I do NOT have a Doctor-Patient relationship. I have an Insurance company-consumer relationship

[Horse with no Name]

My insurance starts on January 1. Every January 1, my deductibles roll over, we are given a formulary list--make necessary medication adjustments, and we basically start over and I hold my breath HOPING that my physician is STILL covered under our "new plan". In the past 20 years, I have been stung and had to change doctors of whom I had long-term relationships with because my insurance company did not choose to continue doing business with them that particular year.
So, in essence, my insurance company chose my physician for me. In several instances, it has not been a good choice. I almost died from it.
I have been on medication for two years for a chronic problem. My condition has been very well controlled and maintained on it. My physician and I CONSULTED the insurance company formulary before deciding on this particular medication because I wanted to control the costs.
So--in essence, my insurance company chose my medication for me.
NOW-- starting in JULY--when there isn't ANY way under the sun that I could possibly change the conditions of MY insurance contract, I get a letter from my Healthcare provider--Blue Cross Blue Shield.
It is telling me that the medication that we chose from the list that THEY gave me, is no longer going to be covered. They SUGGEST that I contact my physician to change it to a medication that is covered.:wtf:
The first paragraph states:
"Blue Cross Blue Shield and CVS Caremark, the INDEPENDENT company that manages your prescription benefits, are committed to helping you live a healthier life by keeping YOUR prescription drug costs more affordable".
Okay...what a fucking lie. They are COMMITTED to keeping THEIR bottom line healthier. I am an expendable commodity because MY insurance costs (according to my contract) will NOT go up (this year anyway) because I have copays that they are contractually obligated to honor. So my costs have NOTHING to do with it.
I am so tired of the fucking lie "Keep the government out of my healthcare"...when I would prefer ANYTHING to the money-grubbing life-sucking forces of corporate profits at-all-costs that are already IN my healthcare.

[annabanana]

1. With me it's usually... My Doc & Me against the insurance co.

Neither of us can stand this stupid system...

[Horse with no Name]

6. I am hearing more and more of that.

Problem is, "WE" hardly ever win.
We are fighting for a procedure that was done last summer that we had an authorization number for that they denied AFTER it was done. We aren't making much headway.:(
I truly HATE those gangsters.

[Selatius]

2. If the leftists get what they want, we'd have France's health care system.

You have the freedom to see which physician you want under their system whenever you want, and your prescriptions are covered if the physician prescribes them to you. The government would cover 80% of your costs, and you foot the rest. Many choose to purchase private supplemental insurance to cover the remaining 20%, but the vast majority in France do not wish to replace their public plan with a bunch of private insurers. The system is far easier for average people to understand than the American system.

[Horse with no Name]

7. I don't mind paying my share

I don't even mind paying for others to have healthcare because at this time and place, I have a good job. I DO mind not being able to have a cohesive relationship with my physician and be able to follow whatever treatment he recommends without a gestapo-force dictating what treatments we can--but mostly cannot--follow.

[Tangerine LaBamba]

3. And yet,

the assholes keep harping about "keeping the government" out of our health care system.

You know what? Medicare has taken very good care of a lot of people for a long time. I'm happy to have the government handle my health care needs if they leave what goes on between me and my physician alone.

I am so sorry for you for this, Horse. It's fucking unconscionable, and it sucks, and I wish I could do something to help you. I just hope you can find a medication that works. I know that my insurance company denied coverage of the only medication that could help me - after we tried three others - and I'd have paid for it myself, except it's over the fucking moon in terms of cost - so my physician wrote a letter, and, wham! They covered it.

Perhaps that alternative is available to you?

I hate them, I really, really hate them right along with you.

Good luck, Horse ....................

[Horse with no Name]

9. I will most likely look at some of my other medications

and change THOSE to cheaper prescriptions and evaluate a couple of others that I take intermittently to see if I even need them--if at all possible--and then pay the difference in my medication.
I am fortunate that I am able to do that, but, I really shouldn't have to.
Thanks for your kind thoughts.:hug:

[uppityperson]

4. I know what you mean, good rant and a thought for you re RX's

My insurance won't cover my natural thyroid medicine as it "isn't on our formulary". However, the insurance guru at the clinic I go to filled out a form to ask for it since I reacted negatively to the synthetics that are covered. I got a waiver and they will pay for the med, although it is cheaper to pay cash and buy it 3 months at a time than monthly thru insurance.

I don't know what BCBS/CVS_C does, but call and ask what you need to do to get a non-formulary medicine.

My ins dropped ALL the doctors in my county by mistake a few yrs back. There were a couple months where you had to travel to a neighboring county (being rural this is a ways) to get ins paid health care by a doctor who had never met you before.

They do chose your doctor and medicine and treatments and THIS IS WRONG.

[kaiden]

5. I have a "third-party intervenor."

When I fell and partially tore my rotator cuff in March, I was barraged with the "third party" correspondence demanding access to my "other" insurance -- i.e., homeowners, automobile, etc. It seems that the insurance company to whom I've paid premiums for a decade wanted to find out what other insurance I had that it could possibly pass my actual care (and subsequent surgery) to. I call bullshit. It was all I could do to keep a civilized voice when talking to these people. Long story short: I DID have a tear, they DID pay for surgery -- and they can bite my ass.

[Lydia Leftcoast]

16. My brother has had to deal with that sort of thing

Husband and wife both have insurance through their employers, both are REQUIRED to get family coverage, so they're supposedly double insured, but when they need medical treatment, both insurance companies claim that THE OTHER is responsible.

[Horse with no Name]

22. My sympathies

They spend more time and resources trying to get out of paying than they do to just pay.

[aquart]

8. Tell your congressional representatives.

[Horse with no Name]

23. I do

and sometimes I even mail ones that might can do me some good.:(

[thecrow]

10. Try one of these...

http://www.google.com/search?sourceid=navclient&ie=UTF-8&rlz=1T4GFRE_enUS324US324&q=concierge+doctors

[glinda]

11. I have BCBS and they suck. Expensive, harpy, don't cover a lot, raise rates constantly.

[Horse with no Name]

24. They called my doctor for a peer to peer consult recently

and the fossil that they dug up to talk to my "top 100" doctor had no clue what he was talking about. None whatsoever.
I complained and they are going to let someone else talk to him--and promised to brief him on the complaint.:wtf:

[waiting for hope]

12. We have Blue Cross Blue Shield too -

and are waiting for some shoe to drop here any day concerning our coverage. My husband is on statins and has had problems with his back - I just know that they are going to either drop or change a coverage and it sucks that you have to live day to day wondering if they are going to screw you over something that really isn't that bad - :hug: Horse, hope everything works out okay.

[Horse with no Name]

25. Sending good thoughts to you and your husband

It's hell to live day to day wondering if they will indeed fuck you up as much as they possibly can--or are they going to give you a pass. Then you can relax for a minute, but then you must worry about the next time.:hug:

[chill_wind]

13. Righteous points. K & R.

[Horse with no Name]

26. Thank you. n/t

[knitter4democracy]

14. Your doctor can fight for you on that.

My stbx-husband's an internist. He's fought for patients in the past when they've needed a particular medicine and won. If the doctor can convince the company that it's the only medicine you can take and the options of you not taking it are more expensive, they'll give you a waiver. The problem is that the waiver usually has a time limit so your doctor has to call repeatedly to get it.

[Horse with no Name]

27. Currently, my doctor has to fill out 7 pages of paperwork so I can qualify

for my intermittent FEMLA every 3 months. We are also in the middle of a protracted dispute (a year) that we are fighting the insurance company on.
There comes a point when I just cannot ask him to do anymore.:(

[MadMaddie]

15. But...But...But the Repugs say that if government gets involved

then the gov will interfere with the patient and the Drs decisions..:sarcasm:

The Insurance companies do it every damn day and it seems to never get brought up in the conversations we hear day in and day out. HMO's have been the biggest boondoggle in American history and I would say they have cost many people their lives by denying coverage and treatment

[Horse with no Name]

28. Yep. And people DIED from mismanagement of HMO's

those stories never make it to the frontlines. Just the boogie man.:(

[eridani]

17. I'm scared shitless that that could happen to me

I turned officially diabetic on my 62nd birthday, and the retiree insurance doesn't cover my current doctor, whom I have been seeing for 25 years. When my COBRA runs out, I lose him. My husband, who is old enough for Medicare, gets to keep him. You've already sufferd the consequences for that kind of screwing around with providers. I'm hoping we get a real Medicare-like option so I don't have to go through that.

Here's hoping you can get a decent replacement for your meds.

[Horse with no Name]

29. We all live with this fear

It is the ONLY reason I keep my current job. The ONLY reason.:(

[Kansas Wyatt]

18. Every talking point that Republicans and the Insurance Industry comes up with...

Against Government Health Care, is exactly what people are stuck with today with the Death Merchants.

Every one of their arguments can be turned around and used against them, and there is LESS accountability, fairness, and regulation with the Death Merchants.

[bertman]

19. Error: you cannot recommend . . . But I CAN kick the hell out of it.

Thanks for posting this, Horse with no Name.

You are THE perfect example of the ad our Democratic leadership should be running all over American teevee and radio. Here we have the classic "right-wing" fear scenario in full-blown living color--SOME FACELESS BUREAUCRAT is making your MEDICAL DECISIONS FOR YOU------------
AND IT AIN'T THE FRICKIN' GOVERNMENT!!

Please pardon the caps. Our Democratic so-called leaders make me so fricking sick. Nancy the Chief Chicken in Charge, is whining about not giving the public option an "unfair advantage" over for-profit insurance companies. AAAAAARRRRRGGGGGGHHHHHHH!!!!!

Sorry, but I HATE THESE INSURANCE BASTARDS AND THEIR CONGRESSIONAL TOADIES. FUCK THEM ALL.

[blm]

20. Exactly right....why aren't THESE types of ads on the air?

.

[truth2power]

21. I am so sorry for what they're putting you through, Horse. You know,

even if I printed out this entire thread and carried it around with me to show the other side of the health care issue, they still wouldn't believe what you and others on this thread are saying. They would say, as the "operatives" of various sorts who lurk here say, "Prove it!".

Yet, if Rushbo told his listeners that aliens flew out his ass this morning, it would be accepted as gospel truth on its face.

* * * *

I was standing in line at the post office a couple of weeks ago. It was a long line, and the woman ahead of me started complaining about there not being enough clerks at the desks. She remarked about how the government can't do anything right. I told her that the post office is not, specifically, government run.

Well, she shut up. Then the man behind me started about how government health care wouldn't work. I told him that Dick Cheney's health care seems to be working just fine. People started looking really uncomfortable. I guess they thought it was going to break out into a knife fight or something. So, I just let it go.

Then, on Saturday I was in line at the bank. The man in front of me was talking to the teller, I couldn't hear, but I did catch, "Do you feel stimulated?" It seemed clear he was talking about the economic stimulus. I sort of chuckled and he turned around and said that Obama's been in office for 6 months and he's driving this country into socialism. <sigh>

I said, "Oh, please! Stop listening to Rush Limbaugh and the rest of those hate-mongers." He continued his rant and I finally said, "What is socialism?" He just looked at me for a few seconds and then turned and walked out. I'm not making any of this up.

Stories like yours, Horse, seem not to be making any impact, either on Obama or our elected so-called representatives. Yes, campaign contributions are a part of it. But the insurance and pharmaceutical industries, through their paid shills (Rush, Hannity etc.) have found a way to access the primitive brain in enough of the populace to obstruct progress toward single-payer.

The survival instinct (residing in the primitive brain) is exceedingly powerful.



edit> tightened up the rhetoric a bit.