Post by MixedBerryJam on Jun 27, 2019 13:54:37 GMT -5
I would like to complain on behalf of my brother, who is being treated for multiple myeloma. The standard protocol is chemo for 2 weeks, then a week off, then another two weeks on/one week off cycles for up to 18 weeks, then a stem cell transplant. He's just begun his second cycle.
My complaint on his behalf is twofold. First, the main drug he takes ONE DAY A WEEK for TWO WEEKS for each cycle is $2305 PER CYCLE. And plus, the insurance company will only authorize one cycle at a time, so WHILE HE'S ON THIS CYCLE'S CHEMO he has to deal with getting his NEXT CYCLE'S chemo authorized. And I asked about getting them all authorized at the start and apparently THIS IS IMPOSSIBLE MA'AM.
On the upside, CVS has a program that is providing this drug for free, so a rare yay to them. But why is ::flails at this wholefucking thread:: all necessary in the first place? (Narrator: It is not.)
It sucks. It's even worse when you're going through IVF treatments and insurance covers jack shit. No meds, no treatment, nothing. Sadly I don't want to tell you how much we've spent on fertility treatments in less than 1 year.
We're penalized if we want to have a kid yet people who can't take care of the ones they have get knocked up and the government pays for them.
I understand where you're coming from with the unfairness and non-existence of fertility coverage (and for experiencing infertility at all). I have been down that road myself. That said, the bolded is an incredibly narrow and harsh view that is also unfair to use as a blanket response to impoverished families.
Have you checked with your insurance company? I got an MRI recently. The hospital called and told me my estimated portion was like $900 and asked if I wanted to prepay. I said no because I know that my insurance only requires a $150 copay for outpatient radiology studies. Providers’ quotes prior to actual insurance processing of claims is not always accurate.
This! I also politely decline to pay for services until they are submitted to my insurance company because unless they are submitting AT THAT MOMENT your amount could change. My son had a ton of medical issues and it was a race to who filed, it may look like my deductible isn’t met yet but when you actual file at the end of the day or the end of the week, it will be met from other services that filed first.
It’s easier to pay a bill that can be tracked with an EOB vs tracking down a refund later. Even when we weren’t close to deductible I used this explanation and no one has given me a problem about it.
It sucks. It's even worse when you're going through IVF treatments and insurance covers jack shit. No meds, no treatment, nothing. Sadly I don't want to tell you how much we've spent on fertility treatments in less than 1 year.
We're penalized if we want to have a kid yet people who can't take care of the ones they have get knocked up and the government pays for them.
We're penalized if we want to have a kid yet people who can't take care of the ones they have get knocked up and the government pays for them.
What the fuck is this bullshit?
You should have seen her initial response to katieb4tom ‘s call out. It was even grosser. Looks like she already DD’d it. I meant to quote but got distracted.
Anyway...I’m sympathetic to infertility and finances/insurance. Trust I’d Be over $30k richer and less grey if they didn’t suck, but this comment is shitty Meg.
Post by seeyalater52 on Jun 27, 2019 19:59:44 GMT -5
I’m absolutely the most bitter infertile person on the planet but I also spend every day of my life making sure low income people have health care and food and clothes for themselves and their families. Because it isn’t a zero sum game, and them getting to have kids (and having more kids than they even want to have because of shitty access to family planning options) has no bearing on me whatsoever. And because I’d never be privileged enough to insinuate that people who are poor aren’t “helping themselves” like Megs did in the post she deleted.
Post by katieb4tom on Jun 27, 2019 20:57:10 GMT -5
I saw she deleted her response to me. I hope she rethought it. It’s a hard road, infertility, but we can’t assume we know everything about families with multiple children at certain income levels. I think it’s a good reminder how our own shit really messes with our perspectives.
It's the insurance company's advantage to keep you in the dark. Fewer claims paid, more $$$$$$$$$ for them.
I do all the insurance stuff in my dental practice. Granted dental is not as complex as medical but it is by no meals simple. I'm the doctor and I own the practice but after my disability, I settled on focusing mainly on the insurance. It is maddeningly confusing. You really need a sharp person to understand and maneuver through their shenanigans. For example, it should be really simple to look up what is covered, what's not covered, age limits, etc. in this day and age of the internet. But the insurance company websites are sparse and you are often forced to call them to get this info. Then they don't volunteer a single iota of relevant information to you unless you know to ask the right question.
Easy example I get all the time - new adult patient thinks they have an orthodontic benefit. We log in with their insurance info and see "$2000 Orthodontic" and the patient is ready to do a happy dance but we say "wait" because nowhere will you find the age limit until you call. When you call, then they will tell you the age limit is 19 so the adult patient actually has "$0 Orthodontic." How simple would it be to just put that upfront?
I’m sure it looks that way from a doctor’s point of view but there are very good reasons why some of this is the way it is. You should only ever pay a bill based on the insurance EOB you receive. If your doctor is demanding more money then you call up your insurance and they have a whole department to handle it for you. One big reason why you can’t go online and see what the cost would be for anything is because contracting is a major part of insurance and a big part of the benefit of having insurance because the insurance company negotiated on behalf of their subscribers with each hospital/doctor/group etc for the contracted rate. Contracted rates are proprietary information and it’s in the best interest of the provider not to let their contracts be public knowledge because if they make a deal with Company A that a service will be $100 then every other insurance company will want that rate and they can make more money by telling Company B who maybe has fewer subscribers and therefore less bargaining power than the lowest they can go is $500. But that’s part of what makes the whole system terrible and why we need to start talking about healthcare from scratch instead of just “improving” on the current system.
So is there any way to get this info? I gave up today because I was so frustrated and plan to try again, but will it be a waste of time? Is there really no way for me to find out the amount that I will be billed before having the procedure?
We're penalized if we want to have a kid yet people who can't take care of the ones they have get knocked up and the government pays for them.
What the fuck is this bullshit?
I didn't finish the thought process since I had conference calls the rest of the day. What I meant was there's a lot of people that have 5,6,7,8 kids who refuse to go out to try to support their family and instead rely on the state government to give them money each month. I don't mind them getting assistance, however feel they should try provide for themselves/family as well. If they can't provide for the family they have then why go out and have more kids?
I didn't finish the thought process since I had conference calls the rest of the day. What I meant was there's a lot of people that have 5,6,7,8 kids who refuse to go out to try to support their family and instead rely on the state government to give them money each month. I don't mind them getting assistance, however feel they should try provide for themselves/family as well. If they can't provide for the family they have then why go out and have more kids?
You should probably just stop. You are only burying yourself deeper at this point.
Post by lovelyshoes on Jun 28, 2019 8:20:37 GMT -5
megstoo liked in commiseration for huge oop for fertility treatments. The costs are higher than the already ridiculously quotes initial price. My accountant said it looks weird to have so much on medical Out of pocket costs when you have a good profession since you should then have good insurance. How freaking nuts is that? Not only is my insurance expensive, it’s crap and doesn’t cover anything to do with fertility.
megstoo liked in commiseration for huge oop for fertility treatments. The costs are higher than the already ridiculously quotes initial price. My accountant said it looks weird to have so much on medical Out of pocket costs when you have a good profession since you should then have good insurance. How freaking nuts is that? Not only is my insurance expensive, it’s crap and doesn’t cover anything to do with fertility.
Thats how ours is as well. Last year our tax guy just looked at was and said oh this isn't bad. I can only imagine what he's going to say this year. We have all the receipts to back everything. We (everyone) spends so much in premiums and a lot of things don't get covered (for some cancer treatments even) which is sad.
I didn't finish the thought process since I had conference calls the rest of the day. What I meant was there's a lot of people that have 5,6,7,8 kids who refuse to go out to try to support their family and instead rely on the state government to give them money each month. I don't mind them getting assistance, however feel they should try provide for themselves/family as well. If they can't provide for the family they have then why go out and have more kids?
This is....not better. I assure you people are not rolling in the dough on government assistance and that their preference would be to supporting themselves. Things are not always this simple.
Anyway--this thread reminded me that when I was trying to figure out my IVF coverage the insurance people told me IVF is not covered, but an IUD is covered at 100%. Not helpful to my problem, lady! (She was wrong...IVF was covered for my 2nd cycle). Getting answers out of insurance people is impossible. I agree there should be a more comprehensive book available with all coverage. I don't even need exact dollar amounts (I mean that would be nice), but at least a percentage of the coverage and any applicable limits. I'm fairly capable of researching and understanding insurance, but it was almost impossible with this. I can't even imagine how people with less knowledge navigate the system.
I didn't finish the thought process since I had conference calls the rest of the day. What I meant was there's a lot of people that have 5,6,7,8 kids who refuse to go out to try to support their family and instead rely on the state government to give them money each month. I don't mind them getting assistance, however feel they should try provide for themselves/family as well. If they can't provide for the family they have then why go out and have more kids?
This is....not better. I assure you people are not rolling in the dough on government assistance and that their preference would be to supporting themselves. Things are not always this simple.
Anyway--this thread reminded me that when I was trying to figure out my IVF coverage the insurance people told me IVF is not covered, but an IUD is covered at 100%. Not helpful to my problem, lady! (She was wrong...IVF was covered for my 2nd cycle). Getting answers out of insurance people is impossible. I agree there should be a more comprehensive book available with all coverage. I don't even need exact dollar amounts (I mean that would be nice), but at least a percentage of the coverage and any applicable limits. I'm fairly capable of researching and understanding insurance, but it was almost impossible with this. I can't even imagine how people with less knowledge navigate the system.
It’s impossible. I called insurance twice before I had to switch to my current one since my employer decided to go with an even worse plan and I asked all about ob coverage and got two completely different answers. I picked the plan that i thought would be the least expensive to me after everything is paid, but I still don’t know if I made the right choice. There is no rhyme or reason for what is covered, what my share will be and I called my ob’s office too and billing confirmed they don’t know until they bill and get a response from insurance. How can no one know? Why does insurance provide different information depending on the rep you get?
This is....not better. I assure you people are not rolling in the dough on government assistance and that their preference would be to supporting themselves. Things are not always this simple.
Anyway--this thread reminded me that when I was trying to figure out my IVF coverage the insurance people told me IVF is not covered, but an IUD is covered at 100%. Not helpful to my problem, lady! (She was wrong...IVF was covered for my 2nd cycle). Getting answers out of insurance people is impossible. I agree there should be a more comprehensive book available with all coverage. I don't even need exact dollar amounts (I mean that would be nice), but at least a percentage of the coverage and any applicable limits. I'm fairly capable of researching and understanding insurance, but it was almost impossible with this. I can't even imagine how people with less knowledge navigate the system.
It’s impossible. I called insurance twice before I had to switch to my current one since my employer decided to go with an even worse plan and I asked all about ob coverage and got two completely different answers. I picked the plan that i thought would be the least expensive to me after everything is paid, but I still don’t know if I made the right choice. There is no rhyme or reason for what is covered, what my share will be and I called my ob’s office too and billing confirmed they don’t know until they bill and get a response from insurance. How can no one know? Why does insurance provide different information depending on the rep you get?
I finally found out we had IVF coverage up to 3 cycles, but I never did get a good answer on what counts as a cycle (frozen vs. fresh). I'm glad I never needed to find out, but my god it should not be this difficult. Like...don't you have a book with definitions or something you can send me? How do you make these determinations when you're reviewing claims? Or is that a crapshoot too?
It’s impossible. I called insurance twice before I had to switch to my current one since my employer decided to go with an even worse plan and I asked all about ob coverage and got two completely different answers. I picked the plan that i thought would be the least expensive to me after everything is paid, but I still don’t know if I made the right choice. There is no rhyme or reason for what is covered, what my share will be and I called my ob’s office too and billing confirmed they don’t know until they bill and get a response from insurance. How can no one know? Why does insurance provide different information depending on the rep you get?
I finally found out we had IVF coverage up to 3 cycles, but I never did get a good answer on what counts as a cycle (frozen vs. fresh). I'm glad I never needed to find out, but my god it should not be this difficult. Like...don't you have a book with definitions or something you can send me? How do you make these determinations when you're reviewing claims? Or is that a crapshoot too?
I honestly think it’s a crapshoot. Once I had two sonograms ordered by the same dr done at the same facility. The insurance treated one as regular dr and the other as being read by a specialist from a different practice and it costs hundreds more n They were both read by the same Dr! Same dr at the same facility done on the same day. You can’t imagine the convo I had with my insurance. She kept trying to tell me it was different dates, read by different doctors, ordered by different doctors, all a bunch of bs. And at the end she said, I think we made a mistake and it should all be billed at the higher amount and I am going to adjust that. I lost it and asked for a manager. She was more helpful but still useless. I told them then Better not adjust anything to make me pay more. I had to escalate it up. Seriously, how do they decide this?
I didn't finish the thought process since I had conference calls the rest of the day. What I meant was there's a lot of people that have 5,6,7,8 kids who refuse to go out to try to support their family and instead rely on the state government to give them money each month. I don't mind them getting assistance, however feel they should try provide for themselves/family as well. If they can't provide for the family they have then why go out and have more kids?
You should probably just stop. You are only burying yourself deeper at this point.
I see she deleted one again, so I’m glad you got it.
Except you do mind them getting assistance, because you think that you are entitled to assistance but not the them. How do you know they haven’t tried to take care of their children? How do you know how they’ve gotten pregnant?
No skittles for poor people! For someone who is struggling, you lack a lot of compassion.
I didn't finish the thought process since I had conference calls the rest of the day. What I meant was there's a lot of people that have 5,6,7,8 kids who refuse to go out to try to support their family and instead rely on the state government to give them money each month. I don't mind them getting assistance, however feel they should try provide for themselves/family as well. If they can't provide for the family they have then why go out and have more kids?
Your tropes of the lazy welfare recipients are wrong and harmful. I remember you being bullheaded about watching a known racist Roseanne show bc there was nothing else on. You gonna be bullheaded about this too?
The truth is the majority of welfare recipients are working poor bc business in the country refuse to provide (1) living wages and (2) health insurance that covers anything worthwhile.
You can be mad for you without dogging on people whom youve never met and don’t know their struggles.
I need ham like water Like breath, like rain I need ham like mercy From Heaven's gate Sometimes ham salad or casserole or ham that’s free range, all natural I need ham
I didn't finish the thought process since I had conference calls the rest of the day. What I meant was there's a lot of people that have 5,6,7,8 kids who refuse to go out to try to support their family and instead rely on the state government to give them money each month. I don't mind them getting assistance, however feel they should try provide for themselves/family as well. If they can't provide for the family they have then why go out and have more kids?
Your tropes of the lazy welfare recipients are wrong and harmful. I remember you being bullheaded about watching a known racist Roseanne show bc there was nothing else on. You gonna be bullheaded about this too?
The truth is the majority of welfare recipients are working poor bc business in the country refuse to provide (1) living wages and (2) health insurance that covers anything worthwhile.
You can be mad for you without dogging on people whom youve never met and don’t know their struggles.
Your tropes of the lazy welfare recipients are wrong and harmful. I remember you being bullheaded about watching a known racist Roseanne show bc there was nothing else on. You gonna be bullheaded about this too?
The truth is the majority of welfare recipients are working poor bc business in the country refuse to provide (1) living wages and (2) health insurance that covers anything worthwhile.
You can be mad for you without dogging on people whom youve never met and don’t know their struggles.
I need ham like water Like breath, like rain I need ham like mercy From Heaven's gate Sometimes ham salad or casserole or ham that’s free range, all natural I need ham
megstoo liked in commiseration for huge oop for fertility treatments. The costs are higher than the already ridiculously quotes initial price. My accountant said it looks weird to have so much on medical Out of pocket costs when you have a good profession since you should then have good insurance. How freaking nuts is that? Not only is my insurance expensive, it’s crap and doesn’t cover anything to do with fertility.
Thats how ours is as well. Last year our tax guy just looked at was and said oh this isn't bad. I can only imagine what he's going to say this year. We have all the receipts to back everything. We (everyone) spends so much in premiums and a lot of things don't get covered (for some cancer treatments even) which is sad.
When I attempted fertility treatments, my insurance would decline everything if the word fertility was even mentioned. One of the things that was declined was a cholesterol test. The office recoded it so that not everything was related to the "fertility" consult. It is frustrating to deal with insurance because of things like that.
share.memebox.com/x/uKhKaZmemebox referal code for 20% off! DD1 "J" born 3/2003 DD2 "G" born 4/2011 DS is here! "H" born 2/2014 m/c#3 1-13-13 @ 9 weeks m/c#2 11-11-12 @ 5w2d I am an extended breastfeeding, cloth diapering, baby wearing, pro marriage equality, birth control lovin', Catholic mama.