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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by bleauberry on December 9, 2010, at 20:57:31
In reply to Claim Denied For Lexapro, posted by Phillipa on December 6, 2010, at 13:37:21
This is just a hint of things to come if the national health care fiasco isn't majorly gutted and started over. You think this is bad, you aint seen nothin yet.
Any kind of nation sponsored health care has never worked as planned, including medicare.
When medicare takes over the role of a doctor, as in your case, it is sad but predictable.
Unintended consequences of otherwise well intentioned plans. Unfortunately, they never go back and fix the unintended consequences.
You asked what if it was a cancer drug or some life sustaining drug. Well, according to the actual wording in Obama care, there will be a panel of "experts" that decide whether your treatment is worth it or not, based upon how much it will cost, whether you are productive or not, and your age. People have denied death panels, but there it is.
That said, how friendly do you think those panels will be to someone's depression? Generic celexa instead of lexapro? Maybe neither, take XYZ instead. The panel will instruct the doctor what to prescribe for you. It's all in the bill.
Anyway, sorry Phillipa. I don't personally see Lexapro being any great drug for you, but still, it could have been, ya never know, but to have the choice stolen from you by elitist paper pushers is really sad.
Posted by Phillipa on December 9, 2010, at 20:57:33
In reply to Re: Claim Denied For Lexapro, posted by bleauberry on December 6, 2010, at 18:50:14
Blue oh I've read of the death panels and heard from a lady older that now colonoscopies as of coming year will be denied to anyone over 76.
Got another call back and now the cost lowered from $110.00/mth to $88.00 cause the pdoc sent in some form. Still too much so the insurance said she needs to do something called a three tier. To get a lowered price. As for luvox after 11 years I doubt a higher dose will do anything. And the addition of lexapro to luvox is a good thing for now as the pdoc thinks this lexapro could get me off the luvox. But if meds poop out anyway what's the point? And as for chemo never. Too many side effects nausea vomiting and white cells down. I would rather do without as couldn't afford it anyway. Meds are just too expensive. And can you imagine a hospital stay if you own a house all would be gone with one illness. I'm staying away from doctors. Phillipa
Posted by ed_uk2010 on December 9, 2010, at 20:57:33
In reply to Re: Claim Denied For Lexapro, posted by bleauberry on December 6, 2010, at 18:50:14
>.....to have the choice stolen from you by elitist paper pushers is really sad.
But isn't that how insurance works? If all claims were accepted, there wouldn't be any money left to pay for anything.
Posted by Phillipa on December 9, 2010, at 20:57:33
In reply to Re: Claim Denied For Lexapro » bleauberry, posted by ed_uk2010 on December 7, 2010, at 15:00:34
Not with private insurance. But I just have the government one and it stinks!!!! PJ ps third appeal sent hopefully today
Posted by emmanuel98 on December 9, 2010, at 20:57:34
In reply to Re: Claim Denied For Lexapro » bleauberry, posted by ed_uk2010 on December 7, 2010, at 15:00:34
Bleauberry - The problem here isn't big government health plans. The problem is that the Medicare drug plans are run by small insurance companies that all have different formularies. If you start out with one plan that covers a drug you use, then need a different or new drug, it may turn out that that new drug isn't in the insurance company's formulary. If the drug plan had been added, instead, to normal Medicare, the problems and confusions would be much reduced. Also under the Part D drug plan, Medicare is forbidden from negotiating prices with drug companies, leaving the negotiating to these hundreds of (relatively powerless) drug insurers, who, rather than negotiate at a disadvantage, just drop expensive drugs from their formularies.
Posted by Phillipa on December 9, 2010, at 20:57:35
In reply to Re: Claim Denied For Lexapro, posted by emmanuel98 on December 7, 2010, at 20:15:46
Great and well written explaination. Thanks Phillipa
Posted by glydin50 on December 9, 2010, at 20:57:36
In reply to Re: Claim Denied For Lexapro » ed_uk2010, posted by Phillipa on December 7, 2010, at 20:03:40
~~~ Don't you choose a plan yourself as part D of Medicare? They vary alot but on step drugs, alot -not all - will cover if the paperwork is filled and filed. Usually the policy requires a "fail" on a first line med thus the "step" to step program meds.
My policy is also like that. They removed Lex from their formulary several years ago so every year I and my doc had to file paperwork. I did do a trial of Citalopram when this happened but found I didn't feel as well. My plan has Lexapro back on its first line formulary now.
Having gone thur mess with my Father over picking a Rx plan, they are hugely variable as to coverage and picking one that is a good fit is difficult.
Posted by Phillipa on December 9, 2010, at 20:57:36
In reply to Re: Claim Denied For Lexapro » Phillipa, posted by glydin50 on December 7, 2010, at 22:54:31
For sure. None cover benzos but inexpensive same with synthroid. This coverage is free luvox. Now we are on tier 3. From one at 110 to tier two 88 hopefully she filed three today. Hey If it comes to it and it works will get doc to prescribe 20mg pills and split as she does this now even with luvox which amazingly it's CVS that the cost is 0. They have a prescription plan also and even the synthroid is cheaper. Phillipa
Posted by Glydin50 on December 9, 2010, at 20:57:37
In reply to Re: Claim Denied For Lexapro » glydin50, posted by Phillipa on December 7, 2010, at 23:57:32
It's open enrollment time now. A time, for my family, that's 50/50 "can there be a better fit?" versus dread and confusion : )
Posted by jane d on December 9, 2010, at 20:57:37
In reply to Re: Claim Denied For Lexapro, posted by bleauberry on December 6, 2010, at 18:50:14
> This is just a hint of things to come if the national health care fiasco isn't majorly gutted and started over. You think this is bad, you aint seen nothin yet.
Not so. You may not be aware of this but private insurers have been doing this for years with expensive drugs. Especially expensive, heavily marketed drugs with cheaper alternatives. I had something similar happen to me over a decade ago. There may or may not be valid arguments against health care reform but this ain't it.
Jane
This is the end of the thread.
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