address and take the total mileage x 2 (to account for round-trip) and count on my calender how many times I went to doc last year for appointments and script pick-ups and enter that total into Turbo Tax, which then multiplies the mileage by the current years amount allowed per mile.

Good luck, hope everyone gets money back this year!

[RedDaisyLady]

@C_Dub- I've never taken that deduction because I wasn't sure how to prove the mileage, in case of audit. Your way sounds great. And yes, it really does add up. I also recently heard someone say they kept a little notebook in there car. They used this as a log. They would write down the date and odom reading, when they departed to and returned from the Dr. This would get kinda difficult for me. I would forget to write it down. Not mention, I very seldom just go straight to the dr. and come straight home. Your way sounds a lot better!