Skip to comments.Obamacare Plans Bring Hefty Fees for Certain Drugs
Posted on 03/22/2014 9:03:17 AM PDT by Oldeconomybuyer
Breast cancer survivor Ginny Mason was thrilled to get health coverage under the Affordable Care Act despite her pre-existing condition. But when she realized her arthritis medication fell under a particularly costly tier of her plan, she was forced to switch to another brand.
But some have been shocked at how much their prescriptions are costing as insurers are sorting drug prices into a complex tier system and in some cases charging co-insurance rates as high as 50 percent. That can leave patients on the hook for thousands.
"I was grateful for the Affordable Care Act because it didn't turn me down but ... it's like where's the affordable on this one," said Mason, a 61-year-old from West Lafayette, Indiana.
(Excerpt) Read more at abcnews.go.com ...
uuhhhh...if some chooses anything but the most reasonably priced option, why should the insurance money someone else pays subsidize it? People just don’t understand how insurance works.
You don’t need Death Panels when you have death policies.
The Great Man said: "Life is tough. It's tougher when you're stupid."
Easier to buy into the lies of socialized heathcare than to think about how insurance is supposed to work.
Guess we’re learning what’s in the plan...
ABC news is reporting this?
I better read the entire article...it must be her fault not Obamacare.
I do not have any insurance that covers medications and, fortunately, don’t take any meds unless there is a specific problem. Faced with upcoming eye surgery I had no choice but to get some prescriptions filled. Good grief - I thought I was going to have to sell my first born in order to pay for them.
Went on-line and found a whole slew of coupons that cut the cost almost in half and it was not for generic replacements either. There are still some options out there if people want to take the time to look for them.
“I’m Covered” folks now looking their gift horse in the mouth ..... and not liking one little bit what they find .... nope, nope, nope. The reality on the ground is a 180 from hope, hope, hope ....
...they were going to tax someone else behind the tree."
If one has a CHOICE for a more reasonably priced drug, you're exactly right.
Not everyone has a CHOICE, sometimes there really is only one option or one class of options when that person requires a drug that's still covered by a medical patent that hasn't gone generic yet.
Many cancer and biologic drugs fall into that category and that's what insurance is for. Insurance is about risk pooling and the insurer has to manage their costs effectively for everyone covered by a policy and risk pool to get the treatment and medications they need while still making a profit.
I’ve been buying generics from Canada at a fraction of the price.
The entire “insurance” model needs another look. Drugs and medical treatment are not expensive because some people don’t have “insurance.” They are expensive because some people DO have “insurance.” “Insurance” now means that those who don’t pay for it subsidize those who do. In the end the current definition of “insurance” harms everybody.
In the last few weeks I've been in the ER and to three doctors offices due to a shattered elbow. At my GP's office and two Orthopaedic doctors offices they all had big signs saying "We do NOT accept Covered Illinois" (ObamaCare)
In Illinois, thousands of doctors were listed as "in network" for "Obamacare" without those doctors ever being contacted. I've been with the same GP and Orthopaedic doctor for years and know both really well. They both complained about the number of calls they get and arguments that ensue between their schedulers and callers because they're on a list they never asked to be a part of.
Liberals lied, sick people died.
I commented before on the same thing happening in California .... and the insurance companies dragging their feet on removing docs from networks when they don’t sign contracts to make the networks look better ..... interesting to hear that it’s happening in Illinois as well.
So very sorry about your elbow .... “shattered” sounds bad, hope it heals up quickly and without complication! ~Q
Yup, those of us with insurance are subsidizing those who do not. We're also subsidizing Obamacare.
Thanks. Cast comes off Monday. Doc to evaluate where I am, hopefully cast stays off and I can start re-hab.
You might be subsidizing charity care, but otherwise you can't subsidize folks without insurance who pay their own way.
You need to start reading the posts on market-ticker.org about the scam that is our current medical insurance setup. A hospital might charge $800 for a set of tests, the insurance company negotiate it down to $400, but if you'd gone around the corner to the private lab you might pay $80. So your insurance company charged you $320 over the going price just to make your paperwork go away.
The big scam is that government allows monopoly pricing and hidden pricing in the medical industry, and tries to funnel everything through the insurance company so they maintain their profits.
That is not actually correct. If you are "self-pay" you are charged "list price" for medical procedures and medicines.
Insurance companies commonly pay medical providers "negotiated discounts" from list prices. Those discounts are often around 40-50% of the "list price". Plus the insurance companies pay 90-120 days net.
The uninsured who actually pay their medical bills are cross-subsidizing everybody else.
If you're talking about GoodRx, I use them also but was disappointed to see they take only about $20 off a $350 Rx for my mother, and Costco's price is a little less anyway. But for one of my prescriptions, yes, they save me 80% of the cost unbelievably, which shows how much pharmacies are marking up even a common generic.
you do understand that health insurance is regulated by the states and the feds???? and the insurance have to pay 85% of premium's back in care and 15% is admin cost's
all health insurance plans have contracts with hospitals . most on a % basis to pay claims, hospitals run up the price and have for a very long time, so place your blame on them not the insurance co. or and FYI have have been on the claims paying side for 20+ years
That was well underway even before Obamacare, and my plans have included 50% coinsurance for brand name for at least ten years.
Don't have to read those posts, I see what's going on as I look at my current medical bills for my shattered elbow.
Immediate Care Center billed my Insurance Company $79 for X-Rays and $49 for the Radiologist to read the X-Rays to confirm my injury. Doctor who saw me billed $79 for the visit (15 minutes of their time.)
My Orthopaedic Doctor's office billed the Insurance $800 for a "surgical procedure" to set my elbow, another $200 for X-rays that were taken after my arm was cast, and we haven't yet received the Radiologists bill for reading the X-Rays. I also had X-Rays, Radiologist and Doctors visits one week, and two weeks after my initial visit to confirm the seet was still in place.
I already know the difference between the Immediate Care center and the Orthopaedic's office: The Immediate Care Center charged a much lower rate for paying CASH vs having to submit an insurance claim. I paid cash out of my Health Savings Account.
Yes, I know what a scam Health Insurance is, much of it has to do with government regulation and the fact that a handful of Health Insurance companies have a stranglehold on Illinois. Best thing that could happen is tort reform followed immediately by increased competition, letting consumers purchase coverage across state lines, rather than the 50 state oligopolies that we have today.
Many/most self-pays DO NOT PAY,which is why our insurance rates are so jacked up, and doctors charge exhorbitant rates for their services.
How many doctor and hospital (especially ER) never end up paying a cent, that ultimately we are paying for? More than I suspect either of us thinks.
Correction: Paid for it using my HSA.
The uninsured who actually pay anything are a rare breed. A good friends wife is the billing administrator at a local community hospital. We've actually had the discussions about who really pays and its not the uninsured paying "list price."
Nine times out of ten the uninsured either pay nothing, or pay a negotiated rate that is considerably less than the hospital's "list price" and only then after months of hounding the uninsured individual for payment. The hospital collects what it can, and "writes off" the rest as bad debt which is claimed on the hospitals taxes.
That's what really happens.
How many doctor and hospital (especially ER) never end up receiving a cent, that ultimately we are paying for?
I find myself so often wishing for a “LIKE” button on FR! Your post would get one!
“Went on-line and found a whole slew of coupons that cut the cost almost in half and it was not for generic replacements either. There are still some options out there if people want to take the time to look for them.”
It is amazing how many people don’t want to do what you did, and my wife and I do.
Yup... and it also has to pay scads of new bureaucrats.
Don’t you feel PRIVILEGED, America?
If you are uninsured ("self-pay"), Doctors and Hospitals require immediate payment or a large deposit at the time of service. They get paid.
If you remember to ask for the cash discount, you may find that it is 50%-60% off the "list price". But you have to ask for it, or you won't get it.
Insurance companies commonly pay providers 40%-50% of "list price". You should get the same deal.
The entire "health insurance" system is a scam that shifts costs to the unwary. Insurance companies are the direct cause of higher medical costs. Gullible people who think they will get "free medical care" drive this system.
Emergency services are the one area where most of the uninsured do not pay their bills. By law, Hospitals cannot refuse emergency services. The ER is filled with indigents who use the ER for their primary medical needs and never pay. Hospitals make up for their losses by cost-shifting to people who do pay.
Found two places to get coupons - goodrx.com and helpprx. Coupons from either place saved me a whole lot of money. Don’t understand why people wouldn’t think to look on-line.
What I have found is that there is generally always a coupon someone on the internet for most everything you need to buy, particularly basic stuff. Found one place where I could buy Cheer, Cascade, paper towels and toilet tissue. First time buyers could get 35% off plus free shipping. I took advantage of that. Not only were the prices significantly less because of the discount but the free shipping allowed me to get the basics without having to schlep it all from the store to the car and into the house. Should not have to buy any more of these items for at least nine months.
I did see #26 and considered it carefully before posting.
I have in-laws who are doctors and nurses and a wife who worked as an operating room clerk. I have heard plenty of horror stories about patients who could not pay and insurance companies that would not pay legitimate and supposedly covered charges.
Providers that stay in operation simply must raise rates to do so. They have to pay a large administrative staff to keep on top of the ever-more complex insurance claims procedures.
I have listened to plenty of bitching about $100,000 charges that were settled for $5000 rather than spend ten years fighting the insurance company in court.
That is why you can offer cash up front and sometimes get a 50% discount.
There is at least one national provider that lists their prices openly for major surgical procedures - paid in advance. Those prices are at 80% discount from the after-the-fact billings done by regular hospitals.
I would stand by the assessment that the "Health Insurance" system is what is driving medical costs up at uncontrollable rates. It's not an "Insurance" system. Its a "sticking someone else with the bill" system.
“Found two places to get coupons - goodrx.com and helpprx. Coupons from either place saved me a whole lot of money. Dont understand why people wouldnt think to look on-line.”
Both are good choices, I make a copy of each offer, take them to the pharmacy and let the pharmacist decide what is best for us re costs and refill capability with the offer.
Some pharmacists will beat those offers and give a better deal without the offer.
Certainly not arguing about over-billing by a doctors office or hospital to recover as much as they can due to non-payers (patients and Ins Co's alike) as I demonstrated that in one of my posts above.
Not arguing discounts or the ability for cash paying patients to negotiate discounted rates rather than full list price.
What I think we've been debating is "who pays for the non-payers?" I highly doubt your doctor and nurse relatives interact with a hospital's billing systems and deal with recovery rates as my friend's wife does, as she runs the billing department at the hospital. I can only relay what she's told me regarding non-payers at the hospital she works.
I don't think either of us can make broad based statements about what the hospitals or doctors offices on a larger scale are doing as a whole. Raise rates yes, how they handle write-offs due to non-payers probably not.
BTW, when you're in the hospital ER, you do know that after you sign the form that states you're liable for financial payment you receive treatment. The nurses and doctors don't know what your medical emergency is until they examine and treat you.
That information then put into the hospital's computer systems and a bill is generated, which you're expected to pay on your way out the door.
If you've provided proof of health care coverage, you're all set once a co-pay is made, assuming that's required.
The people who fall thru the cracks are those who sign the form and present credit cards or state they'll pay cash on the spot.
They still get treated based on the policies of the hospital, and receive their bill at the end like anyone else.
When you get to the end of the process and the patient states they don't have enough money or the amount charged to their credit card doesn't clear THESE are the people who end up either not paying at all, negotiate a lesser rate (after the hospital's billing staff spends considerable effort tracking them down) or pay the amount due in total.
Those WITHOUT INSURANCE who actually pay the full amount are a very, very small number. It is far more likely that the hospital will have to write off a significant part or ALL the bill if the patient is a complete deadbeat or indigent.
IIRC, your argument is those paying "list price" are subsidizing those of us with insurance, and that insurance is a scam.
My point based on the one source I have on this matter is that the people who end up paying full price out of pocket is such a small number, that it's not possible that they're subsidizing those of us with insurance.
My point is in-fact the exact opposite, that inflated insurance bills (as I demonstrated in a previous post using actual dollar amounts from my own recent experience) are actually one way Hospitals and Doctors try and recover for lost revenue due to those who are uninsured.
We both agree health care insurance is a scam. I think the rise of concierge medicine or Immediate Care Centers that don't take insurance and require cash/credit card authorization before treatment such as the one I used when I broke my elbow are going to fundamentally change how we receive and pay for our healthcare.
The example I made in a previous post on this thread where an immediate care center that did not accept insurance (cash/approved charge only) charged me only $79 for 5 X-Rays vs. my Orthopaedic doctor's office which charged $200 to do 4 X-rays.
The difference between the two was that one did not accept insurance and the other did. The one that does has to jack up their rates and pay for a staff to chase down payment from all the different insurance companies who have their own rules and billing codes before a payment is made for services. I got that invoice from my insurance company yesterday in the mail. Doctors office billed $200 for 4 X-rays. Insurance paid $119. Note that's higher than the Immediate Care center that charged me $79 for 5 X-rays the night I fell and shattered my elbow.
Yes, insurance is a scam, but they're not the only ones participating in the scam, and you can't hold them solely responsible. There are multiple actors here including doctors and hospitals who inflate their rates, as well as the uninsured who incur alot of loss in the health care system. (Especially in Emergency Rooms where the cost of care is the highest!)
It's taken me almost 30 minutes to type this with my left hand since my right arm is still in a full arm cast, shoulder to fingers. I'm kinda done typing for the day. :-)