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[WilliamPitt]

This message was self-deleted by its author (WilliamPitt) on Fri Apr 4, 2014, 02:41 PM. When the original post in a discussion thread is self-deleted, the entire discussion thread is automatically locked so new replies cannot be posted.

[truebrit71]

1. Hall-of-Fame Bullshit artist...

....you nailed it the first time 'round...

[WilliamPitt]

3. I long for a time machine.

I helped, in my own small way, to promote this thing, because of the pre-existing conditions aspect that would benefit my wife. I feel like a fucking dupe.

On edit: I AM a fucking dupe. Last time that happens.

[truebrit71]

11. My wife is a breast cancer survivor...

...and I was in the same boat regarding the pre-existing condition thing...not encouraging to hear that it too was a bait-and-switch...

[wordpix]

546. I'm a cancer patient---without ACA I would have NO insurance

So far my med. bills have been astronomical for specialists, diagnostics and major surgery, but most have been paid by insurance. Without ACA my pre-existing condition would make me ineligible for any insurance, and right now I'd be broke and would be looking at selling my condo---this after a lifetime of work and nearing retirement age.

So I thank Pres. Obama from the bottom of my heart. Just remember he tried to do more but was blocked and compromised by the repukes, who are still trying to end O-care. Direct your anger where it needs to go---against the repugs

[truebrit71]

550. I hope your recovery is 100% successful...

...but I will be angry at whomever deserves it...

[wordpix]

554. Wm Pitt---pls. inform your Congressional rep about this

I was having probs with my private insurance co. that said I'd be cut off from finishing my contract before the ACA became operational. I also had probs with the ACA website in my state, making calls on way-too-busy phone lines, etc, and I contacted my Congressman's office. They gave me a health care constituent services rep, who was invaluable in dealing with my complaints. I had her email address and phone no., and we were in regular contact as each problem cropped up until the resolution.

[Jefferson23]

565. Sounds like good advice, hopefully that may help Will's wife.

All the best to you with your recovery.

[Dorian Gray]

709. This is great advice

but it sucks that we have to do this and advocate so hard.

I truly wish the ACA went further. In the deepest recesses of my heart, I pray that this moves toward Single Payer someday.

[Mojorabbit]

23. My copay (medicare part d) for my MS med is 1650 a month

I have had some help from grants but that is running out so I will have to go off the med again. I don't know who can afford that kind of copay. You would have to be a multimillionaire to do a lifetime of this medicine. I hope you can find some help so that she can resume her treatment.

[TrollBuster9090]

204. For which medication? Just curious.

A) For which medication? (Is it an experimental drug? As I understand it, there is no effective treatment for MS, just standard drugs (like corticosteroids) that manage the symptoms and episodes; while some of the experimental ones like Amantidine haven't been proven effective, and therefore are not covered.)

B) I thought Medicare Part D was now obsolete, and

C) That's a copay of $20,000 per year. I thought the ACA limited copays to $5000 per year, unless Medicare isn't included, or you're talking pre-ACA?)

[Mojorabbit]

220. Aubagio. I was in the experimental trial for several years and then the FDA approved it

and I am paying for it at this time. It is Medicare with the part d plan from United. It is a pill which is glorious after doing the injections for so long. I still do the steroids etc to manage symptoms.

[steve2470]

222. I looked up Aubagio to help out Pitt

It's damn expensive at retail prices, $4,868.41 a month. Good thing you can get it !

[truedelphi]

358. But I think she is saying she could afford it for a while,

But now the $ 1,600 a month means she cannot.

[Pharaoh]

538. But how much does it actually "cost" to make the drug?

This is the question that is never asked by anyone. Why is that?

Most of the chemicals in drugs are super cheap. But they can charge what they like as some people need these drugs just to function, or to just stay alive. Yay capitalism and for making a profit on your life/death.......

[steve2470]

541. excellent point nt

[Hoyt]

579. While drugs are too high, it's not like you do a google search and make it in the kitchen.

There's a lot of research, failures, expensive FDA approval, big lawsuits when an adverse effect occurs, etc.

While I would have no problem with all drug research, production, etc., being done by the government, they would likely not pursue a lot of these type of drugs.

[Pharaoh]

654. Sorry but I don't buy all that shit

viagra was discovered by mistake, researching a blood pressure drug. Viagra = $18.00 per pill.

I don't know but do the math. The chemo drugs are astronomical.......why? Because people are told they will die with out them. Not necessarily true either BTW.


But, agree to disagree. Don't want a long argument thread!

[Hoyt]

658. Then, why don't a couple of unemployed PhDs down the street make them and sell at half the price.

[Pharaoh]

659. They would be arrested.

[Pharaoh]

660. but you can get a generic in Canada for about 3 bucks.

[Hoyt]

661. So, it is more difficult than you suggest. Like I said,

let the government do it and pray the white wing Republicans keep funding drug programs, like they back all other social programs.

[Doctor_J]

389. Medicare part d was the prelude to heritage care

Krugman called it the middleman multiplication act.

[Hoyt]

656. Definitely better before 2006- no drug coverage, elderly doing without, cutting pills in thirds, etc

[wordpix]

548. cannabinoids show promise for MS

http://the420times.com/2013/10/cannabidiol-could-help-treat-multiple-sclerosis/

Lots more on the web.

I'm a cancer patient and can't get it legally in my state yet, even though med mj is legalized for 2 years. Cannabidiol has antitumor properties. I am lobbying in my state now to get moving on mm and get the dispensaries up and going.

[Mnpaul]

172. I knew we were screwed

when Billy Tauzin was welcomed with open arms at the WH while the single payer folks were told to take a hike.

[Doctor_J]

392. but it's all Lieberman's fault

He forced the president to give big insurance 600 billion dollars a year

[pnwmom]

590. The National Health system in the UK has a formulary.

So does Canada's. So does Medicare and Medicaid's.

This has nothing to do with the ACA, except that his broker gave him false information about his choices. The ACA requires all insurance companies, on or off the exchange, to accept all patients, including those with preexisting conditions. Each insurer has its own formulary, so he should be comparing all the plans offered in his state to see if any of them list the particular drug his wife needs.

[truebrit71]

591. On the NHS if you need meds, you get meds.

Very simple.

[pnwmom]

592. You get meds if they're listed as available on the formulary.

http://en.wikipedia.org/wiki/British_National_Formulary

The British National Formulary (BNF)[1][2][3][4][5][6] is a pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about many medicines available on the National Health Service (NHS), including indication(s), contraindications, side effects, doses, legal classification, names and prices of available proprietary and generic formulations, and any other notable points.[7] Though it is a national formulary, it nevertheless also includes entries for some medicines which are not available under the NHS and must be prescribed and/or bought privately (such as alprazolam tablets or minoxidil solution). A symbol clearly denotes such drugs in their entry.

[truebrit71]

595. I have two elderly parents that use the NHS all the time.

When they need meds, they get meds. No hoops to jump through...Doctor prescribes them, they take them. No muss, no fuss.


Of course the conservative arseholes in power are trying to destroy the NHS anyway they can, so I'm sure there will be "market-based improvements" brought to bear...but hopefully they will be removed from power next year...

[pnwmom]

596. That's because the doctors are choosing medicines off the formulary.

The same as doctors here do with Medicare patients, whose choices are also limited by a formulary.

http://en.wikipedia.org/wiki/Formulary_(pharmacy)

United Kingdom[edit]

In the UK, the National Health Service (NHS) provides publicly funded universal health care, financed by national health insurance. Here, formularies exist to specify which drugs are available on the NHS. The two main reference sources providing this information are the British National Formulary (BNF) and the Drug Tariff. There is a section in the Drug Tariff, known unofficially as the “Blacklist”, detailing medicines which are not to be prescribed under the NHS and must be paid for privately by the patient.

In addition to this, local NHS Trusts, including Hospital Trusts and Primary Care Trusts (PCTs), produce their own lists of medicines deemed preferable for prescribing within their locality or organisation; such lists are usually a subset of the more comprehensive BNF. These formularies are not absolutely binding, and physicians may prescribe a non-formulary medicine if they consider it necessary and justifiable. Often, these local formularies are shared between a PCT and hospitals within that PCT's jurisdiction, in order to facilitate the procedure of transferring a patient from primary care to secondary care, thus causing fewer “interfacing” issues in the process.

As in the United States, NHS trusts actively encourage generic prescribing, in order to save more of the budget allocated to them by their Strategic Health Authority, and ultimately, the Department of Health.

[OwnedByCats]

608. Exactly

The NHS runs perfectly compared to these insurance companies that make everything complicated, all in aid to screw you.

[HuckleB]

609. I've been told otherwise by more than one Brit.

[Spider Jerusalem]

682. Only if it's been approved by NICE

http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence

[CaliforniaPeggy]

2. Anger IS a gift, my dear Will, and one you use most effectively.

K&R for this most excellent rant.

[uppityperson]

207. "fuck you mr president you piece of shit used car salesman" is an "excellent rant"?

I do hope that is not what you meant.

[CaliforniaPeggy]

208. And if I did?

I'm just agreeing with Will.

[uppityperson]

235. If you did, it makes me sad to see 2 long term duers like you and he think that is ok

Without that, no problem

[CaliforniaPeggy]

238. I regret that you're sad. But I do stand with Will on this topic. n/t

[uppityperson]

240. I wish we'd gotten single payer, but can not understand calling him that. Or putting all the blame

on Pres Obama as it is not all hos. Blame congress, ins companies, and even Will for not checking to see if it was covered. It sucks, but to rant at Obama that way? bah

Best wishes to all with their healthcare, and insuruance companies are legalized gambling out to make a profit.

[JEB]

283. Miserable fucking crap shoot dealing with Insurance vultures.

Death and agony are their stock in trade. Fuck'em all.

[magical thyme]

301. NH does not offer many options for insurance

it's Anthem or nothing, iirc.

[truedelphi]

369. Look. Obama was so pathetic on this issue that even Jon Stewart called him out.

Mid August the summer of 2009.

Stewart: So a university student at U of Colorado Boulder, asks the President about public option, and the student seems to have the idea that public option is related to socialism or being a commie.

Does Obama take a moment to educate the young man. No instead, he apologizes for the existence of public option by saying (I am paraphrasing) 'Public option is but one tool in an entire tool box of options that Congress can employ. But since I am the President, and I am part of the Executive Branch of the US government, the separation of the three branches of government means I must bow out of the discussion until Congress has put its finishing touches on the piece of legislation that they re putting together.'
#### End of Stewart related material


Then we all come to find that while Obama is claiming his lack of using the bully pulpit for the public option, his own Chief of Staff, one Rahm Emanuel, was meeting with Liz Fowler to put together everything that the Big CEO types from, Big Pharma and Big Insurance wanted.

What is going on right now inside America's Body Politic is that people have had it. Over the last week, I have been tabling on an local issue, unrelated to party politics, and what I am hearing again and again is "Sorry but I quit voting."

Most people will just give a grin and giggle and say, "you know," when I ask why they won't vote in June.

But some people articulated that they see no real reason to vote in a rigged system. One man spent some ten minutes tracing his life as a voter, concluding with, "Well in 2012 they told me they were the lesser of Two Evils, and I kept hearing a voice in my head say, 'Lesser of two evils is still evil.'"

I concur with that man. If there is no one in Washington or in a leadership position in either party that cares about reforming politics, outside of maybe Bernie Sanders, or Liz Warren, with the rest of them being whores to Big Corporations, then why should I give a rat's ass in hell about the Democratic party?

[uppityperson]

370. So you agree President Obama is a "piece of shit used-car salesman" deserving "fuck you" on DU?

Edited to remove un needed snark with apologies.

[truedelphi]

379. Thoe were not my words,

So don't put them in my mouth.

But I did say that this whole situation of having two parties bought and paid for by Big money is pathetic.

And it is also as one other poster pointed out here, Fascism.

That "F" word is a far greater indictment than the swear words. You can be offended that angry people are using "anger words," or you can be offended that we have devolved as a meaningful republic with free elections, and are now ruled by whores to Big Business, it is your choice. I know what I am offended by.

[uppityperson]

382. My apologies, I edited to remove the unneeded snark. Yes, there are a hell of a lot of problems,

but cursing out the president and calling him a used car salesman doe snot address the issues. And isn't needed on DU to discuss wtf is going on and wtf to do about it.

Again, my apologies.

[hfojvt]

559. because greater of two evils

is still greater.

The conservatives in this country, the Koch billionaires are still out there electing Republicans and pulling the Republican party always to the right, to the right, to the right.

I am sure they will be happy if we stop resisting that.

[Enthusiast]

503. They should have pushed for single payer with all their might.

When the President took office he had a MASSIVE mandate.

Instead the President said that single payer was a bridge too far and would be "too expensive". Well, he knew better. He knew damned well that single payer would have been substantially cheaper but it would lock out the for-profit vulture killers.

President Obama deserves considerable blame.

[red dog 1]

706. + 1

President Obama should have at least TRIED to get a single-payer health plan; but he didn't.


As far as the OP:
I agree with : "Fuck you, insurance industry"

But I don't agree with:"Fuck you, Mr President, you piece of shit used-car salesman."


I posted an OP on the possibility of changing the ACA into either single payer or a universal health care plan
"Can Obamacare be changed to make it a single payer health plan?"
http://www.democraticunderground.com/10024670957/

[Enthusiast]

708. Thanks, red dog 1.

Somehow, the ACA allows individual states to enact a single payer system as Vermont has. I believe California is trending that way also.

We must have single payer now! There are far to many of us suffering because of the greed factor.

[Scuba]

517. No, the insurance companies are not legalized gambling, they're mass murderers for profit.

[kelliekat44]

532. Sorry for your situation and sorry that you feel that way about the President. But the blame goes

the insurance and pharma-industrial-complex in my opinion. It is all so much bigger than one President. I believe an appeal is in order, first , and than a reasonable complaint to the President conveying what you have learned that I am certain he has no idea that this is happening We are in the first stages of trying to make the ACA really work for us all. It seems a bit unfair that the criticism should be so unforgiving at this point. What is this really about?

[uppityperson]

569. Hi, did you mean to reply to Will?

[brush]

476. Pitt has done that before

He ranted about the President using the injured Sargent Cory Remsburg as a prop during the State of the Union speech.

He totally missed the point that the President was trying to make — that the kind of injuries the solder suffered were the results of endless wars with endless deployments. The President called for the end of our constant war footing.

It was the first time in my lifetime that a sitting president made an anti-war remark.

It was extraordinary but, somehow it was too subtle for Pitt and he posted an even worse rant against Obama. Makes you wonder about people who fly off the handle with mis-targeted anger — especially the ones with supposed gravitas.

[Cha]

479. "Too subtle for Pitt.." that's about it. Went right over his head which was

easy to do because he was down there working on the worst angle he could possibly come up with.

[JI7]

480. nothing was missed, Pitt is just playing to a certain crowd looking to be popular

[brush]

481. Guess it's the Obama haters. nt

[Kahuna]

498. Yep and yep!

nt

[quakerboy]

613. Damn him for "playing" at having a real life problem.

Maybe he doesn't even have a wife. Or if he does, he probably doesn't even really care about whether she has access to medication that she needs. Because he's just playing at being a living, caring person with a family.

Its amazing to see the heartlessness here, from people claiming to be democrats or progressives. Care about our fellow man? Not if it might impede our ability to praise the political figure of our choosing!

[Jakes Progress]

616. He'd be okay

if he just wrapped himself up in Obama-Glo and ignored his wife's pain. Blind adoration is a great salve.

[Cha]

455. It's an "excellent rant" to those who don't care that his rage is misplaced.. it would be a

more cognizant rant if he were actually throwing his ugly insults at whomever was actually causing the problems with his wife's meds.

[sobenji]

525. THIS

How true. Because the millions of people who can now get insurance don't matter because his wife's medicine isn't covered.

blame express scripts, blame optum RX, blame United healthcare, blame anthem, blame big Pharma, blame Lieberman (fuck him), blame Bayh. Blame everybody.

But the president did what he could to get as many people insurance as he could. Is it perfect? No. Is it a good start? Yes.

Go fight for the coverage. There's lots of good advice in this thread that tells you what to do. Start with the insurance company, go to the Department of Insurance, find a lawyer friend who can help write letters. But fuck the president because you didn't get coverage for a drug? Nope.

[truebrit71]

564. A-fucking-men! Well said!

Sick of the compassion-free, toe-the-liners around here..

[kath]

582. it was a great post.

Too bad it was hidden.

[truebrit71]

585. The apologists can't handle the truth I guess...

..

And boy there's a lot of them around it seems...

[quakerboy]

615. This

after reading the first few responses, a fairly equivalent but less well spoken rant was in my mind. Everyone should take the time to unhide this. And the fact a jury hid it, over all the other crap ive seen fly by unhidden, says some ugly things about DU.

And a hearty fuck you to every person posting like a heartless Republican on this thread. Democrats have compassion. You do not. You have outed yourself to anyone who is paying any attention, though you will likely skate by for now because you are pretending to be aligned with Democrats.

[truebrit71]

618. I too was amazed that it was hidden...

...especially looking at some other posts that were left alone...although it was fairly obvious by some of the responses that the apologists are well-coordinated..

[Cha]

635. Thank You, sobenji!

[Cha]

638. Oh My, that post that was hidden addressed to you,

was a nasty piece of ignorant work.

[Auntie Bush]

711. Well said! +100

[Autumn]

4. No. How could those bastards do that?

can you look into another plan that might cover it?

[WilliamPitt]

8. Heh.

There are ten different health insurance companies in NH. According to the independent (family friend, ally) insurance adjuster I spoke to at length this afternoon, pursuing coverage with any of them would be a waste of time. Why? Because - according to dude - the whole "You cannot deny coverage to people with pre-existing conditions" thing only applies to insurance companies within the ACA network. You heard all that shit about "Grandfathering." Well, this is that, and all of them will turn us down because they still can.

I am in the process of running down the facts of the matter, but family friend and ally was confident enough to basically tell us not to bother.

So yeah, that, too.

[Autumn]

10. Those mother fuckers covered all the bases didn't they.

I'm so sorry Will.

[Nye Bevan]

53. I'm pretty sure that is not true.

Any insurer selling individual health plans (whether on or off the exchange) in your county cannot discriminate based upon pre-existing conditions. (However, grandfathered plans that are not being sold anymore will not be offered to anyone, whether or not they are in good health). Here in CT we have an off-exchange policy which I bought because all of the exchange policies offered only very narrow networks which excluded most of our doctors. Approval was immediate and without any questions about health. (The off-exchange policies are not eligible for subsidies but are still guaranteed issue).

For example, if you go to Anthem.com and enter your zip code to browse individual health insurance policies, you will get check boxes to choose between "Marketplace" and "off-Marketplace" plans. The "off-Marketplace" plans are not in the ACA network but are still guaranteed issue.

As far as the drugs go, yes, this is frustrating, but you need to persevere. Have every doctor you can write a letter explaining why this drug is essential. Make copies of previous prescriptions to show that your wife has been using this drug for a long time. And send all of this documentation with a polite but insistent appeal that this drug be covered. If the appeal is turned down, immediately appeal to the next level. If you have already reached the top level, immediately file a complaint with your state's health insurance department. I have needed to do this a few times over the years here in CT and not once have I ever failed to eventually get coverage of whatever I wanted. The impression I get is that their business model is to routinely deny coverage secure in the knowledge that many people will just give up, but the persistent complainers who keep escalating their complaints eventually get what they want. In particular, going to the state insurance department always seems to suddenly make them take you much more seriously.

[QuestForSense]

96. Excellent advice.

You can't even pay people to give you advice that is half this good.

[crim son]

649. It's super advice but, dammit,

none of it should be necessary.

[Whisp]

115. ''with a polite but insistent appeal that this drug be covered.''

that ain't gonna happen.

[Lex]

127. " not once have I ever failed to eventually get coverage "

so it has worked

[Whisp]

132. I meant the polite part ain't gonna happen.

[Lex]

143. Oh, I see. Yeah, probably.

Persistence is key. And being the squeaky wheel.

[ConservativeDemocrat]

170. Ranting on the DU about how awful Obama is won't change anything

Hopefully William Pitt will realize that for once.

- C.D. Proud Member of the Reality Based Community

[Lex]

174. It's not like Obama is happy

about people not being able to get their preferred drug for a chronic health issue.

[Whisp]

279. Some think he is. They truly believe it makes him happy that people suffer

because of what they claim he did to them.

There is a post here somewhere with an animated pic of Obama laughing (apprently at the OPs problems).

now that is a piece of shit thing to say.

[ohheckyeah]

456. Unless, of course,

the preferred drug for a chronic health issue is marijuana.

[Jesus Malverde]

486. Great catch!...nt

[magical thyme]

307. it's already gotten him some sound advice

as well as emotional support and a load off his chest.

All of which are good things.

[ConservativeDemocrat]

633. True enough, but I think he could have gotten the same without screaming

Especially about formularies, which all medical systems have, even the vaunted single-payer.

- C.D. Proud Member of the Reality Based Community

[magical thyme]

637. I agree he could have gotten it without the screaming

however, I'm willing to cut people slack in the first wave of combined panic and anger when they discover something really, really bad regarding somebody really, really important to them. And when you're a writer by profession, then the screaming comes out in writing.

Certainly I refrain from blaming them or calling them foolish for making a poor choice, when choices were made under tight time constraints and were set up by the sales people to be as inscrutable as possible.

The formularies, as mentioned in several posts above, are not necessarily available for review until *after* you sign up, which makes it impossible to choose your insurer based on the formulary.

Other insurance industry "fine print" problems are surfacing, and will continue to surface. For example, I just posted about a problem with access to cancer centers. If anybody bothers to read the linked article (and of course many won't, they'll just shoot from the hip) it looks like the issue is going to be examined (and hopefully addressed) next year.

[Doctor_J]

395. we should not have to spend our lives begging insurance companies to

do what they are supposed to do. Do you comprehend how moronic that is?

[Whisp]

403. what I think is moronic is

the poster took the word of some 'personal friend' schmuck that there is nothing else to be done.

A lot of information, just in this thread, that says there is a Lot to be learned and done. He should do the damn homework instead of having another ridiculous tantrum. Tantrums will not do anything for the situation.

[woo me with science]

407. And cruel.

What this thread screams for us, yet again, is the actual level of compassion of the corporate Third Way - its utter contempt for the people it pretends to want to represent.

Corporate rule, whether Republican or Democratic, is all about the bottom line. It is about slick marketing of policies that profit the One Percent, rather than actually seeking to serve the needs of human beings. Corporatism is, by definition, about profit and *never* about human beings. No matter how many pretty promises we hear from corporatists during election years, the contempt you see in this thread is the actual level of compassion that will be offered when actual human beings are harmed by corporate policy.

[ctsnowman]

508. Cruel

is the right word.

[ohheckyeah]

458. You only think that

because you aren't a good little citizen/consumer.

[NCTraveler]

526. "do what they are supposed to do."

They are doing what they are suppose to be doing. Making profits. And they were just given a gift. Not debating you as I pretty much agree with you, just wanted to add what their main goal is. Profits. Their job is to care for investors, not provide healthcare.

[Doctor_J]

529. We got our annual benefits pitch from the insurance rep

and as I sat listening to her tell us all of the wonderful features of company's offering (my annual deductibles this year went from $500 to $8300), that thought kept rolling through my mind. Her job is selling insurance and making money for herself and her CEO. It has nothing to do with keeping me healthy.

[NCTraveler]

533. "It has nothing to do with keeping me healthy."

Truly sorry about your deductible. You are absolutely correct. She was there to sell you health insurance, not health care.

[sabrina 1]

213. While your advice is good advice, considering the system we have, it is truly sad that sick people

have to work so hard to stay alive in this country. While Will can probably do all this, there are untold numbers of people who do not even know how to use a computer, or have anyone to help them wade through all this. And to have to PAY to be so abused, is unconscionable.

Health Care should be a right, but here people are just commodities and the rights go to Big Pharma and the Private Insurance Corps who mostly wrote this legislation. Their right to profit, trumps OUR right to live. It's better that people understand how it is, rather than remain hopeful that there is someone within this system who actually cares about them.

Wendell Potter, Whistle Blower described it perfectly when he told how shocked he was to see Americans lining up for a Third World charity organization, then operating here, in the US. Of seeing Americans being treated in Animal Stalls, desperate for care they could not afford. It touched him enough to go back to his HC Corp and show them his photos, hoping to get a reaction similar to his own very human reaction.

Instead, when he asked them what they saw, what they thought of it the response was 'More Customers'. But how, they had no money which is why they were there?

Now we know. Privatize Medicaid, force everyone to buy HC, if the can't afford it, the Health Ins Corps get it from Medicaid instead of that money going directly to the hospitals and doctors.

As that Public Fund, passes through their greedy hands, 20% or more is pocked by them.

What a scheme, if only we all could pull off something like this.

[Nye Bevan]

236. I'm one of the more pro-free market, pro-capitalism DUers

but I entirely agree that it is a monstrosity that people should be forced to jump through these hoops to get treatment for diseases. Health care is not a commodity that should be managed by the pursuit of profits.

[sabrina 1]

449. Thank you! I support the free Market also, but not when it is abused, and imo, HC should

never have allowed to be 'for profit'. There was just too much room for abuse. Or at least there should have been an option for National HC.

[questionseverything]

250. insurance companies will when forced cover what is in the contract

it will do no good to complain to state ins board if his contract denies it

(and you know that)

[Nye Bevan]

253. On three occasions my insurer has denied coverage for a drug for a family member.

On two of these occasions when I used the insurer's appeal process the decision was reversed. On the other occasion the decision (not to cover) was upheld but then when I complained to the state insurance department they agreed to cover it.

[steve2470]

257. the squeaking wheel definitely gets the grease

A company will only refuse you if it really screws them over long-term and/or hurts their public image. Health insurance management looks awfully cold-hearted denying needed meds for people, especially children, the disabled or the elderly.

[questionseverything]

263. are you saying the ins paid for meds not covered in contract?

now if you were arguing over what is "reasonable and customary" then yes there is contract language that state ins department could help with

but if you are saying you got something covered that was not in contract......I call bs

without knowing what will has in his contract's language, it is impossible to tell

[Nye Bevan]

273. My policies (and I believe most policies) have "non-formulary exception" provisions

with this kind of language:

Non-formulary exception process

The non-formulary exception process provides physicians and members with access to non-formulary drugs and facilitates prescription drug coverage of medically necessary, non-formulary drugs as determined by the prescribing practitioner.
Patients can also have a non-formulary drug without invoking the exception process anytime by paying full price for the drug if the prescribing provider deems the non-formulary drug not medically necessary, but agrees to prescribe the drug due to patient demand.
The prescribing practitioner makes the final decision regarding what drug is appropriate for the member. Non-formulary drugs should be used only if the patient fails to respond to formulary drug therapy, has an adverse reaction to formulary drug, or has other special circumstances requiring the use of a non-formulary drug.

[questionseverything]

280. with that language he probably has a case

as you described....and as I pointed out the ins would pay only if the proper language was in contract

we still do not know what will's contract says

maybe you would like to field this question of mine////////////////////

http://www.bcbsil.com/PDF/rx/rx_list_std_il.pdf

Specialty drugs
Specialty drugs are used in the treatment of medical conditions such as hepatitis, hemophilia, multiple sclerosis
and rheumatoid arthritis. Specialty drugs may be oral, topical or injectable medications that can either be
self-administered or administered by a health care professional. For a current list of specialty medications,
visit myprime.com or bcbsil.com and log in to Blue Access for Members.
Note that some drug classes may be excluded by some plans and therefore may not be covered under your
pharmacy benefit. Your plan may have a different coverage level for self-administered specialty drugs. If you
have questions about your coverage for specialty medications or your prescription drug benefit, call the
number on the back of your ID card.
////////////////////////////////////////////////////////

how do I look it up before I buy?

I have to be a member before I can see the list

cimzia is what I am looking for

/////////////////////////////////////////////

cimzia is about 1600 bucks a month retail so the 700/month cap would screw us over too

[Nye Bevan]

344. Yeah, they are (deliberately, I think) vague about coverage prior to you taking out the policy.

Which sucks and is frustrating. I looked up cimzia on my plan and all it told me was that pre-approval was required (it would not even give a price). For this drug, however, the manufacturer's website seems quite helpful (go to http://www.cimzia.com/cimplicity/patients.aspx). They have a copay savings program where they help you verify insurance coverage and you get a savings card which (they claim) resulted in no out-of-pocket costs for 97% of the participants in 2013. It sounds like what they do is help walk you through the approval process to help you get the drug approved and then absorb any deductible or copay themselves, just accepting whatever the insurance company pays them, with you getting the drug for no out-of-pocket cost. You should definitely look into this; I have used a similar manufacturer's program with another drug and the savings can be enormous. Good luck!

[questionseverything]

575. yes some drug companies have good plans to help

but that really is not the point being discussed here in this op is it?

will was told it was his fault for not knowing what is covered, I think you and I have just shown this is not necessarily true

so what it boils down to is even with insurance "we the people" are still going to be left to the mercy of insurance companies and big pharma.....this is what will's op clearly points to, emotions aside

[Ms. Toad]

604. I have never had an insurance company refuse to provide the formulary

or the doctor list prior to plan purchase. Those are two things I always check, because of long term relationships with doctors - and very costly meds.

Specialty drugs are relatively new - typically they are biologics. But they have nothing to do with the ACA. I'be been fighting that particular dragon for a around 5 years now.

[questionseverything]

606. what i posted is the formulary

but it gives no answers on specialty drugs....deliberately vague is probably the closest to the truth


and the reason it is related to aca is the aca did nothing to prevent the spiraling of med costs......cost containment should of been the first issue addressed

[Ms. Toad]

617. From the first two pages of the formulary at the link you posted:

Specialty drugs:
tobramycin inhal soln (Tobi – brand is NF)
INCIVEK
PEGASYS
ribavirin (Copegus, Rebetol – brands are NF)
VICTRELIS
FUZEON

- and many more in the rest of the list.

I don't see your particular specialty drug - so you should call them with the specific name of the plan you are considering and ask them if it is covered. It appears from they way they have the formulary set out that some specialty drugs are covered on all plans, and others are not uniformly covered - so you will have to ask about a drug which is not uniformly covered. If you are taking a specialty drug, it is probably worth it to make a phone call.

[questionseverything]

620. if you have been reading what will has written

he had asked first thing if his wife's drug was covered,,,,,,ins says yes with a very simple procedure

that turned out to be untrue as she has been rejected twice

if you have fought as many successful appeals as you say you have you know, if it is not in the language of contract it is not covered

no verbal commitment matters

now in will's case I am sure his wife's needs will be met , he is fairly high profile but again I ask, what about those that are not high profile people?

what about those that do not have the time ,energy or means to fight big insurance?

and one more thing while I am at it........we do not know what will's spouses meds cost, some have suggested it is a new pill form of specialty drug that costs 4600 bucks a month....if that is true the economic model for aca is no way sustainable

some things are just too important to leave to a profit driven industry

[Ms. Toad]

624. I have won plenty of appeals for things which were not in the language of the contract.

But - before starting buying a new plan, I would have gotten the details in writing. It sounds like a step therapy drug - and from what he has said, it sounds to me like his doctor's office doesn't have a clue how to complete the proper forms.

The reason I say that is because one of the most medically competent doctors treating my spouse and daughter has zero clue about how to get approval for a step therapy drug. He started out by telling her that insurance probably wouldn't cover it - since he hadn't been successful in getting approval for anyone else. It is actually a very simple procedure - clearly described in the certificate of coverage (and explained to me over the phone). You have to get the doctor to certify that one of multiple other therapies have been tried, and are not suitable, and then it will be covered - because for most people there are better, cheaper, options which they want you to try first.

In our case, it took about a month, with the doctor repeatedly telling my spouse that they had appealed and been denied, and the insurance company repeatedly telling me they had no record of an appeal - and that it was a simple procedure to get step therapy approved.

What it came down to when I unwound it all was that the doctor was clueless, and my spouse did not give them the address/phone/fax for step therapy approval which I had told her to give them, because she assumed they should know how to handle insurance. They had been faxing a regular prescription to the regular prescription number, and having it rejected. They called the same division, who gave them other non-step alternatives, without mentioning that it was a step therapy drug. I was finally able to have the insurance company open a case for the step therapy. That allowed them to contact the doctor directly and request the documentation, and within a week we had the meds.

If it had been my doctor, it would have been straightened out in 2 days max - but this is one of very few doctors I "let" family members handle on their own, since (generally) he doesn't handle the family diseases where where someone with a mind adapted to handle medical matters is crucial (lots of rare/complex diseases in our family).

But making the insurance companies behave has nothing to do with being high profile. It does have to do with being persistent, with knowing your plan, and with having doctors who are either advocates by nature - or who are willing to advocate if you lead the way.

As far as the ACA being sustainable - the premiums are based on averaging the high cost of Will's wife's costs (and my daughter's costs) with the more typical costs that most of us have. They are sustainable - not ideal - but sustainable because that is how shared costs work (either insurance or single payer). I believe the average annual spend per person (including for those very expensive people) is around $5000. They would, of course, be both cheaper and even more sustainable if the insurance middleman was taken out of the picture.

[questionseverything]

640. extra ordinary claims require proof

I think this is one of those claims

you said,

I have won plenty of appeals for things which were not in the language of the contract./////////////////

so I would love to see the documentation

[Aerows]

646. Half the people in this thread defending the ACA

live in either Canada or Australia, and thus don't have a fucking clue how screwed up health care is here. They are just defending Obama because he's Obama. They have absolutely no basis for comparison. If you ask them individually, they will admit it, but publicly, it's all Obama all of the time. Understand what you are dealing with - people that will tell you that the ACA rocks while they have never in their life gotten sick and then had to deal with hospital bills.

[Ms. Toad]

648. Right. Like I am going to post my medical documentation on the internet.

I'll give you enough details of a couple of examples sp that you can at least verify the condition and the difficulty of getting coverage at the time.

I have VTOS (upper extremity DVT), which dates to 1988. The first time I spent a month in the hospital because that was the only option for stabilizing on anticoagulation therapy before being discharged on warfarin. - normally the process of balancing the two anti-coagulation medications takes 5-7 days; my body was stubborn. The second flare, 1998, low molecular weight heparin (Lovenox) was developed - but was only approved for clot prevention in connection with surgery - not as a treatment for clotting disorders. The choice was spending several days in the hospital, or convincing the insurance company to cover outpatient use of Lovenox. With my doctor's assistance, they insurance companies were convinced to allow me the (then) experimental treatment.

Here's a 1999 article about the early reported use of it for outpatient treatment: Savage KJ, Wells PS, Schulz V, Goudie D, Morrow B, Cruickshank M, et al. "Out-patient use of low molecular weight heparin (dalteparin) for the treatment of deep vein thrombosis of the upper extremity." Thromb Haemost. 1999;82:1008–10. There was also an ER episode around the same time "ripped from the headlines' as another show likes to say, in which the more common outcome - denial of coverage - was the outcome. That study of 46 patients was published almost a year and a half after my insurance company was convinced to allow me to use it for that condition as an outpatient. And, a 1999 article which references 12/31/1998 FDA approval for marketing the use of enoxaparin for outpatient use for treatment of uncomplicated DVT - 7 months after my insurance company was convinced to pay for it.

Here is a link to a separate mention of my first rib resection which was done to treat the same problem more recently - next to last paragraph. I obviously must have planted it contemplating just this conversation. Feel free to confirm that first rib resection is the current favored treatment for VTOS.

Another minor victory in the same time frame - the pathology costs relating to removing a mole displaying pre-cancerous traits were covered, but the excision was denied. They routinely denied all mole removal "cosmetic surgery." I didn't have to get the doctors involved in that one - I just challenged them about whether they denied coverage for the surgical removal of breast tissue in to examine the tissue associated with apparently pre-cancerous changes as cosmetic breast reduction surgery. Kind of surprised they bought that one as easily as they did, but they did.

Finally, if you have had many encounters with surgery and insurance, you are aware (or if not you can easily verify) that anesthesiologists are entities unto themselves - and fairly frequently not covered by the same insurance policies as the hospitals in which they work. I had an emergency appendectomy, and the anesthesiologists were considered "out of network," even though the hospital was "in network." The closest "in network" anesthesiologists were more than 50 miles away - and all out of network care required advance approval. Despite not having advance approval, they ultimately granted my appeal because of the emergency nature of the surgery, combined with the lack of disclosure by the hospital that they were using an anesthesia team which was out of network. (Here's an article) which specifically mentions this issue with anesthesiologists

Just 3 of the more generic examples of the many appeals I have won. Sorry - I'm not posting documentation, but you should be able to at least verify that they are the kind of problems which routinely crop up with insurance that are either prohibited by the policy, or beyond the language of the policy.

[questionseverything]

657. ok since you took the time for all that i will try and address it

i still do not think you won anything outside the scope of your language

the first example is closest since the drug you wanted was experimental but the treatment you and your doc wanted saved them a week plus of cost for in patient hospital charges

the second example, if pre cancerous was well with in your language to be covered

the anesthesiologists example rings a bell with me because I had to fight insurance companies for same except we had no network to bind us but ins denied it over and over, first saying it was included in surgeons bill, then saying that they had already paid for it (when actually they had just paid for the supplies), then they said the hospital billed them wrong..... so while I had insurance gal on cell phone I drove to the hospital went to billing clerk handed her phone after explaining to clerk the problem was her....she ripped that insurance gal a new one (in a very polite professional way) and when she got off phone it was covered

/////////////////////////////////////

our entire convo here is sad, what you are describing is how insurance deliberately denies what they rightly should pay (imagine how many people do not fight them and just pay it)

I am not sure why you are defending this system, I guess if you think it's good enough for you and yours you have a right to think that way....I do not agree

out of curiosity, with all your families medical issues how were you buying insurance before the aca? was it thru an employer?

because my house does not have anywhr near the medical problems you have described and we were priced out long ago

[Ms. Toad]

663. All three are outside the language of the policy -

The first was not covered. It was not part of the formulary, nor part of the medical coverage. One of the articles I linked you to discussed how insurance companies dealt with it at the time (pretty much not at all). And - if you look for articles at the time, you will find it was routinely denied - even though it saved the insurance company a considerable amount of money. The stupidity of that is why it was popularized on at least one medical drama within a year of my experience with it.

The second was clearly, by the policy, excluded as cosmetic surgery. It was a ridiculous exclusion, but it was an exclusion.

As to the third - that is the closest to being covered in the language of the policy, in that there was an appeal process to petition to have out of network care treated as in-network. There's plenty more.

And, as I said, those are three which are either relatively generic and which I can point to historical or other outside references to provide some support (or, in the first instance, one I have mentioned on DU before).

As for coverage - it has been a variety of coverage over the years, made more difficult because I have a same gender spouse who has not been able to work for a decade (early onset Alzheimers).

We cannot buy insurance on the open market - prior to the ACA, it would have $15,000 - $20,000/year for my daughter alone, and far more for me based on age. Early in her life she was covered by Medicaid - during a period when my income was minimal and, because our marriage is not recognized, neither of us were eligible to be covered under my spouse's policy.

I had private insurance for a while, the company went out of business, and I discovered I was uninsurable by anyone else. I weighed my options and went with a succession of short term policies (~200/year for catastrophic coverage and no pre-existing coverage), on the theory that I was healthy but for this rare pre-existing condition and the worst that could happen was that my pre-existing condition would act up, I'd have one big splash when I was hospitalized, and then I'd have to buy into the open enrollment at several times the cost my daughter would have to pay.

Since then (99+), I have had coverage through work - sometimes at the cost of my emotional health - staying at my most recent position far longer than it was emotionally healthy because it was the only option for covering my entire family. Our options were - put up with an emotionally unhealthy job, or pay whatever the insurance company felt like charging us under COBRA, then the HIPAA conversion to individual coverage.

I recently switched jobs - taking a 60% pay cut (and worse health care benefits) because the job is better for me emotionally and still provides coverage for all of us.

But my daughter would have been off my health insurance 4 years ago because she cannot manage a full time load at school or work, and we would have had to get her on disabilitiy, but for the ACA. She now has the option, because of the ACA, to be a starving artist and not have to work toward a job she hates because it is the only way she can survive. Her billed medical costs are $60,000 in a good year. She literally cannot survive without the ACA.

So I have very little patience with people with similarly devastating conditions, who don't pay enough attention to take advantage of the system and then blast the system which is far from perfect ** but which offers life to people like Will's wife and my daughter. Because blasting it gives ammunition to those who want to destroy it and replace it with nothing.

What the ACA offers is worlds better than what we had before. *All* we got in the last major reform (~1996) was HIPAA individual policies (with unlimited premiums) available only to those who had a job and left it, and *all* we got the time before that (~1980) was COBRA - 18 month policies again, unlimited premiums and only available to those leaving jobs where they had had health insurance. My daughter can't live for another decade and a half waiting for perfection, just because the major reform we got this time isn't anywhere near perfect.

[questionseverything]

697. maybe this exchange will help you understand

the language was there.....


are you saying the ins paid for meds not covered in contract?





now if you were arguing over what is "reasonable and customary" then yes there is contract language that state ins department could help with

but if you are saying you got something covered that was not in contract......I call bs

without knowing what will has in his contract's language, it is impossible to tell

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Response to questionseverything (Reply #263)

Tue Mar 18, 2014, 09:20 PM

Star Member Nye Bevan (14,816 posts)

273. My policies (and I believe most policies) have "non-formulary exception" provisions





with this kind of language:



Non-formulary exception process

The non-formulary exception process provides physicians and members with access to non-formulary drugs and facilitates prescription drug coverage of medically necessary, non-formulary drugs as determined by the prescribing practitioner.
Patients can also have a non-formulary drug without invoking the exception process anytime by paying full price for the drug if the prescribing provider deems the non-formulary drug not medically necessary, but agrees to prescribe the drug due to patient demand.
The prescribing practitioner makes the final decision regarding what drug is appropriate for the member. Non-formulary drugs should be used only if the patient fails to respond to formulary drug therapy, has an adverse reaction to formulary drug, or has other special circumstances requiring the use of a non-formulary drug.
////////////////////////////////////

I would like to address this quote of yours..

Because blasting it gives ammunition to those who want to destroy it and replace it with nothing. //////////////////////

pointing out problems is the only way to fix them.....I have never seen any1 on du say they wanted to repeal aca only that we want it expanded and costs lowered

[Ms. Toad]

702. Yes. The insurance company paid for meds not in the contract.

Lovenox (subcutaneous heparin) was excluded from coverage for any use other than pre-treatment for surgery. I gave you several links which described what was going on at the time. The vast majority of people who tried to obtain coverage (under any policy) to use it to treat DVT were denied because it was excluded from coverage. At least one of the articles I linked to mentioned this and, as I said, the TV show ER had an episode within a year of my encounter with the standard outcome - the coverage was denied and the patient had to be hospitalized for 5-10 days (standard treatment at the time) when it would have been a whole lot cheaper to pay ~$500 (at the time) for a Lovenox prescription.

My doctors were successful in advocating for me to get it covered, even though it was excluded from coverage.

This was before formularies played a significant role - so it wasn't a matter of getting an exception to the formulary. It was also, under my plan, classified as medical care (rather than prescription).in connection with a single permitted use. One of the articles I linked to mentioned this weird coverage split (prescription v. medical).

As to wanting to repeal the ACA - there are plenty of folks on DU who want to see it abolished. They want single payer, but in the mean time they want the ACA gone. And rants like the one which started this thread aren't helpful.

[bullsnarfle]

540. Connecticut??? Huh.

Come on down and try that in Florida, pal. This place is run by Gov. Voldemort and his minions. Remember him? He CEO'd a crooked health insurance company (like there is any other kind), walked away with a platinum parachute, and used the ill-gotten gains to buy the governorship. He and his cronies own this state. Letters and bitching will get you exactly SQUAT here, dude.

Others have said it on this site, and I will reiterate - Access to health insurance DOES NOT equal health care. You can pay, and pay, and pay, and when the time comes for insurance co. to pony up they just...don't pay. Hey, the doctors may be sympathetic, but they want their money, and if they can't get it from old Double Cross they will go after you. I mean, what are you going to do, hire a lawyer? Bwahahahahahaha...yeah, right.

[wordpix]

557. agree about going to state insurance agency---also go to your Congresscritters

If they're Dems, that is, they will act to help you.

If they're repukes, all bets are off

[thesquanderer]

92. You are not *required* to stay in a grandfathered plan.

As I understand it, for individual insurance purchasers (which it sounds like you are), grandfathering allows--but does not require--you to stay with a pre-ACA plan that you already have, if you like it better than getting a new ACA plan. Most people are probably better off with an ACA plan, but grandfathering is there for the rare exception, or for people who are just scared by the idea of changing to something new. I think you should definitely check into the ACA plans in your state right away and see what your options really are.

Obamacare is not forcing your old insurance company to deny you anything... they would have denied you the same thing before Obamacare existed. After all, grandfather means it's the same plan it was before Obamacare. But at least in theory, Obamacare gives you new, better options that you didn't have before. It's worth trying to find them.

[pnwmom]

324. Will, you have been grossly misinformed by your friend and ally.

We were also working with an independent, whose emails to us had boilerplate on them about having to get approved to get the insurance. I finally asked about this, and he acknowledged that the law was changing as of January 1, 2014 so that they would have to take every customer, without regard to preexisting conditions.

But their email boilerplate still had the false information after Jan. 1. We ended up buying through the exchange. But another option might be better for you -- just not with your uninformed friend.

http://www.nytimes.com/2013/10/26/your-money/health-insurance-options-arent-limited-to-obamacare-exchanges.html?_r=0

In general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and can’t deny you coverage if you’re already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.


http://www.insure.com/articles/healthinsurance/buying-health-insurance-outside-exchange.html?WT.qs_osrc=fxb-182807210

Drug coverage

Drug coverage is yet another variable. You may find you have more options when it comes to drug coverage if you shop off-exchange. Like provider networks, health plans can limit the drugs that are covered, or reimburse more for generics than brand-names, or reimburse more for drugs you buy mail-order than from your local pharmacy.
If you have a health condition and use a particular drug, you should check that it's covered under the plan in which you want to enroll, whether that plan is on the exchange or off-exchange, Coleman advises.
Remember, too, he says, the cap on out-of-pocket expenses doesn't apply to drugs not on a health plan's list of covered medications.

[Nye Bevan]

349. Yes, the main thing to bear in mind is that there is no premium subsidy with an off-exchange plan.

But as you point out, the same rules apply to these plans in terms of guaranteed issue regardless of pre-existing conditions, no out of pocket costs for preventive care, and so on. And at least where I live, the off-exchange plans have vastly superior networks of doctors than the exchange plans.

[Zorra]

5. I repeat: I refuse to die until I have first danced on the mass grave of for profit health

insurance companies.

So very sorry for this massive injustice that has been done to your family, Will.

"Fascism should more properly be called corporatism because it is the merger of state and corporate power." -- Benito Mussolini

[truedelphi]

360. Can i join you in waiting for that dance

To begin?

[Enthusiast]

505. Me too.

[Brigid]

571. Me three.

But I fear it won't happen. I support ACA because -- and only because -- I want it to be a first step towards single payer. On its own, it is little more than a huge giveaway to the insurance companies and Big Pharma.

[Doctor_J]

530. Unfortunately I won't outlive Heritage Care

I have only 20 years or so to go, and it will be at least 50 before we decouple Big Insurance from the government, if at all.

[C_U_L8R]

6. This might help a little...

Heard of this but never tried it...
http://familywize.org

[loudsue]

7. More people need to be made aware that this can happen! This needs to go viral, because

if people are FORCED to buy insurance, then at least the insurance companies should be FORCED to cover keeping people healthy.

[Egnever]

9. You didnt check to see if an ongoing medication was covered before you signed up?

Seems pretty foolish.

[bvar22]

47. Blaming the victim is worse than foolish,

...and in this case it is beyond rude.

[Egnever]

74. LOL

being a victim is beyond foolish. Especially where your health is concerned.

If you need a medicine to live and you cant be bothered to check if it is covered by a plan you are thinking about purchasing you aren't a victim you are a fool.

That's like buying a Prius and claiming to be a victim when you cant tow your boat with it.

Much easier to blame others for your own indifference though isn't it?

[questionseverything]

234. ok i'll bite

http://www.bcbsil.com/PDF/rx/rx_list_std_il.pdf

Specialty drugs
Specialty drugs are used in the treatment of medical conditions such as hepatitis, hemophilia, multiple sclerosis
and rheumatoid arthritis. Specialty drugs may be oral, topical or injectable medications that can either be
self-administered or administered by a health care professional. For a current list of specialty medications,
visit myprime.com or bcbsil.com and log in to Blue Access for Members.
Note that some drug classes may be excluded by some plans and therefore may not be covered under your
pharmacy benefit. Your plan may have a different coverage level for self-administered specialty drugs. If you
have questions about your coverage for specialty medications or your prescription drug benefit, call the
number on the back of your ID card.
////////////////////////////////////////////////////////

how do I look it up before I buy?

I have to be a member before I can see the list

cimzia is what I am looking for

[steve2470]

245. I looked on that pdf file and can't find certolizumab pegol yet nt

[sinkingfeeling]

544. It's called a formulary and every insurance company has them. It is

of the utmost importance that people check the drug formulary for the plan they are about to chose. This is the same thing people who are dependent on a certain drug must go through when they select their Medicare Part D provider. My mother has had to change her providers several times due to changes in her prescribed medicines and one can only do that by looking at the formulary and the tiers of drugs.

Here's an example from Anthem:

https://www.anthem.com/shop/content/olspublic/pdf/2014/english/MAPD_ComForm_Acc_Val_OH.pdf

[questionseverything]

583. yes it is a formulary, that was the point

specialty drugs can not be checked on BEFORE you buy

after you buy you can be denied and appeal and denied and re appeal....all while paying enormous premiums ...lucky us!!!

I remember some guy that said,


I watched my mother fighting cancer, dying and trying figure out insurance company forms from her hospital bed....time she should of been able to spend with her grandchildren and her loved ones

as a nation we embraced that guy and gave him a mandate to change that system but for many we are right back where we started except now no matter how badly insurance acts ,it is by law mandated

[LiberalEsto]

587. We need more consumer protection to protect us from insurance companies

Either that, or single payer.

At the very least, we need to be able to look up their formularies before signing on.

Can the Consumer Financial Protection Bureau do something about this, or is it out of their jurisdiction?

[sinkingfeeling]

602. Then why can anybody go online and get a copy of the specialty drugs?

Here's the one for Anthem BCBS:

https://www.anthem.com/health-insurance/nsecurepdf/pharmacy_NatlAccts_Specialty_DL

[questionseverything]

605. no where in that link does it say what is covered

it says after you have PAID you can ask (beg) the insurance company to let you receive the drug

and they can change it at will according to your link>>>>>

This list may change without notice which may affect your benefit coverage.

[sinkingfeeling]

607. I can't explain it to you. It's how all drug coverage insurance works. Not all drugs

are available under all policies. Special drug lists require special things, like using a tier one drug before being allowed the tier two drug or being pre-approved for the drug by the doctors, or using one brand name instead of another, or having a limit on the amount of the drug you can receive. That's why they're on special drug lists.

Honestly, this stuff has been round since Medicare Part D kicked in. In the case of ACA, the states got to chose how participating companies 'picked' the drugs to be in their formularies.

[questionseverything]

610. people were saying will was wrong for not checking the formulary

before he bought his plan

I posted a formulary to show ,they do not promise to cover certain drugs before you buy...you can only apply after you have paid

your argument seems to be it was always like this and I would agree with that but that does not make it right

[Ms. Toad]

619. The online link for some specialty drugs

is tied to particular plans. The link (and quote) does not say that you cannot find out ahead of time which specialty drugs covered on a particular plan, it says you have to log in to see it online, because what is covered is tied to a specific plan. Have you tried calling, telling customer service person and asking about the plan you are interested in buying, to see whether the drugs you are concerned about are covered?

I have never, on any plan where there was a formulary or a specialty drug list, been denied that information in advance of purchasing the plan. The last time was October. In order to answer my question about a medication in a class that is frequently not covered (and often not listed in formularies), the person on the phone had to find someone on the plan I was considering who was getting that medication to confirm it was covered, and at what price - since it was plan specific. But she found and provided the information to me - as has happened with each of the plans I have had over the last several years.

It is far more effective to find the customer service number and call and ask, than it is to complain on an internet board (which they will never read) that they won't give you the information.

[Ms. Toad]

614. That is not correct.

The last 4 plans I have been on have had a specialty drug category - and in each case I was able to check the coverage and price I would be charged. They cannot, of course, tell me whether an appeal of something which is not part of their formulary or specialty drug list will be approved prior to purchasing the plan - since that is based on unique medical circumstances. But they can (and in my experience always do) tell you the list if you ask.

And, FWIW, I have never lost an appeal (we are billed $60-100,000 a year - so you can imagine I have lots of encounters over insurance issues). In my 30 years of dealing with insurance companies, I have decided not to pursue two claims - out of network co-payment for an air cast which I would have had to drive 100 miles to find in-network, and authorization to see a pediatric (as opposed to adult) orthopedic specialist in connection with a break near a growth plate. Both were related to a doctor I fired for her refusal to assist in the corresponding appeals. I have been successful in obtaining approval for 2 experimental treatments (one surgical, one pharmaceutical), access to numerous step therapy treatments, in network treatment for costly care by an out of network specialist, family coverage for our same gender family (at a 30% reduction in out of pocket expenses) - and many more.

I agree - it should not be so hard, and it has robbed time I could have spent being present for my ill family members. But information, and successful appeals, are possible.

[Control-Z]

644. I was able to make a drug list on the wesite - of any and all level drugs -

and then compare each and every plan's coverage of those drugs before I purchased.

[Hissyspit]

266. "Being a victim is beyond foolish"

Yeah, sure. People just love to get scammed. Read your sentence. It doesn't even make sense.

"Much easier to blame others for your own indifference."

What indifference are you talking about? They've been working on this for months.

And this is JUST like buying a car to tow a boat. (Of course, now that you mention it, car dealers have a long history of being dishonest, unethical scam artists.)

[JEB]

334. Every single insurance company should be regarded

as the heartless lying thieving scum they are. After 45 minutes on hold..."this conversation will be recorded..." FOAD

[Boudica the Lyoness]

446. Could you please tell me what medications I'm going to on

in the future.

Thank you.

[bluestate10]

119. You are dead wrong. There may be alternative medications that work as well.

If a patient insists on a particular medication when other therapies will work that mindset helps NONE of us. I don't know the details of the OP's wife's situation, but I do know that I had three medications that worked for a situation that I had, my plan gave me a choice and I chose it's default, which was the least expensive choice, I am doing perfectly fine with the alternative.

[lapislzi]

262. Excuse me, Dr. Bluestate.

The PATIENT doesn't insist on the medication. Last time I checked, it was the doctors that write the prescriptions, and how fucking DARE a bean counter who wouldn't know how to put a stethoscope in his own ears presume to tell the patient with a life-threatening condition what medication she should be on.

While I am happy for you that you are doing well on the medication that your insurance company chose for you, you have absolutely no business telling others what medications they ought to try.

[uppityperson]

352. "If a patient insists on a particular medication when other therapies will work" and there is the

problem. Insurance companies do not have prescriptive authority in any state I know of, and often other therapies do not work, like in the case of Will's wife.

[Zorra]

94. "Everyone who has ever been deceived by an insurance company is a fool!"

(Post #9 added to the top ten list of things that make DU suck.)

[Egnever]

99. There was no deception

only a failure on Wills part to check their formulary. The insurance company will provide that to anyone that requests it, They have to by law.

[bvar22]

126. Maybe YOU have the knowlege and skills to do all of that,

and if you do, hey great!
..but not everyone is skilled or educated in the ability to see through all of the tricks played on the average American by the Health Insurance creeps.
Do you happen to work for one?
Is that how you know all those words like "formulary".

I only have a Masters Degree,
and have never heard of it before.

YES.
You ARE blaming the victim,
and using this to put on a little arrogant performance about how SMART you are.

It is like Steve Jobs saying
Hey. I built a computer and made a Billion Dollars.
You should do that too,
and if you don't...thats just your own damned fault.


You should be ashamed,
but, somehow, I doubt you can experience that feeling.

<expletive deleted> You!

[bvar22]

258. Yeah, I know.

I should be able to check ALL the fine print in ALL of the policies offered in the Exchange while negotiating through Healthcare.Gov Website... or talking on the phoen with a representative.


How many people who signed up through The Exchange even got a look at their policies?
I think that maybe ZERO could be the right answer.
How do you check the "formulary" over the telephone?
I STILL haven't seen a hard copy of MY policy.

You DO know that in civilized countries,
NOBODY has to do those things?
Yes?

I am not the one calling Will an idiot,
because I signed with an Insurance Company without checking the "formulary" either,
along with several MILLION other Americans.

YOU are the one calling Will and Me and MILLIONS of others idiots.
Well, GOOD for YOU!

This is supposed to be The Affordable Care Act.
and The Exchange was for people who previously were unable to afford Health Insurance.
How many people out of THAT pool of MILLIONS do YOU believe know the meaning of the word "formulary",
much less have the ability to check the Prescriptions, or even pronounce the names of those prescriptions?

YES.
You ARE blaming the victims.
MILLIONS of them.
This particular problem will NOT be limited to Will.

I can't print the words I feel that describe your
Well, everybody should just be as smart as me
smug, elitist, above it all, blame-the-victim attitude.
That is usually reserved for Ultra-(Its your own damned fault)Conservatives and the I Got MINE, FU libertarians".

[JEB]

296. Pretty well sums up my experience as well.

[Enthusiast]

506. A master obfuscater.

[Zorra]

144. Insurance companies have the art of deception down through omission,

evasion, bait and switch, and fine print down to an exact science. Checking the formulary of an insurance company is not always easy, especially after you've been totally beaten down dealing with deliberately insane bureaucracies who eat up most of your spare time when you are just trying to get straight answers from them.

It took me 63 days of intense frustrating, mind numbing struggle in overcoming built in programmatic stupidity to get my insurance plan through the ACA, through no fault of my own, and once I finally got approved for a plan, I was not permitted to examine the overwhelming majority of the details of the plans available to me before I chose one.

Fortunately, I got lucky, and my plan seems to be a good one. However, they apparently deceived my optometrist into believing that they would pay for my thorough eye exam; the optometrist told me the insurance company would pay, and after the exam found out that they were not getting paid. But the optometrist was honorable, and did not require me to pay, and just ate the cost of my exam, because they acknowledged that had told me my insurance was going to cover.

People should not have to go through all this deliberately deceitful, complex maze of crap devised by profit seeking businesspeople whose job it is to rip people off in any way possible in order to receive health services and health insurance benefits.

It sucks, it's evil, and I aim to help destroy the private health insurance industry as quickly as possible by any non-violent means necessary.

[Egnever]

156. Not sure what any of that has to do with checking the formulary before you purchase a plan

Even more so when you have a drug you depend on.

I am not claiming insurance companies are benevolent but the formulary is one thing about them that is black and white. If you dont check it when you are purchasing a plan and there is a drug you need covered you are not a victim.

[TrollBuster9090]

224. As I understand it, no insurance company is required to pay for a medication that hasn't been proven

to be effective. (That's even true in countries with a single payer health care system.) And, if you're talking about a drug that IS proven to be effective, but there are several brand name formulations vs. alternative (generic) equivalents that are proven to be as effective (or in the same ballpark) an insurance provider is free to say you have to use the cheaper one. A problem sometimes arises when somebody is used to a brand name that is five times more expensive than the generic version; or has been using a more expensive formulation that hasn't been proven to be more effective than an alternative, cheaper formulation with the same active ingredients.

That happens all the time; but it's not really a denial of a life-saving medication. It's just a denial of a more expensive version of something that isn't proven to be more effective that some other treatment.

I don't know if that's the case here, though. I'm just saying there's a lot of noise about this kind of thing that goes on whenever people are required to switch plans or providers. And it happened long before the ACA.

[Zorra]

284. I was not permitted access to the formulary before I purchased my plan. nt

[truedelphi]

497. Thank you for relating the realities of the situation.

I am firmly convinced that many of those exonerating or even praising the ACA are younger and healthy and are probably not going to have to actually use the system for quite a while. Or else they re people who are on a premium plan, through an employer or through being able to afford such.

But for people who have to use an insurer that is offering them less than a premium plan, there is a lot of bitter to have to suck on.

Considering the fact that the guy occupying the Oval Office and the Dem majority that had both houses from Jan 2007 to Jan 2011 had continually put out there the possibility of a public option, only to retract such once pressured by industry, it is natural that people are disappointed and if denied coverage like essential meds, even damn angry. There should have been a lot more reform and a lot less in terms of loopholes and give aways to the Big Insurers.

But the Beltway whores are what they are.

[freebrew]

555. You touched on something important..

People w/ certain jobs have 'premium' health plans. The company they work for probably pays a lot of premium for these plans, maybe. If you're getting a subsidy and so getting a 'cheaper' rate, this subsidy is coming from taxes. The insurance company is still getting top dollar for these less than premium policies that should be just as good or better than those so-called premium plans coming from employers.

Anthem can certainly afford to pay for Will's wife's meds. I've been through similar experience and for some reason, the insurance companies would rather be assholes about it. But, from what I've seen, these fights always end up costing the insurance companies more than if they just listened to the Doctor.

[Cha]

180. Yeah, "the insurance company".. maybe pitt should have been "fuck" "fuck" "fuck" "fuck" "fuck"

them.

[Demo_Chris]

118. WTF?!

[bluestate10]

124. The poster made a valid observation. nt

[magical thyme]

318. stating somebody was a fool for not reviewing the formulary before signing up

when YOU ARE REQUIRED TO SIGN UP IN ORDER TO SEE THE FORMULARY

and then it states that your particular plan may not include all the drugs in the formulary

is a lot of things. A valid observation is not one of them.

[Zorra]

316. Third Way Free Marketeers value profit over human well being, so they

don't have a clue as to why the post is so utterly offensive to Democrats and other progressives.

Plus, Pretzel_Winger and his right sock got tombstoned today for engaging in the typical RW behavior of cheating.

[PowerToThePeople]

322. Wow, I did not see that happen.

http://www.democraticunderground.com/?com=profile&uid=298088

Interesting...

[MoonchildCA]

462. There is not enough information posted on the providers' websites to garner this information.

There is limited information on our state site, as well. You can only get the most basic information on what is covered. You can't call--they are overwhelmed and no one answers. My friend signed up for Anthem Blue Cross because she had them before and was familiar with them. She found out, only after she signed up (because you have to be a member to have access), none of her doctors are in her network--doctors who previously took Blue Cross. in fact, the nearest oncologist is 20 miles away, and we do not live in a small town. we have two hospitals here, and neither is in her Network.
She and I both already had "Obamacare." We went from the California Pre-existing Insurance Plan (the absolute best thing ever!), to the Federal pre-existing Insurance Plan (not as great, but adequate), and have now had to transition into the exchange. She has been in pain management for years, and it took her over a month to finally get those meds approved. Her pain management doctor was the only one in her network. He accepted the copay, but now she is being billed for the entire amount--over $200. In-network doctors should only cost the copay. There is no one to call; nobody answers.
She was not sent a booklet on coverage (like our former insurances did). Basically, you're just left out in the cold to navigate it yourself. You really don't know if something is covered until you get a bill.
My husband and I signed up for Blue Shield. We haven't attempted to use it yet, but I'm really stressed after what my friend has been going through.
And full disclosure: I am only alive because of Obamacare. I needed major surgery in 2012; I signed up for CA Pre-existing Insurance Plan, and received a $300,000 dollar surgery the next month. I was prepared to LOVE the exchanges...

[itsrobert]

12. What if my medicine isn't on a plan's formulary?

What if my medicine isn't on a plan's formulary?

If you can't find your medicine on a health plan's drug list in your state's Marketplace, you can request that your plan cover it or give you access to it.

You can request that your insurer cover a medication not on its formulary with the help of your doctor to explain the medical need. If your request is denied, you have the right to appeal your health plan's decision.


http://www.webmd.com/health-insurance/insurance-costs/aca-prescription-drug-costs-faq

[Whisp]

13. I don't think we are getting all the details and facts here...

[itsrobert]

17. Indeed. He's giving up on a new plan because some insurance adjuster advised him not to bother

Why not pursue all angles before the "anger" is posted?

[truedelphi]

385. If the nation's citizenry had been offered real health care reform and not

A Rahm/Liz Fowler extravaganza, no one would have to spend any of their time appealing any thing.

At some point in your happy go lucky life, you might need to use your health insurance. And then you too will get to find out what it is like to have to go without a treatment you need, or a medicine that is essential, due to cost. All the while having to spend hours of your life, that should be being spent productively, dealing with Big Health Insurers.

[theboss]

577. Because he is Will Pitt

He do what he do.

[treestar]

79. I agree, why would an Obamacare plan

leave out a specific medication in a specific case? We are still dealing with insurance adjustors, and people may not like that, but that's what we've got.

And we can't prove single payer plans don't have bureaucratic glitches too.

[Hoyt]

90. They darn sure do. Medicare has no out-of-pocket cap, for example.

And, the drug coverage is subject to even more restricted formularies.

[bluestate10]

130. The accusation does sound somewhat suspicious and was delivered emotionally.

The emotional part pleases some on DU, in particular when the President is targeted, but the emotion doesn't make the claim true. I suspect that there were effective alternatives offered and they were rejected, in such a case even the best plans will reject prescription fills.

[Hekate]

233. Someone's sort of stuck on permanent anger at this point. No, we don't have all the facts.

What we have is a generic "Fuck Obama he's teh evil" post, and I for one have a hard time parsing out what actually happened and what alternatives were tried.

I do know that my husband reads his company-offered insurance plan's fine print every year so there will be no surprises.

We've known what a formulary is for at least 25 years, because some of our meds (especially mine) are routinely denied every single year. My primary doc is sick of countersigning the letter I keep on file in my computer testifying in excruciating detail what side effects are caused by my taking a particular cheap generic, but I print it out and he faxes it from his office with his own note. Every year.

If at first you don't succeed, keep trying. Keep notes in a file, with dates and contact info.

I'm going to get put on ignore for this, or flamed, but the OP married a woman with a severe, chronic, and progressive disease. My sympathies are with them both. But it means he signed up for a lifetime of reading the fine print and doing the research. I wish them both all the best, but Obama is not teh evil because of it.

[SidDithers]

386. Good post...

Sid

[wickerwoman]

477. "he signed up for a lifetime of reading the fine print and doing the research"

Only because he lives in America which, last time I checked, doesn't have a sign up sheet. If he lived in a number of other countries, he and his wife would just go to their doctor and get care.

I have absolutely no idea what a "formulary" is. If I get sick, I don't run to the internets and start shopping for a health insurance plan or researching which medications are covered among dozens of "options". I go to the doctor and get what I need.

But then I live in a country that actually gives a fuck about helping people instead of squeezing every last dime out of them and then blaming them for being broke and sick and tired and too busy to read dozens of pages of fine print specifically designed to screw them over.

What are the hundreds of millions of Americans with below average intelligence or learning disabilities or ESL issues or overwhelming stress from poverty and working three jobs to scrape by supposed to do? Suck it up and believe that they are the problem, not a system that doesn't give a shit about them and is intentionally designed to disadvantage them?

[Hekate]

483. Lucky you. But in the OP's case, he is a highly articulate professional writer, activist, & teacher

...with none of the disabilities you list. He has become progressively more enraged at Obama's perceived perfidy, and it has caused him to blame everything, including his own decisions, on Obama. I've been reading his posts and essays for nearly 12 years, and he's shared a lot about his life on this board. I'm sincere in my sympathy for him and the woman he loves -- but I am not sympathetic to this latest screed, because as far as I can tell he is working backward from a foregone conclusion.

Saying there are "hundreds of millions of Americans" simply unable to cope with the best President Obama and the Dems were able to cobble together given the intense opposition they face is rather overstating the case. If that were so the entire population of the US would be covered by your blanket statement.

I don't know what paradise you live in, but you are not in possession of all the facts about what we are trying to do here, where we live. You are taking the frustrations of some folks on one discussion board -- and in particular one man -- as if they were the whole story, and they are not.

There are a lot of DUers who would like to brainstorm ways to help the OP through this trying time. However, given the progression of his rage at Obama, I am not optimistic of the outcome.

[wickerwoman]

484. I am from America

and I left specifically so I wouldn't have to deal with this kind of shit. I still have family who are going through it and I thank my lucky stars every goddamn day that I don't have to. Emigrating from the US was the single best decision of my entire life.

This is not an issue which is specific to one person and brainstorming ideas to help Will through this one particular crisis misses the point. He's pissed off at a broken system and he has every right to be. Telling him that it's ever so slightly less broken than he is making out (while also suggesting that the burden should be on him to navigate it) is not helping either him or the larger problem.

[truedelphi]

496. I realized about two years ago that being enraged

At a puppet, even a puppet that occupies the Oval Office, was a bit of a waste of time.

[Humanist_Activist]

42. Appealing the decision doesn't guarantee coverage, just a review, and it can still be denied...

for non-medical reasons(i.e. medication is too expensive). By which point the appeals process will eventually be exhausted.

[itsrobert]

51. Yeah, it also can be approved

It doesn't hurt to appeal. Nobody said it has to be approved. I must of missed that part.

[Humanist_Activist]

66. I'm assuming what the OP meant by a 3 month fight is that they already...

went through the appeals process, and were ultimately denied.

After that point, you are SOL unless you can get some type of charity or government help.

[itsrobert]

73. I'm assuming nothing

other that he wants to fuck the President and thinks the President is a used car salesman.

[treestar]

80. The President ends up responsible for all the bad things that happen

But wouldn't get credit for medications approved immediately! Naturally. Nobody like to fight with insurance companies. But then who is to say even single payer would not result in this type of fight? The government might claim a medication not needed where patient and doctor disagree.

[itsrobert]

82. Happens all the time in the Miltiary Tricare System

but there is an appeals process and my wife was able to get the medication her doctor recommended.

[TheKentuckian]

683. They are about a 100 times easier to deal with than say any BCBS

They have the simplest criteria and formulary is easiest get an override on. As far as I can tell, if you have a condition where it is generally agreed that a treatment is effective then it will be covered with little mess at all.

Off label and experimental applications, you may have some trouble but FDA approved comparably simple compared to most.

I suggest Will approach the manufacturer for help, that is often the last line of defense nowadays but you generally will have to be in a situation where they will not cover a formulary alternative for you either.
There are some charitable foundations but funds are very limited because they have been hit up hard for the past few years.

Is this Obama's fault? Of course not.

The problem is of course these maddeningly stressful, quality of life, and even life and death issues were not taken from our plate and this is because mostly we do not have systemic reform but rather what we actually did was really more closely align the individual market with the large group market and improve access via a hodgepodge of approaches in exchange for guaranteed customers and a mainline to the treasury so the deal is over sold.

A lot of people looking for relief will find none, we have the same system as before with some curbs on SOME of the roughest edges. This has turned out to largely be standardization, which is a good thing because the individual market was fucking Thunderdome crazy town but it is still very ugly.

Satisfaction with large group plans is driven by lack of use and employer subsidy, folks that have to use it tend to hate it almost as much as individuals because of the hell they put you through and the costs start to show up beyond premiums and copays.

[Humanist_Activist]

84. I don't blame the President personally, this system predates him by about 40 years...

and the institutional stagnation of it means that the ACA was going to be a compromised compromise that isn't going to solve most of the problems it claims it can solve. Barring an outright revolution, or radical cultural and political shift, we aren't going to see our private/public system fixed completely in probably another generation or two. The ACA may be a good first step, but it isn't the end all, be all of health care reform.

[lumpy]

151. Yes. That's about all I got out of the whine.

[JoeyT]

49. Via HHS.gov

http://www.hhs.gov/healthcare/rights/appeal/appealing-health-plan-decisions.html

Some Important Details

The parts of the Affordable Care Act that concern internal appeals and external reviews apply only to health plans or policies that were created or purchased after March 23, 2010. Plans created on or before March 23, 2010, may be “grandfathered health plans.” The appeals and review rights do not apply to them.

Edited to add: Which is sort of confusing. In one place it says created or purchased, in the other it just says created before may be grandfathered.

[MannyGoldstein]

510. Later today I'm sending the Koch brothers a letter appealing their decision

to not give me $100 million.

How do you think I should spend the money?

[itsrobert]

14. Are prescription drug plans the same in every state?

Are prescription drug plans the same in every state?

No. All health plans in a Marketplace must include prescription drug coverage, but each state sets the list of covered medicines, called the formulary. For instance, one plan may have many more medicines in one category or class than another state does.

http://www.webmd.com/health-insurance/insurance-costs/aca-prescription-drug-costs-faq

[Baitball Blogger]

15. My heart goes out to you and your wife, Will.

There were loopholes with the early HMOs too. We need to work together to get this information out to the executive office. I bet we can make a difference.

[itsrobert]

16. How do I know if a health plan will cover the medicines I take?

How do I know if a health plan will cover the medicines I take?

Check the plan's formulary, also known as a preferred drug list. You should be able to get this from any health plan you're considering. Sometimes a plan's formulary will be on its web site.

The formulary lists each brand and generic name of medicines that the plan will help pay for. To look for your medicines, you need to know:
•The medicine's exact name
•The dose you take
•How many pills your doctor usually prescribes

http://www.webmd.com/health-insurance/insurance-costs/aca-prescription-drug-costs-faq

[bvar22]

50. Thats nice.

What about the medicines I might need next year for a condition I haven't yet developed?

In civilized countries, they don't have to do that.

[progressoid]

18. What? For profit health care screwing people for profit?

Who wudda thunk it.

We also have "coverage". But we don't use it because it's too expensive. We're basically shelling out cash in the hopes we are covered for any catastrophic problem.

[marzipanni]

72. 80% of what people pay is supposed to go toward health care

not for a bunch of people sitting in cubicles trying to figure out ways NOT TO PAY for health care!

Will, appeal that decision!-
http://www.hhs.gov/healthcare/rights/appeal/appealing-health-plan-decisions.html

[progressoid]

114. No.

80% of what insurance companies collect is supposed to go to the provider. But that's after the co-pay and the 7800.00 deductible. Then 80% goes toward health care.

It's not the Afordable Care Act. It's the For-Profit-Insurance Act.

[Recursion]

444. No. That's two separate issues.

80% of insurers' revenues must go to treatments. If less goes, they have to cut refund checks to policy holders (this has already happened several times).

Plans are are required to, on average, pay 60, 70, or 80% (depending) of their pool's total medical costs. The deductibles are how they get there.

[progressoid]

472. Two separate issues - same wallet.

I'm paying deductible out of pocket before my insurance company will begin to pay for treatments. 80% notwithstanding.

[Recursion]

475. Yes, that's what deductibles are

There are plans with low or even no deductibles, but their premiums cost more. It's a question of which one makes better sense for you.

[Jack for Sanders]

19. Imagine that

[Whisp]

131. Yeh, I'm so sure Obama gets a jolly laugh out of peope not getting their medication

disgusting.

[itsrobert]

21. What's the medication and what is your plan you are on?

Did you not look at the covered medications of that plan before you selected it? Especially if that medication is important in a family's members survival? Have you appealed the insurer's decision?

[TBF]

38. Blaming the victim - that makes it better.

[itsrobert]

46. I'm just asking questions

Trying to find out what went wrong here so others can learn. And to see if all avenues have been exhausted prior to posting this "anger". Maybe there is something that was missed, that may help.

thanks!

[TBF]

55. People really aren't that stupid itsrobert -

well, Repugs are that stupid - but most people are not. They know when they are being screwed. Mr. Pitt's anger, granted, is basically misplaced. I agree with him on so much - but I think he doesn't go as far as we need to. I believe he still sees capitalism as salvageable given progressive governing.

I don't see POTUS as the real problem. He's functioning as expected by the folks who hired him.

The underlying problem is an economic system in which things like health care are for-profit. Capitalism has to go.

[Lars39]

86. A better question would be why aren't the formularies standard from one policy to the next.

[one_voice]

22. Fuck you, Mr. President, you piece of shit used-car salesman. From my heart and soul, fuck you.

[Wait Wut]

24. +1

[WilliamPitt]

25. Thanks for kicking my thread.

My post #8 above:

There are ten different health insurance companies in NH. According to the independent (family friend, ally) insurance adjuster I spoke to at length this afternoon, pursuing coverage with any of them would be a waste of time. Why? Because - according to dude - the whole "You cannot deny coverage to people with pre-existing conditions" thing only applies to insurance companies within the ACA network. You heard all that shit about "Grandfathering." Well, this is that, and all of them will turn us down because they still can.

I am in the process of running down the facts of the matter, but family friend and ally was confident enough to basically tell us not to bother.

So yeah, that, too.

Explain it away, apologist. My wife is counting pills.

[uppityperson]

32. "explain that away, apologist"? WTF. It would seem someone with your ability to use words would

be able to rebut an argument by doing more than insult. And yes, I am aware I kickedyour thread, hoping others see how you insult President Obama.

[bluestate10]

146. The OP's behavior was fucking insulting and wrong. I happen to live in the same state

as the OP. Our state's medical environment is dominated by big HMOs and Doctor collectives. I am a member of one of the biggest Doctor collectives in the state and am covered by one of the largest HMOs. I have yet to see a situation where prescriptions were denied when people were using within what health maintenance models indicate keeps the person healthy. If patients do have to pay, they only pay for the prescription fill that goes out the model, once back in that model, the prescription is free or comes at a vastly reduced price. I am younger, but my plan is loaded with elderly people, many cancer patients, I have seen no one complaining about being denied needed medication or being bankrupted to pay for medication.

[okaawhatever]

373. Thank you for a boots on the ground assessment. I think we'd all like more details to see if there

is an answer to this that perhaps hasn't been presented.

[Cha]

165. The raging anger at the President gets in the way even if it isn't Obama's

fault. That doesn't matter.. what matters is..



Yeah, Kicking the Thread..

[one_voice]

78. I feel for your wife Will..

Last edited Tue Mar 18, 2014, 06:18 PM - Edit history (1)

I really do.

I'm on disability and take VERY expensive meds. I've had to go without because I didn't have the money. I think we should have universal health care.

You know nothing about me and yet you insult me calling me an apologist. I'm not, I just think we should be better than the other side.

While your wife is counting pills, I'm going on two months without one of my most important meds. Today my doctor gave my husband samples of his diabetes med to get him through till our insurance goes into effect.

Not liking how you expressed yourself is NOT the same as being an apologist.

I truly hope you get this worked out---NO ONE should go without meds---I know, I'm doing it.

[Orsino]

171. Psst. The president didn't write the law.

And had he written it more to our liking, Congress would not have passed it.

[marble falls]

523. Manny, are you saying only pre-existing conditions that have never been exposed to insurance.....

are covered by ACA but those already denied will continue to be denied as grandfathered by earlier denial? How haven't we been told this before by the "liberal" press?

[tridim]

531. Manny. LOL.

[uppityperson]

29. Seriously, wtf. If that is not alerted on or hidden, is calling Pres Obama that is ok per

DU Community Standards, I just don't know about this place.

[WilliamPitt]

30. He hasn't fucked you over.

Yet.

Cope with a different opinion.

[ProSense]

34. What does the President have to do with your insurance company's formulary?

I mean the attack seems purely gratuitous.

It's your responsiblity to check to see if your medications are covered. This was true before the ACA.

The fact is that you can work with the insurance company to see if they will cover it, and you can appeal their decision.

[treestar]

70. I can see getting angry at an insurance company adjustor

Who won't do what you want right away. But the POTUS is not the first person I'd think of. Just weird.

[Cha]

193. It's a habit of his. Obamacare has absolutely nothing to do with this crisis but

there he is.. calling the President all kinds of stupid juvenile names, stomping his feet, and raging at Pres Obama.

[Lydia Leftcoast]

83. Well, maybe if Obama had TOLD the insurance companies what to do instead of

meeting with them behind closed doors to ASK them what they were willing to do (sort of like Dick Cheney meeting with the oil companies), Will's wife might not be in this position.

[ProSense]

88. Formularies are not determined by the President, and existed before ACA

They exist in Medicare Part D.

Being uninformed is not an excuse to attack the President.

[Lydia Leftcoast]

93. True, formularies existed, but that doesn't mean they SHOULD exist

to the extent of denying people the meds they need to half a progressive disease.

Either way, those closed-door meetings with the insurance companies stink to high heaven.

Governments are supposed to tell private businesses what they can do, not the other way around.

Who but major corporations gets to tell the president and Congress which potential laws they are willing to follow?

Oh, and the pharmaceutical companies deserve a hearty "fuck you" as well for profiteering in the only country in the Western world that doesn't regulate drug prices.

And no move to reform Medicare Part D completely instead of just shrinking the doughnut hole? No reforms that allow Medicare Part D to negotiate drug prices?

[ProSense]

117. Well the

"True, formularies existed, but that doesn't mean they SHOULD exist"

...bizarre thing about attacking the President and Obamacare is that the law did improve the situation.

Appealing Health Plan Decisions

The Affordable Care Act ensures your right to appeal health insurance plan decisions--to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”

http://www.hhs.gov/healthcare/rights/appeal/appealing-health-plan-decisions.html

[Recursion]

445. Canada has formularies. The UK has formularies. Single payer doesn't work without them.

Neither does a system like the ACA.

The only way to not have formularies is to nationalize pharmaceutical production, though that ends up just being formularies by another name, since then the government is deciding what drugs to make when.

[SidDithers]

603. Prescription medications are not covered in Canadian Health Care...

That's why many of us have Extended Health Benefits through our employers, which covers Dental, Vision and Drugs.

For large expenses, people can apply to their Province for drug coverage (Trillium Foundation in Ontario), and seniors get drug coverage when they hit 65. For the rest of us, we're on our own.

Sid

[bluestate10]

159. EXACTLY!!! I related that fact in an earlier post. My sense is that the OP is

detailing all facts. I happen to live in the same sate as the OP live in or lived in. I know how health maintenance in my state works, and my plan has a large percentage of seriously ill or aged people - FUCKING none have complained about being bankrupted to pay for or denied needed medication. The predictable amen chorus cheered the OP on, probably because of what the OP called a President who has been a honest actor on health care reform.

[1StrongBlackMan]

198. So how would THAT work ...

a President TELLING a private business concern what it can, or cannot, do?

[Lydia Leftcoast]

400. As opposed to having the companies tell HIM what to do?

It's a pretty easy choice. Governments make laws. Companies are supposed to obey them. What's so hard about that?

[1StrongBlackMan]

513. Well ...

Getting government to make the laws. In case you forgot ... Presidents don't make laws; they only sign (or veto) them.

[marble falls]

527. Most importantly Presidents execute the laws and enforce them. Thats why its called the executive ..

office and the FBI(for example) is part of the executive branch. President propose laws or directions and Congress acts on this one way or another.

[Lydia Leftcoast]

586. My complaint is not about what Obama's legal powers. It's about

ASKING the insurance companies which laws they are willing to obey.

Having companies help write the laws that will regulate them is the essence of corruption.

Everyone on DU raised a stink when Cheney met with the oil companies behind closed doors, and rightly so.

So why was it OK for Obama to meet with the equally greedy and corrupt insurance companies behind closed doors? He did it before even the broad outlines of the ACA had been released.

Why was it OK to take the weakest possible bargaining position and START by offering what he thought the Republicans might accept? If he had started with single-payer, we might have ended up with a public option. Instead, he dropped both strong positions in favor of Romneycare, and the Republicanites still didn't vote for it.

A president with guts would have gone on TV FIRST and said to the American people,

"I am going to propose a single-payer system to Congress. It will have five main points: 1) Every legal resident of the U.S. will automatically be covered from birth, 2) There will be no deductibles (although there may be modest co-pays), 3) It will be financed by....(there are many possible alternatives, so I'm not naming one here), 4) Doctors and hospitals will still be in private practice, and you will be able to choose any licensed medical practitioner you please, 5) Visitors to the U.S. and illegal immigrants will be provided with care only for life-threatening emergencies and then sent to their home countries for further treatment. They will pay full price for non-emergency care.

"We can have this, just like Canada, the Western European countries, and most of the East Asian countries, if Congress will approve it. The insurance companies will sponsor media campaigns full of horror stories from supermarket tabloids or outright lies. They will try to bribe members of Congress to vote against it. If you want this passed, you need to call or write your House and Senate representatives and tell them that you want America to have not only the best but the most accessible health care in the world."

Then he would have rounded up the Democratic Congresscritters and told them to go to their home districts and reiterate the five points to their constituents in all public appearances. Congresscritters who refused (the Max Baucus types) would be told that the national party would fund a primary challenger who would accuse them of not caring about the health of the American people.

That's what a real leader would have done, not consult an industry about which laws they were willing to obey and make it hard for the public to find out what was in the ACA.

I had to Google like crazy to find an executive summary, and there was none on any government website. I finally found a summary on the website of the Kaiser Family Foundation. That's just wrong: trying to pass a piece of legislation that will affect everybody but leave the average American in the dark about what it contains.

That lack of transparency had three negative effects: 1) It allowed the right-wing to have a field day with horror stories from British and Canadian tabloids, even though the systems of the two countries are different from each other and neither is like the ACA, 2) People who were FOR health care reform THOUGHT that Obama was working on single payer. I heard this again and again, and having read the Kaiser summary, I had to correct them. 3) Since people had no idea what was in the bill, they were not motivated to lobby their Congresscritters.

Our only hope is that the states are able to put together single-payer plans on their own. I will be eligible for Medicare in a couple of years, so even Minnesota's strong effort will be too late for me, but I hope that future Americans, unlike me, won't have to go without medical care because their insurance premiums take up too much of their income.

[truedelphi]

398. You are not the only person here making sensible claims and

Statements. But for some reason, (or lack thereof) the usual crowd from the BOG cannot understand the meanings that are being explained.

[1StrongBlackMan]

561. What is sensible about claims and statements like this ...

maybe if Obama had TOLD the insurance companies what to do instead of meeting with them behind closed doors to ASK them what they were willing to do ...

Anyone/everyone that took and passed an 8th grade Civics course should have a problem with that nonsense ... usual crowd from the BOG, or otherwise.

[truedelphi]

598. What they are trying to emphasize in a statement like that one,

is how Obama went around all summer of 2009, telling one and all that he could not participate in the situation of using abully pulpit for anything related to the drfting of an insurance piece of legislation.

Then we come to find out that Rahm Emanuel and Liz Fowler were busy that same summer, initially using rooms in the "WH Basement" and then when activists started demanding to see the logs of whomever it was that Emanuel and Fowler were consorting with, then the meetings with the insurance CEO's began to take place some blocks away from the WH.

Together those two drafted a piece of legislation that was over 2,000 pages long, and basically written by the Industry. It was filled with give aways to the Big Insurers and mandates that will add immensely to the Big Insurers' profits, without many regulations in terms of price containment, or even ways for individuals to appeal the devious methods that Big Insurers utilize to avoid handling payments to the insured.

So there are several things going on here:

One DUPLICITY A President claims the following: 'Public option is but one tool in an entire tool box of options that Congress can employ. But since I am the President, and I am part of the Executive Branch of the US government, the separation of the three branches of government means I must bow out of the discussion until Congress has put its finishing touches on the piece of legislation that they re putting together.' (Obama's Answer given to Univ of Co student, Boulder Co, mid Aug 2009) But meanwhile his chief of staff is drafting the legislation with Liz Fowler and drafting it according to the whims and desires of the Big CEO's at Big Insurers.

Two: The wholesale deliberate evading and ignoring of what needed to be done. On this very board, I witness person after person lamenting Reagan.

But Obama is Reagan on steroids. We have gone from a nation where 9 cents out of every dollar of profit goes directly into the coffers of big banks, (circa the 1980's) to a nation where 49 cents out of every dollar of profit that is generated goes to the banks. All due to Obama appointments.

Perhaps if Obama had FDR as a template for his Administration and not Mr Reagan, (who let's face it, he praised and praised and praised in his autobiography), then we would still have a vibrant middle class. Instead, many thinking people realize we have been sold out.

[1StrongBlackMan]

601. Okay. eom

[Lydia Leftcoast]

684. Thank you!

That is exactly the kind of thing that I was referring to in my criticisms of the ACA.

At the end of Bush's Reign of Error, people were hungry for some real reform...of a lot of things, not just health care.

But the powers-that-be, including a lot of the Democratic leadership, didn't want real reform, because they were doing just fine, thanks, so they found a young candidate with a lot of personal charisma who could talk a good game and play a populist on TV.

A lot of people who were too young to remember the Eugene McCarthy/George McGovern/Robert Kennedy era or who had never worked on the Dean or Kucinich campaigns were fooled.

I was always skeptical, and my skepticism was justified early on in Obama's first term. (Please note that this does not mean that I supported Hillary Clinton in the primaries. I voted Unaffiliated in my precinct caucus. I KNEW that Hillary Clinton is a corporatist through and through, but I would have voted for her over McCain any day.)

[Cha]

123. Details.. everything is President Obama's fault when it comes to one

Will Pitt and his stupid anger issues which need management and is not the gift he pushes.

[uppityperson]

35. You miss the point of calling him "a used car salesman piece of shit".

Cope with TOS.

[Dreamer Tatum]

43. +1 nt

[treestar]

69. Is he the insurance adjustor?

Did he specifically promise you this medication?

[WilliamPitt]

75. He handed the proces over to them.

So, yeah.

Buck stops.

[bluestate10]

166. That is a bullshit claim. Congress passed the ACA, the President is doing his best to

implement what was passed. BTW, on a personal note, I live in the same state that you live in or lived in. I think your claim is BS. I am in a plan that has mostly old and very ill people, I am in the minority as a younger healthier person. I watch those people filling prescriptions, I watch them going in to the examination room, NONE complain about being bankrupted to pay for medicine and as far as I know, none insist on a particular medication when their doctor offers effective alternatives.

[MADem]

350. Maybe you shouldn't have left MA for "tax free NH?" It's nice up there but you get what you pay

for.

Move over the border to VT, see if you can get a better deal there....of course, they've got taxes too, pretty robust ones.

I think your anger is misplaced and I agree with those who said you should have checked the formulary first. Since you didn't do that, you need to work on appealing the decision, working directly with the pharmaceutical company that manufactures the drug, seeing if you can't get samples from a physician, or finding an alternative med.

Or move to VT.

But coming on DU and getting all dramatic and pouty? It's an old act, Will--it's immature and it's not getting that "Ooooh....ahhhhhhhhhh" reaction anymore. No, the ACA is not perfect but YOU didn't do your due diligence, either. And calling the POTUS childish names isn't going to fix your situation, it just makes you look like a petulant jerk.

[brush]

482. And the President of the United States personally fucked you over?

Get off it and get over yourself.

And btw, I hope your wife gets her meds and gets well.

[one_voice]

31. Jury left it 3-3...

some people can do/say whatever they want with no repercussions.

That's something I'd expect to see at the cave, freeperville, etc. Not here.

I disagree with much of what the president has done/hasn't done, but damn.

I think Single payer/universal health care is what we should have gotten.

Standards only apply to some and more to others.

[Autumn]

33. I was wondering what the results were.

So I checked and it's been alerted for SOP violation.

[one_voice]

122. I wasn't the original alerter.

I got the same message you did.

[The Straight Story]

37. The jury on your post was 3-3

On Tue Mar 18, 2014, 05:09 PM an alert was sent on the following post:

Fuck you, Mr. President, you piece of shit used-car salesman. From my heart and soul, fuck you.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686242

REASON FOR ALERT

This post is disruptive, hurtful, rude, insensitive, over-the-top, or otherwise inappropriate.

ALERTER'S COMMENTS

It seems there are better ways of expressing anger than this over the top one.

You served on a randomly-selected Jury of DU members which reviewed this post. The review was completed at Tue Mar 18, 2014, 05:15 PM, and the Jury voted 3-3 to LEAVE IT.

Juror #1 voted to LEAVE IT ALONE
Explanation: No explanation given
Juror #2 voted to HIDE IT
Explanation: No explanation given
Juror #3 voted to LEAVE IT ALONE
Explanation: No explanation given
Juror #4 voted to HIDE IT
Explanation: No explanation given
Juror #5 voted to LEAVE IT ALONE
Explanation: This alert is on the wrong post. Should be on the OP by WilliamPitt. This post by one_voice is pointing out the verbatum comment in Pitt's OP. It's obvious one_voice is dubious to this comment by WilliamPitt since the forehead slap emoticon is used. Alerter needs to re-read for comprehension.
Juror #6 voted to HIDE IT
Explanation: No explanation given

[one_voice]

62. Wow...

[The Straight Story]

63. I voted to leave (for obvious reasons)

I don't think the alerter thought it through very well

[one_voice]

81. Yeah I agree...

[uppityperson]

41. Incredible.

And I agree with what you write too.

[Cha]

135. Oh he thinks he can throw any fucking insult he wants against the President ..

Last edited Tue Mar 18, 2014, 11:14 PM - Edit history (1)

but, he finally got locked out of his own stupidass thread..

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686372

Edit: clarity.

[alcibiades_mystery]

368. ROFL

Ouch.

[Number23]

465. Hopefully that post and this overall thread will result in some admin attention

This whole thread is just about one of the most cringe inducing, moronic things I've ever seen here. The OP needs to go sit his ass down somewhere.

It has never, EVER dawned on me to criticize a president because an insurance company didn't cover something I thought it should cover. And that includes every president (Repub or Dem) that have been in office since I got my first insurance plan.

[Cha]

469. It's the Knee Jerk Obama Syndrome.. and this

one knows with Obama Hate comes many Recs.

It's too bad about the Med crisis with his wife in the state of New Hampshire but JHC .. don't compound it by taking it with a venomous attack on the wrong person.. even if that person is his favorite whipping post.

[Whisp]

136. jury Left it.

A randomly-selected Jury of DU members completed their review of this alert at Tue Mar 18, 2014, 03:42 PM, and voted 3-3 to LEAVE IT ALONE.

Juror #1 voted to HIDE IT
Explanation: I sympathize with the poster's wife's medical situation; and if he'd even said 'fuck you Mr President for caving in' I would have voted to leave. But calling him a 'piece of shit used car salesman' is a step too far, and plays into the hands of the anti-healthcare Right.
Juror #2 voted to LEAVE IT ALONE
Explanation: So because "many others are finding that ACA is a blessing," those who find problems should just shut up? I would never have used the words that this person used to describe the president, however, the president can take care of himself. If this poster had directed those words at a DUer I would vote to hide.
Juror #3 voted to HIDE IT
Explanation: No explanation given
Juror #4 voted to LEAVE IT ALONE
Explanation: This is a long term poster. He is understandably upset by reality and angry, like many Progressives that the ACA was not enough, not sufficient, but was better than nothing. His outrage is understandable, a little over the top calling the President a used car salesman, but does not warrant disappearing the message.
Juror #5 voted to HIDE IT
Explanation: poster may be upset but this is over the top
Juror #6 voted to LEAVE IT ALONE
Explanation: I don't blame the poster for railing at the insurance company and the president for producing an inadequate health care act that benefits the insurance companies.

[uppityperson]

142. Thank you. "a little over the top"

[Cha]

378. Well, the pitt fans weren't on this jury.. and he wouldn't know "truth" if it gobsmacked him

in the face.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686372

[lostincalifornia]

176. I agree. In the past calling the President a "POS" would have been a clear violation. One thing

for certain now, is the standards are who happens to be on the jury, and it can vary from jury to jury

We can all understand the emotion involved however.

[Cha]

182. Really. Misplaced anger.. but the President is always handy when it comes time

for will pitt to get his pos rage on.

[Oilwellian]

209. I find your anger misplaced

I suspect if it were your spouse's life at stake, you would be lashing out as well. It IS Obamacare that is the cause of Will and his wife's problem.

I find your comments cold and heartless considering the circumstance they now find themselves in. It's not ALWAYS right to defend fucking Obama.

[Cha]

218. I'm not Raging at the President for something that isn't his fault. Throwing all kinds of idiotic

insults in a prepubescent hissyfit that only got him locked out of his own thread.

[mythology]

669. Lashing out in this fashion doesn't do any good

It's poorly aimed and generally doesn't actually convince other people to listen to you. In my experience acting in anger and frustration is worse than stopping, calming down and then looking at a situation rationally and finding the best solution for the situation you're in.

Plus, there's information in this thread that could prove useful, but if he's too angry to hear it, then that won't help his situation.

And from the information given, I don't see how you can say this is the fault of the ACA. There's simply not enough information here to state that conclusively. For example, what specifically are his other insurance options in his state? And no, saying that somebody else told him not to bother isn't actually looking at options. Are there programs that can help pay for the drug regimen? Alternative treatment options? How specifically did the ACA cause this? If it's true that the plan is a grandfathered plan, then why wasn't the drug denied previously? Without knowing far more information that is presented, I can't say whether the ACA is part of the problem in this situation or if it's not.

But given how many times examples of how the ACA was causing somebody's insurance to go up, or get canceled have turned out to be inaccurate, I'm generally fairly cautious about believing such claims.

[AnalystInParadise]

267. Amazing and oh so tolerant

of you to bash a guy that loves his wife and is angry. Typical.

[Whisp]

362. typical as well to defend that OP

which could have been a positive learning to get advice and help from the many knowledgeable people here on the subject, but instead used the opportunity as a toilet to shit in.

[AnalystInParadise]

372. I don't like Will

We don't see eye to eye on anything. BUT his wife is suffering, so I will exercise my humanity and not go to DEFCON 1 when he blows off some steam. If only other so called progressives showed the same humanity and humility. Instead some people want to settle scores and throw feces on a guy that is hurting that lost his cool. Give me a break.

[Whisp]

374. I don't like him either because he tends to *ahem, exaggerate things

for reasons that I can only guess at.

[AnalystInParadise]

377. If there is proof

REAL PROOF of exaggeration, not anecdotal BS like so many around here treat as proof. I will gladly retract my support. Until then I see nothing wrong with a guy with a suffering wife venting his spleen.

[brush]

485. See post 476. Pitt has went off mistakenly on the President before

He seems to look for any reason to blast the President — obviously an Obama hater.

[AnalystInParadise]

652. And before today

has no bearing on today.......

[brush]

664. Seems to show a pattern

of behavior — anger management issues.

[dilby]

26. Yeah this sucks.

I am terrified of losing my insurance through my employer because I do have pre-existing conditions and if I have to go onto the ACA there is a good chance I will be in the same boat. The worst part is because this has become law and all Americans are required to have insurance there is no way to reverse this and move to a single payer option. The people once again get screwed while Insurance Corporations laugh all the way to the bank.

[WilliamPitt]

27. It's a fucking shark tank.

Tie a pork chop around your neck if you jump in; maybe it'll be over quicker.

[NightWatcher]

28. After all that fighting, we end up with insurance companies

I'm in a similar boat, sick and uninsured (waiting on Medicare). What we should have got was Socialized Single Payer EUROPEAN Styled healthcare (note I didn't say insurance).

Sick and broke sux

[obliviously]

36. Sometimes you just have to take a pain pill

It is in the fine print

[Lex]

39. At least put in an appeal.

Sometimes that actually works.

[lostincalifornia]

181. That should be the first course of actions. In fact if a physician says the patient absolutely

requires this medicine and not and alternative, that usually does it.

A generic medicine did NOT work for me, but the brand name did. My Doctor authorized it, and it was covered. It did cost me slightly more though.

[Hekate]

247. Same here. Every single year I print out my original letter detailing what the generic does to me...

... because that is the hoop I have to jump through. Otherwise the Rx company sends me the cheap generic with no notice -- and it makes me really sick. I give the letter to my doctor, he adds what he's required to add, and it gets faxed from his office.

Every year.

[bvar22]

40. Getting the Website UP, and getting people Signed Up was the EASY part.

Getting these parasites (For Profit Health Insurance Industry) to actually deliver quality health care is going to be the hard part.

As far as I can tell, The Affordable care Act provides NO Watch Dog Agency to hole the vultures accountable,
or no streamlined service to handle and expedite complaints.

It looks like we are still on our own if we feel we are treated unfairly.
We have to get a lawyer and file suit against these Mega Monsters and endure the years of financial hardship and distress necessary to reach a solution.

Sorry to hear about your problems,
and I sincerely hope you can find the needed medicines at an affordable price.

Bill Moyers

Republicans have now lost three successive elections to control the Senate and they’ve lost the last two presidential elections. Nonetheless, they fought tooth and nail to kill President Obama’s health care initiative. They lost that fight, but with the corporate wing of Democrats, they managed to bend it toward private interests.
So we should be clear on this, Obamacare, as it’s known, is deeply flawed. Big subsidies to the health insurance industry. A bonanza for lobbyists. No public option. And as The New York Times reported this week, “Millions of Poor Are Left Uncovered by Health Law.” Largely because states controlled by Republicans refuse to expand Medicaid.

http://billmoyers.com/segment/bill-moyers-essay-shutdown-showdown/

Health Insurance =/= Health Care

[Aerows]

621. "The Affordable care Act provides NO Watch Dog Agency"

Of course it doesn't. The main priority is to shield insurance companies and increase their profits. That somebody gets health care is a secondary consideration.

[Hoyt]

44. I'd feel angry too. But was she on this med before, and are there any alternatives?

As bad as insurance companies are, they seldom deny mainstream meds unless it is to switch to an equivalent alternative. I'd check with state insurance commissioner if they are denying a whole class of meds.

[Lex]

97. My partner's MS drug is covered under the state employee plan in NC

which isn't the best plan in the world so I wonder if an appeal can work in Will's wife's case.

[Hoyt]

105. I think there is a way with this one. At least I hope. Sorry they are going through this.

[Doctor_J]

551. He shouldn't have to "appeal" to get her medicine!!!!

The doctors prescribe medicine. The insurance company pays for it. Two steps, not one or two or five appeals, requiring the patient to act as physician, pharmacist AND lawyer.

My head hurts.

[Lex]

553. "Shouldn't have to" is a different issue altogether. nt

[theboss]

580. A lot of medicines do essentially the same thing

Insurance companies often limit a class of meds to one or two choices. It's frustrating, but it's been a part of health care for a while now.

Frankly, this was a lot easier when your choices were "Penicillin" or "an infection that will kill you by Tuesday."

[bluestate10]

175. I suspect that cheaper alternatives were offered and rejected. Some alternatives,

although effective cause undesirable side effects, but resolving that type of problem is between the patient and doctor - the President and the ACA has nothing to do with that.

[MADem]

361. If the DOCTOR agrees that the drug is needed, the insurance companies will go with the doctor.

I think there's more here than meets the eye. The doctor may have indicated that an alternative medication would be just as efficacious.

[Hoyt]

363. I agree, something is missing. I'm not sure insurance companies always go with docs, especially

when close alternatives are available.

[MADem]

375. If the doctor puts his or her foot down, the insurance companies will fold.

The patient is allergic to an additive in the alternative; the alternative doesn't work as well on the patient, whatever....but if the doctor doesn't agree on the medical necessity, they won't go to bat just because a patient "likes" what they are on and doesn't want to switch to something new.

No formularies are more onerous than military medical ones--even for active duty people. The doctors generally will not go to bat to get a patient a med that is off the formulary without first trying the one(s) on it. But if it's obvious that the stuff ain't working, they WILL fold if the doctor insists. It's a pain in the ass but it can be done.

People who think single payer would "solve" this problem need to think again. What single payer is about is a minimum standard for ALL, not "every little optional or high end drug you want or need, when you want or need them."

The UK National Health doesn't hand out designer drugs or the high-end stuff as a first resort, either. Nor do they authorize cutting edge surgeries very easily, either. You have to "go private" for that. In fact there are parents who save/hold fundraisers to raise 40K pounds for specialty operations for children with cerebral palsy to be done in USA because they are not covered in the UK as a rule, and the few that are covered use an older system with a longer recovery time.

[Hoyt]

387. I get it. Most folks here would really get po'd if faced with formularies in Canada, England, etc.

A couple of years ago, I was "forced" into Kaiser Permante and it didn't cover some of my meds. I griped, but eventually found their covered alternatives were fine.

No country can afford a wide open single payer system, and I'm fine with that. Heck, even Medicare has some large coverage gaps.

[1000words]

45. We needed (and asked for) a public service. They gave us a consumer product.

Do the math.

Some folks will tell you to be thankful for the crumbs. Fuck them, too.

[bluestate10]

177. Single Payer isn't going to happen until republicans are either proven completely

wrong or are voted out of office. Neither of those outcomes come about by calling President Obama names.

[1000words]

189. Crumbs

Review my last sentence, again.

[bluestate10]

206. Your last sentence is a collection of words that have no logical basis.

Reality is what it is. We won't get Single Payer until republicans have been routed. That is a fact that spinning fantasy doesn't change.

[sendero]

281. One thing is dead certain..

... we will not get single payer until there is a champion fighting for it. Obama is a champion of mediocrity and infinitesimal improvements. So there is that.

[bvar22]

264. It wasn't The Republicans who stopped the Public Option.

It was the "Centrist" Democrats.

[djean111]

501. You may as well be speaking with tongues.

Centrist Democrats are pretty much Republicans. Non-centrist Democrats are jeered at and undermined.
The democratic party is run by the Third Way now.
Obama is a centrist. I have no reason to believe he would champion single payer if all of congress was Democrat.

[TBF]

48. Capitalism has to go -

there is no reason on this earth that we have to subject health care, water, shelter, education, etc to a for-profit system. We are being strung up by a bunch of billionaires who enjoy hoarding their wealth. The fucking system needs to go. We all know who the president works for (and so does he - and my guess is he doesn't want to end up like Kennedy so he is playing their game).

I don't know what else to say. We need more people as angry as you. But we need to be angry at the right thing & fix it. And we need to remember there are many more of us than there are of them.

And, no, it ain't gonna be easy.

[PowerToThePeople]

106. Pay us or DIEEEE!!!11!!

I was going to comment earlier on the banker jumper thread that they were just preempting the guillotine parade by jumping.

I understand the anger against the liar, he who said he had our backs but turned out not to.

Capitalism and the profit motive IS the real underlying problem here. It is the "root of all evil." Nothing will change for long while that system is still in place.

[Lex]

52. This article might be of help?

http://www.washingtonpost.com/national/health-science/things-you-need-to-know-about-the-affordable-care-act-and-prescription-drugs--but-probably-dont/2013/12/09/c00054c4-5eba-11e3-95c2-13623eb2b0e1_story.html

If you are taking medication for a chronic condition or something that has a high retail price, you may want to ask whether your plan maintains a separate list of specialty pharmaceuticals that are covered. You should keep in mind that the formularies are constantly in flux, and right now more than usual. For some plans on the exchange, the drug formularies are a work in progress as medical and patient advocacy groups continue to press insurers to add certain medications they think are important to cover.

[bravenak]

54. You should not call people pieces of shit.

I sympathize but fuck that piece of shit nonsense. A write who can't come up with a better turn of phrase?
I never even called bush a piece of shit. And he was.

[tridim]

61. I think Will's account has been hacked. There is no other explanation. nt

[WilliamPitt]

64. Nope.

[tridim]

67. Then it's just the gift of anger.

Sad.

[zeemike]

183. And he should not be angry when his wife's life is at stake.

Sad.

[tridim]

512. He is angry ALL THE TIME, at Obama. nt

[zeemike]

514. And you are hyperbolic ALL THE TIME. nt

[tridim]

515. Genius response in this shit thread.

Congrats.

[zeemike]

516. Sometimes being a mirror is all you can do.

And I am sure you will never look in it.

[bravenak]

76. I am feeling a bit scared for him if that is him.

Last edited Tue Mar 18, 2014, 09:01 PM - Edit history (1)

I hope he was hacked. We democrats are supposed to be above the juvenile name calling and be proactive with finding solutions. We can solve this problem if we work together. We all want single payer. I hope he contacts the drug company and asks the for the pills. They will often give them to you free if you cant afford them and it is good press for them. It worked for my neighbor downstairs. She and her doctor called them up and asked for them and they said sure. She has them now.









On Edit: my mistake. Name calling is apparently fine here. I will know better from now on not to mention it.

[CJCRANE]

120. I hope it's resolved.

There seems to be some slight confusion in the details, but obviously it shouldn't be this complex.

I hope he explores all the options and we get a happier update in the near future!

[bravenak]

129. I think we can figure out a way if he is interested.

Once he is a bit more calm perhaps he can post a thread asking for advice. If he gives the name of the drug and the manufacturer we can help him together to petition the for the drug he needs. Maybe together? I think we can solve this problem with out any further namecalling.

[Wait Wut]

140. That's a great idea.

Maybe you could send him a message with your suggestion. He's had a post hidden in this thread, so he can't reply here.

[bravenak]

148. Good idea.

I will try it in a bit.
Didn't know about the hidden post. We need to help him.

[Cha]

225. Not me.. I recognize his raging knee jerk reaction for Pres Obama..

[bravenak]

268. But, i bet we could help him if he wants our help.

No need for him to suffer in anger if he can be helped. He can go back to hating Obama right after he gets his (wife's)medication. I'm sure he has a whole slew of other complaints. I counld do without all the pieces of shit shit. I expect better from a literary master of his stature. My dissappointment with his verbiage is profound, indeed it is.

[Cha]

282. Yes, bravenak.. I believe this poster said it best..

"Or...you can carry on without insurance, never getting to see a doctor, and die from the high blood pressure you didn't know you had.

I have been denied insurance for over 12 years. Scratch that...I was offered a 'plan' for $1200/mo that included a rider that excluded coverage for pretty much everything except falling out of my car. I now have a plan for $75/mo that doesn't exclude a damned thing and also covers meds for 50% of cost. Granted, it's been so long since I've been able to see a doctor that I'm absolutely terrified to go, now. But, I will...eventually. And, I will be grateful that I have insurance that will cover any catastrophic issues that may come up.

What Will is going through is tough, but he's received some helpful advice that he doesn't seem to want. I guess it's easier to be angry than actually fight. A lot of people are seeing real benefits from the ACA. Like everything else, this will be improved over time."

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686725

Bolding mine.

[bravenak]

292. He should take the advice on this and rail about another issue.

I would like the piece of shit comment to be deleted. It is so depressing to hear democrats call democrats piece of shit right before the mid terms, or at all really. On DU, we can just say this about democrats? When did this start being okay? Is it only ok to call Obama a piece of shit? Or can we call any elected democrat a piece of shit on here? I would think that would be depressing for turnout in the midterms, and i assume we might, maybe, WANT, to win? Any nonmember curious about democrats in the mid terms might be very turned off thinking that democrats consider their own president a piece of shit. Or am i crazy? Dont we want to draw more curious left leaning people to our party? Not scare them away?

[Cha]

304. Well he did this one "piece of shit used car salesman" Hidden and will wouldn't know "the truth" if

gobsmacked in the face.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686372

[Motown_Johnny]

56. Open enrollement does not end until the 31st, look for a new plan

It is still possible for you to change your coverage so that the medication your wife needs can be covered starting April 1st.

[WilliamPitt]

68. It's New Hampshire.

Options:

1. Anthem BlueCross BlueShield

...and six days of rain.

[sheshe2]

100. But you said in a post above that NH has ten options, have you tried the other nine?

[bluestate10]

184. Since health-care costs can't be deducted from taxes unless you run up an enormous bill,

why don't you cross the border into Massachusetts or Vermont and join better plans. Massachusetts is the best choice given the variety of plans available. I apologize, I thought that you lived in my state, you instead live in the currently second most backward New England state (next to Maine). The problem is your state, New Hampshire hadn't expanded Medicaid as of two months ago, even with Democrats leading the state.

[Motown_Johnny]

265. First, edit your OP. This is a state issue

and blaming President Obama makes no sense at all. Most of us have a wide variety of choices.

Second, speak with a navigator just to make sure that BC isn't screwing you and that there is no better plan available.

Third, contact the manufacturer of the medication. Most companies have plans to help people afford the medicine they need.

Forth, look into a supplemental prescription insurance. I had some company send me cards for one last week. I gave them to a friend who has health issues in the hope that she can enroll with that company. I can look into it if you have issues finding something.


I wish you and your wife the best. I have to believe that there is an answer out there for you and I hope you find it.

[Purrfessor]

502. We have Anthem and use eScripts as their mail order pharmacy

My wife's doctor prescribed a new medication. The first eScripts rep I spoke to said it was not covered. I called a second time and was told by a different rep it was not covered by eScripts but was covered by their specialty pharmacy, Accredo, which dispenses these newer, specialty drugs. The rep connected me to Accredo. I provided them the requested info from our end. They contacted the doctor and within 10 days we received the prescription. It was covered. I just had to speak to the right person in order to navigate the maze. Your situation may be different but you should inquire further. If eScripts is your mail order pharmacy, call and ask them about Accredo and if the drug is available via that route.

[JoePhilly]

57. Have you gone to the National Multiple Sclerosis Society web site?

Particularly ... this section...

http://www.nationalmssociety.org/Resources-Support/Insurance-and-Financial-Information/Health-Insurance/Appeals

Looks like hey provide materials to help you and your doctor appeal such decisions.

[steve2470]

205. I found this on their website as well

http://www.nationalmssociety.org/Treating-MS/Medications/Aubagio

Financial Assistance Program

MS One to One, www.msonetoone.com or call
1-855-MSOne2One (1-855-676-6326)

This was for Aubagio. The other MS drugs, I'm guessing, may have similar pages.

[DebJ]

396. Kudos for you too!

[DebJ]

394. Cool! Nice to see some real assistance being offered!

[tridim]

58. Misplaced anger is the downfall of many great people. nt

[1000words]

77. Misplaced loyalty, too.

[Aerows]

622. Even moreso. n/t

[msongs]

60. aca is not about health care, it is about health insurance companies health care may or may not be

better

[treestar]

65. So it was covered before, and now isn't?

And the entire ACA would be just fine, it if met one person's specific needs only? You'd throw out coverage of everyone else over this?

And why not fuck Congress and Joe Lieberman? What did you think the president was, a magician who could just make them pass a good single payer system? I wish we had that too, and no doubt so does Obama. But not enough of our fellow citizens do.

[WilliamPitt]

71. You're missing the point.

They are providing general coverage, and then denying coverage for specific medications.

Which makes the general coverage useless. My wife can go get a free scan that shows how fast her disease is ravaging her, because she doesn't have the medication she needs.

Shell game, tree.

[ChazII]

101. +1

I have heard of other cases similar to yours. Granted they are only anecdotal but they come from an internet community of those who have NF1.

[lostincalifornia]

185. I you feel there are no alternatives, or your physician's authorization cannot remedy it, then start

to investigate the viable pharmacy's in Canada

[bluestate10]

196. She asked you a simple question. WAS the drug covered by you plan before

implementation of the ACA? Were there restrictions on the use volume? Unfortunately the ACA didn't fix all problems - the President has to implement the law and has only limited levers that he can use during implementation, and when he uses one of those levers the right goes bullshit.

Why do you think the President can and/or should tunnel down to a plan prescription policy and override that policy? The right would be calling him a love child of Stalin and Hitler if the President corrected a bad local plan.

You live in a state that doesn't offer a good choice of plans. That sucks for you and is wrong, but understand that isn't the fault of the President.

[pnwmom]

435. Your agent falsely told you a non-exchange insurer may deny someone for preexisting conditions.

And with regard to medications, formularies have to include choices from every class of medications.

You need to check all the formularies of insurers available to you, both on and off the exchange. Your agent friend is wrong about that being a waste of time. He's either being lazy or he has a vested interest in your staying with whatever plan he found for you. Or both.

[theboss]

578. Are other MS medications covered?

Is the problem this one specific medicine is not covered?

This is a common problem - going from one plan to another and having a drug fall off the formulary.

Sometimes, you can get it added. Sometimes, you can find another drug.

Of course, you provided no info here.

[dembotoz]

85. that is the problem with using the existing insurance companies

when you give a weasel
the chance to be a weasel
it will be a weasel
because it is a weasel


there should have been a button labeled
who does this fuck
on the information page for the plans

[Lydia Leftcoast]

87. A long shot and possibly illegal

but do you have contacts in Canada who could write a prescription that you could buy for a reasonable price?

Elderly snowbirds from Minnesota who winter in Texas or Arizona buy their meds in Mexico.

[lostincalifornia]

190. Just use the prescription that the U.S. doctor wrote, and have it filled by a reliable pharmacy in

Canada through mail order. People do that all the time. You need to make sure it is an accredited pharmacy and research it out, but that should work

[MADem]

364. Or go for a drive. It's not like he's all that far from the border.

If he gets to Canada by lunchtime he can be home for dinner.

[Aerows]

623. Medication from Canada

is like 1/4 the cost of a prescription in the US. Why people don't see this as a problem, I will never know. Why are there no regulations to prevent price-gouging?

If something costs 1/4 of the price in another country, somebody is profiting handsomely and basically robbing the public.

[lostincalifornia]

626. One argument that has been used is that we are subsidizing the other countries costs for the drugs,

which is why ours are more expensive.

Whether that has any validity or not I do not know, but one thing is certain, Congress had opportunities equalize the issue, and does everything to subvert it

[Aerows]

628. It's a bullshit argument

Nobody sells anything unless they profit from it. Drug companies wouldn't sell it in other countries if they didn't make a profit from it. They just have free rein in the US to charge whatever they think they can get away with, even if it comes down to life or death for their fellow human beings.

[lostincalifornia]

666. Regardless a lot of the problem is Congress

[Aerows]

667. No arguments from me

Congress couldn't operate a bake sale without screwing it up, never mind managing a nation's legislature. There are only a handful of them that actually give a damn about the American people.

(Oh, and your post is 666 ... spooky)

[lostincalifornia]

672. So should I self-delete?

[Aerows]

673. I was just teasing

I didn't mean anything by it, I just noted the number.

[lostincalifornia]

675. I didn't take you seriously, though I did repost the same response, just in case

[Aerows]

677. Seriously, I really didn't mean anything by it

It was a playful post.

[lostincalifornia]

678. I know. LOL

[Aerows]

680. You never know

I've probably angered an entire legion of Obama fans, but I will relate my story, and join with the other voices that demand better than we have health care.

[lostincalifornia]

674. Regardless, a lot of the problem is Congress

[Aerows]

676. A lot of the problem

is a thoroughly corrupt system where lobbyists write the laws and Congress members sign them in exchange for campaign donations.

That's the main problem, and it doesn't just happen in the health care industry. I wish I had a solution to the problem, but I don't. The system will only change when it buckles under it's own weight.

[Common Sense Party]

89. Does RomneyCare have the same problem in Mass?

If so, it's surprising that this wasn't known BEFORE the ACA was passed and rolled out.

[bluestate10]

202. The OP lives in New Hampshire. Until LePage took over in Maine, NH was the

reddest New England state. Even though New Hampshire is led by Democrats, as of two months ago, it hadn't done Medicaid expansion. I live in Massachusetts, I have yet to see patients get denied needed medication or have problems paying for it. The ACA was modeled after the Massachusetts plan.

Let me get something straight. Don't call the Massachusetts system RomneyCare. The Democratic Legislature in Massachusetts had to repeatedly override Romney vetoes to get the plan we have. If Romney had his way, Massachusetts residents would have had a fucking barbaric healthcare system.

[MADem]

365. The plan in MA is very good. I've got friends and family with complex medical issues and they

are very satisfied.

It's fun to call it "Romneycare" for one reason, though--to fuck with Romney! He used to get so MAD when people would say it, so it's a great "Nanny nanny boo boo"--hell, this thread is all about behaving in an immature fashion, after all....

[dionysus]

91. calm down Will, have a stiff drink. nt

[Mr.Bill]

109. If only we could get them

to cover the stiff drink.

[dionysus]

199. yeah it's probably out of network.

[Bluenorthwest]

95. If there is any research or other assitance any of us could provide, please ask no matter

what. There is nothing so enraging as seeing a loved on suffer needlessly. I am very sorry she's having to endure this. It is unconscionable.

[Auggie]

98. Did anyone expect insurance companies to allow their profits to be fucked with?

No way

[dilby]

108. I cerntainly didn't.

When I saw the ACA I immediately saw a system where the people would be ripped off by Insurance Corporations. Single Payer was the only solution because now every American can have health insurance but it does not mean they can have healthcare.

[CJCRANE]

102. I hope you're able to resolve this, Will.

Channel that anger and get the DU crowd into action!

[rudolph the red]

178. New Jersey?

[nadinbrzezinski]

179. You are right, my mistake, he should call his delegation from Massachusetts.

Still services should be able to help. That is what they do.

[nadinbrzezinski]

329. And I was right. Will lives in New Jersey.

I will self delete cause it matters not, and gave him the exact same advise on the FB. Coming from me it means bird droppings or something like that. He should include the insurance commissioner as well.

The only thing I will add to this, is that this is why we need single payer, period. I am not holding any hopes the present dysfunctional political system will give us results friendly to the people's needs. We need far more than people pissed off on website.

[rudolph the red]

338. The OP lives in New Hampshire.

[nadinbrzezinski]

342. My apologies, he should still contact his delegation

That still applies.

It does not matter what state you live in. Never mind, that is less valuable than bird droppings since it is coming from me. I mean that.

[rudolph the red]

346. Agreed

sorry, didn't mean to be negative, just wanted to be accurate.

[Douglas Carpenter]

104. true.. but no "mainstream" candidate for President in the last 30 years would dare disobey

the insurance companies. That is the simple reality our utterly corrupt and depraved political culture.

[LiberalAndProud]

107. I'm so sorry, Will.

The ACA has been a boon for some, and I'm genuinely glad for them.

So. Now you're faced with the question of paying for the medicine your wife needs or paying for your insurance. Would that be a fair assessment?

So. Let's celebrate our contribution toward reducing the deficit.



Obamacare falls far short of what it should have been. I guess the president is as good a receptacle for our disappointment as any. The legislation we ended up with probably has nothing to do with the debacle that was Mrs. Clinton's task force. Probably.

[seveneyes]

110. It's these kind of inexcusable problems with the ACA

That made passing the bill before we could see what was in it a real problem. I am afraid there will be many more people in a similar situation before it gets any better.

[cheapdate]

423. It's simply not true that nobody read the health care bill before it was passed.

The house and senate worked separately on different approaches to health care reform. The house debated several different approaches and approved of legislation that included a public option (which was the approach favored by the president). The senate advanced a bill out of the Finance Committee. This was the bill that eventaully became law.

I'm not going to recount the entire series of procedural steps that eventually led to passage of the senate bill. Suffice it to say that up until right near the end, the house continued to fight for its legislation and the senate continued to push for its bill to be adopted. With time running out, house leader Nancy Pelosi conceded and brought the senate replacement bill to the house floor for a final house vote.

The house approved of the senate changes and when asked by the press about the vote, Pelosi said with resignation and I'm sure no small amount of frustration that she hadn't read the bill. Her entire energy had been focused for more than a year on passing the house bill. She hadn't read the senate bill.

But by no means does that mean that no one read or understood the senate bill before it was passed. The "Baucus Bill" had been under consideration in the senate finance committee as early as 2007. The committee published an early draft of the bill in November 2008, just days after Barack Obama's election. By that time, the senate had been holding hearings on the bill for more than a year.

The bill would not be passed until after another year and half of hearings and debates. During that time, it was subjected to the most intense interest, scrutiny, and debate of any other single piece of legislation in my lifetime. The debates took place in Washington and around the entire country. The bill itself was publicly available for this entire time. Many people read and reviewed it.

Both the bills (the house and senate versions) were publicly available. Both bills were thoroughly reviewed and scored by the CBO. Both bills were thoroughly scrutinized and reviewed by numerous health policy institutions who published review papers, summaries, and guides for anyone who was interested. Private and professional groups with an interest reviewed the proposed legislation exhaustively. Anyone who was interested could review the bills. I did.

[seveneyes]

504. The most basic...letting a doctor decide which medicine, not an insurance company

Should have been written in stone. Inexcusable.

[cheapdate]

665. As has been pointed out by others on this thread,

any viable system will include cost controls. Even a not for profit public system will have cost controls. That's reality.

As it was, the health care reform law passed without a single vote to spare -- including all 58 Democrats and both independents (Lieberman and Sanders). Robert Byrd had to be wheeled onto the senate floor in his wheelchair to cast his late-night vote for cloture to move the bill for a full vote.

The Democrats had a 60-vote majority in the senate for only a window of time -- between the time when Sen. Al Franken was finally seated and the time when Scott Brown won the special election to replace Ed Kennedy.

It's easy to call the health care law "inexcusable" but it could have just as easily fell short by one or two votes and died -- just as the DREAM Act did.

We would have completely blown any opportunity to make any positive change. Insurance companies would be free to continue dropping policy holders when they get sick, denying coverage to the very people who needed it the most, etc. There's no telling when, if ever, there would be another opportunity. Certainly not now and not in the near future either.

It's easy to call it "inexcusable" when you're not the one counting votes in the senate and weighing chances for winning or losing while the window for action is closing.

I think the law does a lot of good and is a good start. The SCOTUS decision on Medicaid expansion was a big blow, but in the long run it may help to turn opinion in some red states where governors and legislatures have refused the expansion, so it too may wind up being a positive.

One day we may have a congress ready to work again to improve health care. Obviously, that means a Democratic congress because as long as the Republicans have any control at all it's not going to happen.

Vote for progressive Democrats.

[Skip Intro]

111. It isn't what was promised, we were lied to, and people are suffering for it.

I'm sorry you and your family are among them.

[ProSense]

128. No one "lied" about the problem in the OP.

In fact, it's the OP's responsiblity to check to see if his insurance company covers his family's medications.

Drug formularies are not the President's decision, and existed before the ACA. They exist in Medicare Part D.

The one thing the ACA did do is introduce a new rule applicable to appeals.

Appealing Health Plan Decisions

The Affordable Care Act ensures your right to appeal health insurance plan decisions--to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”

http://www.hhs.gov/healthcare/rights/appeal/appealing-health-plan-decisions.html

[Lex]

153. The President's personal choice is probably single payer.

But that wasn't going to pass at all.

[Doctor_J]

419. no it wasn't

He lied about that in the campaign.

[Lex]

420. Sure

I'll take your word for it that you know what he personally wants in place as opposed to what could reasonably pass.

[bvar22]

581. In 2008, Camnpaign Obama said that he preferred Single Payer,

but couldn't support it here because we would have to "build it from scratch",
and it would be easier to build upon our existing private system.

Now, "build it (Single Payer System) from scratch" is indeed a LIE.
There are TWO Pre-existing successful Single Payer Systems if the USA:
Medicare and the VA.
We could have expanded either one.

[Skip Intro]

274. Oh please.

Obama said, clearly, if you like your plan you can keep it. He said clearly if you like your doctor, you can keep your doctor. No if that, or unless this. In fact, he said period. Repeatedly. For months. And he knew it wasn't true. Those are and were lies. If you claim to others that something is true, and you know it to be false, you are lying. He said people's rates would go down, $2500 per year for the average family. Rates went up substantially, skyrocketing for many, making it unaffordable for some. He had to know that was a false claim too.

Millions of real people have been negatively affected by the ACA, after they were told, promised, lied-to, that they wouldn't be. They have every right to feel betrayed.

So trust is lost. Thing is, when you lose trust, thinking people won't believe anything else you have to say, either. Does anybody believe his assurances that the NSA isn't spying on the American people at large? I don't know anyone who takes him seriously on that. It is assumed he is lying at this point.

Btw, saying to people like Will, and as I believe you have said to me as well when I relayed a negative experience with Obmacare, that in essence, we shouldn't have believed the hype from Obama, and should have read the fine print, is a lowly tack to take after the fact.

[ProSense]

327. What

"Obama said, clearly, if you like your plan you can keep it. "

...the hell does that have to do with the OP?

[Skip Intro]

343. It's all a parsing and spin game with you, Prosense.

I don't think even you buy you at this point.

[ProSense]

351. This thread isn't about facts.

It's fly paper for those who want to attack the President based on inaccurate information.

[Skip Intro]

353. Little here is about facts when those facts "hurt" Obama.

Because spinners come along and do their best to obscure those facts, often by attacking the character of the messenger.

[Rex]

696. It has become so very obvious over the years.

Have to agree with your assessment.

[Demo_Chris]

112. Good news! No matter how bad they fuck you, thanks to Obama you still have to buy it. nt

[bluestate10]

113. I don't need expensive medication, but sometimes I get rejected for a maintenance medication

because my use rate goes outside a model. When rejected, I tell the Pharmacy to fill the prescription and I pay for 100% out of pocket. This happened before the ACA and hasn't changed.

There may be alternative medications for your wife that are less expensive, medical plans default to the least expensive medication that works. I don't know your wife's medical details, so I won't render an opinion, I just related my personal experience with medication.

[Aerows]

625. Quick question

Why is it that a prescription for a common drug in the USA costs 4X more than it does in, say, Canada?

Do you happily pay 4X more for anything else besides a prescription and think you are getting a great deal?

[Bernardo de La Paz]

116. While you are at it you should fuck the 5,000,000 who now have insurance & didn't before.

There is too much desire for all-or-nothing perfection.

I"m sorry about your wife's condition, but go ahead, take nothing or take the better deal you had before ACA.

[dilby]

121. Having insurance is not the same as having healthcare.

So what you have insurance, doesn't mean anything if it does not cover the stuff that saves your life. So you can go get a checkup that is great and the doctor can tell you that you have high blood pressure but you still have to pay out of pocket for the medication.

[Wait Wut]

137. Or...

...you can carry on without insurance, never getting to see a doctor, and die from the high blood pressure you didn't know you had.

I have been denied insurance for over 12 years. Scratch that...I was offered a 'plan' for $1200/mo that included a rider that excluded coverage for pretty much everything except falling out of my car. I now have a plan for $75/mo that doesn't exclude a damned thing and also covers meds for 50% of cost. Granted, it's been so long since I've been able to see a doctor that I'm absolutely terrified to go, now. But, I will...eventually. And, I will be grateful that I have insurance that will cover any catastrophic issues that may come up.

What Will is going through is tough, but he's received some helpful advice that he doesn't seem to want. I guess it's easier to be angry than actually fight. A lot of people are seeing real benefits from the ACA. Like everything else, this will be improved over time.

[Number23]

467. Thanks for your post.

[Bernardo de La Paz]

139. True. But Obama made affordable insurance the law of the land.

Affordable is better than nothing, even if it is far from perfect. I doubt if anything better could be gotten through in this day and age. It will have to wait for another Democrat, who will push through a better system in a more receptive time and will probably be accused (with some truth) of also being a "used car salesman" because even that system will not be perfect.

[dilby]

152. Single Payer would have been better.

A single payer option like Medicare with the ability to purchase private insurance if you wanted the Mercedes Benz version of healthcare would have been the solution. It would have covered everyone without them paying to make a private company richer and it would have silenced people who prefer their existing healthcare.

[Lex]

154. I bet the President would have definitely preferred single payer, but

that wasn't going to have a snowball's chance in hell of passing. Not at this point.

[dilby]

158. Well now it never will.

We have a system that basically says you have to pay a healthcare tax to a private company that may or may not offer you services.

[Bernardo de La Paz]

162. "Healthcare tax" phrasing is Republican framing of the issues.

... regardless of what Justice Roberts wrote in his opinion.

[Lex]

163. No, this mediocre ACA is a step on the road to eventual single payer once

people get used to most everyone being covered, they are going to want more and the overall savings that single payer would bring.

[jeff47]

439. Nope, the ACA makes it more likely

The ACA moves the battle to the states. It's much, much easier to pass single-payer or public options in blue states.

Those plans won't have the 20% profit, so they'll be cheaper, causing some to switch. Those plans won't result in a pile of dead bodies, causing more to switch for price. That gives a better risk pool, making the public plans even cheaper. Private insurance won't be able to compete.

With real-world examples in those states, it's going to be much, much easier to create such plans in purple states. Which will follow the same course.

All those examples will make the national battle much, much easier.

[Bernardo de La Paz]

160. Of course, but too many scared Dem congresspeople would have voted it down.

That is not Obama's fault.

[Skip Intro]

366. +100. n/t

[truedelphi]

380. When those five million go to use the insurance, then

maybe you'll "get it."

Health insurance is not health care. And unless you have decent insurance through your employer, or you are rich enough to have a premium policy, you will indeed find out that carrying around a bright and shiny plastic card that you pay X amount of each month for the privilege, is only something offering you the right to sit and listen to elevator music on the insurance appeals' line.

[brush]

488. Not true and you know it

If you have a health insurance plan you do not have to cough up out of your own pocket the thousands of dollars to get treatment in a hospital.

You have to know that paying the full bill for just a day or two or three in a hospital can break the average person.

With insurance you will pay a just percentage of it.

[Bernardo de La Paz]

499. I get it. Insurance is not health care. But they will get more care than they got before.

Maybe you'll get that. At least they'll have some care even if it is not gold-plated US House of Representatives member care.

[Duval]

125. Oh hell! I'm so sorry, Will. n/t

[boston bean]

134. You live in MA right?

Weren't you mandated prior to ACA to have health insurance?

Did your prior plan cover the medication?

I'm sorry your wife has been denied medicine she needs. That really sucks and should not be happening in a civilized society.

[MADem]

384. He moved to tax free NH, there are fewer options up there. nt

[Duval]

138. WRP, if it were

my husband, I would have felt not only anger, but fear. We are retired, and our secondary insurance is Blue Crap, Bull S&*t. They upped the price of meds we take as well as the percentage of our co-pay. I just hate it for you and your wife.

[lumpy]

192. Just what mankind needs, more hate. That will sure come in handy in obtaining pills for Mrs.Pitt.

[naturallyselected]

141. I have had many a fight with Anthem about non-approved medication

Won some, lost some. It stinks, but I didn't expect this to change under the ACA. I have found it is sometimes worth the fight - I have unexpectedly won a couple of battles.

I came across this article from the Toronto Globe and Mail. A couple years old now; I don't know if the situation has improved.

Link:
http://www.theglobeandmail.com/news/national/time-to-lead/the-cost-of-drugs-breaking-the-bank-to-stay-alive/article4263623/?page=all

Clip -

Julie Easley had just graduated from the University of New Brunswick when she was diagnosed with Hodgkin's lymphoma. She was 23 and broke - with exactly $9 in her bank account.

Thankfully, in Canada, her medical care was free of charge - or so she thought.

In fact, while physician visits and in-hospital care like chemotherapy are covered by medicare, Ms. Easley soon learned that the essential medication she needed to take out-of-hospital was not.

End clip -

So single payer doesn't necessarily solve this problem. I don't know what percentage it is, but many in Canada buy private drug insurance for just this reason.

I'm sorry to hear this. As long as the pharmaceutical companies want the prices they do for some medications, we're stuck with these tragic occurrences.

[kardonb]

147. fu

only illiterate people need to resort to foul language ! You should have informed yourself about medication coverage the Co. you signed up with provides . ts always cheap and easy to blame everyone else for your own mistakes . Grow Up .

[meanit]

187. What would have been different

if he checked the medication coverage prior to signing up? It's still not covered and it doesn't sound like any of the plans cover it, but he still has to have the insurance by law.

[Hissyspit]

275. Let me get this straight...

You are complaining about a long-term poster's use of language, which has ALWAYS been allowed here in the interest of freedom of ideas, and you start your post with "fu?"

Right.

[Agony]

149. ANY medication that a physician prescribes should be covered by health insurance

fuck this uncivilized bullshit and anybody who supports it. this is not complicated, end of story.

I have encountered this personally, sorry Will (and anybody else) that you are dealing with this. The same anger flows through me.

This is one of the reasons why _we_ are not exceptional.

[steve2470]

168. I completely agree

see my post at http://www.democraticunderground.com/10024685964#post164

[pacalo]

150. I understand Will's anger.

Prescriptions are expensive -- something lost on those who served as jurors on his hidden post.

Between my husband's very expensive medications & those for my son, we couldn't afford their monthly prescriptions without the help of our insurance coverage.

I would be as livid as Will if the same happened to us. I hope Will uses his anger to right this wrong.

[Whisp]

161. I could too if it weren't for a certain history of

consistently overwrought hate and misdirected anger toward this administration under a whole lot of subjects.

[pacalo]

169. I agree with you to a certain extent, Whisp.

Considering all the roadblocks Obama has to contend with, I think he's among the top presidents in my lifetime. He's a victim of circumstances (the PTB) in many issues that cause arguments on DU.

However, Will has a right to be very upset about this issue.

[brush]

489. Not to call the President "a piece of shit" though. He's got anger issues — and with the President

[pacalo]

495. We don't know at this point that Will won't regret his choice of words.

And it's okay for a Democrat to have anger issues with the president; he's a public figure who makes decisions that impact our quality of life. Whenever I see a Democrat have anger issues with president, I understand that the president has harmed someone's interest on issues very important to them.

[Whisp]

543. Not in that childish and disrespectful way.

That one has been banned a couple of times from DU but somehow manages to come back and start the road there again and again by not being able to control his anger.

Sorry, calling the President a piece of shit is Not acceptable. That is something some asshole teabagger would say in Congress or at a moron rally. It is Not acceptable here.

[brush]

588. IMO he should regret it. You can express anger issues without being digustingly disrespectful

And it even makes me wonder why this extreme anger is being openly voiced on DEMOCRATIC UNDERGROUND (THIS IS NOT FREE REPUBLIC AFTER ALL) towards a black president — who happens to be a DEMOCRAT.

COME ON, ALREADY!

He went waaaaaaay too far with his choice of words. And he's a writer no less. No excuse for calling the president a "piece of shit."

[marble falls]

535. The language may be over the top but the opinions aren't. I look forward to his posts.

[blindersoff]

155. check with the company that makes the medication

I am on an MS injectable drug and when I changed insurance through my employer in November found out that my cost would go up almost $100/month (from $80 to 175). My insurance company advised me to call the Pharma company and ask them about copay assistance. It took about 3 weeks to get it all together, but my copay is now $10 per month. Just goes to show you how much the mark up is on these drugs. The caveat was that I could not be on Medicare or Medicaid in order to get this copay assistance. Good luck to you and your wife. Keep her from getting stressed out (and you too!)

[tarheelsunc]

157. I thought "covers preexisting conditions" meant that you would be able to get affordable insurance

Whether or not it covers specific treatments for specific conditions depends on 1) if the plan is required by law to carry that and 2) if the company chooses to add that coverage on their own. Like others have said, you should be able to get info on what's covered by the insurer and what's not before actually enrolling.

[steve2470]

164. Hi Will, I just looked up Aubagio...

which apparently is a commonly prescribed drug for MS. I looked it up on my website for my plan with Blue Cross Blue Shield of Florida at http://bit.ly/1gyyj5M (password required for a member).

It's not covered under my plan and I pay good money every month for my policy. Cost per month (if one had to have this per one's doctor) runs $4,868.41 per this site.

I guess all I'm trying to say is, you are not alone in your predicament. If I or my son were to be diagnosed with MS and require Aubagio, for instance, I would be in serious financial trouble.

[Wait Wut]

214. I found some info...

...without really being educated on the drug or the disease, the site looks like it has some options. I also researched a few other drugs and they all seem to have some type of solution to the (ridiculous) costs of the mediations.

https://www.aubagio.com/aubagio-copay?s_mcid=PSAOGO37

[steve2470]

219. yes good point

I saw that page after I made my post. If I had to take that drug, I'd be beating down every door I could find to afford it. It's "retail price" is just unaffordable.

[Wait Wut]

227. Maybe we should be pissed off at the pharmaceutical companies...

...and not the President. Hell, I'm only half blaming the damned insurance companies for this. I am curious to know what they end up paying compared to what you or I would pay, though. I'm fairly certain they aren't shelling out 5 grand.

From what I've read here and a few other places, our friends in Canada are in the same boat with medications. Single payer doesn't seem to be a complete solution. So, we need to start going after the right companies for the right reasons.

Years ago, I remember this being a priority. I think we've become sidetracked with other issues and forgot that people can't afford to take their damned pills. Will has the opportunity to make this hot DU issue, but I think he needs to refocus his energy a bit. His anger has gotten the best of him, which I can somewhat understand, but it isn't going to change anything.

[steve2470]

229. It is a serious issue

Of course, big pharma has to make their enormous profits before they lose patent protection, and Wall Street usually loves the pharma companies for their profits.

Health care for all before profits, not the other way around.

[Wait Wut]

231. It is, but...

...what are we going to do about it? I have to admit, I was surprised to hear that Canada has the same issues. Can we put a target on big pharma and make it stick this time? I'm going to assume they're a little nervous with all that's going on in healthcare. Maybe now is the time to start pulling the curtain back and putting them back in the spotlight.

[one_voice]

237. Maybe we should be pissed off at the pharmaceutical companies

Yes, yes, yes.

Pharmaceutical companies are horrible.

This is an old article, but it still applies.

Americans pay some of the world's highest prices for their prescription drugs. While other governments usually negotiate prices, the United States has traditionally let companies decide for themselves what to charge.

According to one study, Americans paid an average of 54 percent more than Europeans for 25 commonly prescribed drugs. Some essential drugs are especially costly in the United States. A month's supply of Eldepryl, a Parkinson's disease medication from Somerset Labs Inc., costs about $28 in Italy, $48 in Austria and $240 in the United States.

*snip*

http://www.nytimes.com/1991/05/24/business/why-drugs-cost-more-in-us.html

another one http://www.cnn.com/2004/ALLPOLITICS/01/27/timep.drugs.tm/


I can't find a more recent article. The only thing that has changed is it's gotten worse, imo.

[marble falls]

537. You mean we aren't pissed at Big Pharm already.

[Wait Wut]

576. I remember not that long ago...

...when this was a hot issue here and everywhere else. We got sidetracked with the ACA. I think it's time we refocus.

[Aerows]

641. Canada has price controls

Here, they just charge whatever they think they can get for it. They might as well be holding people at the barrel of a gun because if it is a choice between life or death, most people will choose life until they drown in debt.

[Wait Wut]

685. It's insane.

It makes the US look like a country full of fools. I tried finding some politician or anyone, really, that seemed to have an interest in making changes and couldn't find a damned soul. This weekend I'm going to start sending out some emails to people I think may give a damn. If you have any suggestions of names to add to my list, I'd appreciate it. It probably won't do a damn bit of good, but we have to start somewhere.

I'm grateful that I can have insurance after 13 years. But, there are still too many people suffering because of the cost (and denial) of prescription medication. It's damned heartbreaking.

[lostincalifornia]

167. find another insurer under the exchange that will cover it. If they do then find out if you can

change insurers since this is before March 31. If they don't, then see what appeal process is available with the insurer.

[Politicub]

173. Did you look at the insurer's formulary?

That's the first thing I look at when presented with health plan choices. My husband has several medical problems, and not all insurers cover his durable medical and medication needs. This is the reality in which we live.

I think this is an episode where you should look in a mirror and shake your fist. It's research you should have done, and blaming the President seems counterproductive.

But yes, fuck for-profit insurers. I'll join you in saying that.

The ACA needs a lot of fixes, but getting away from job lock just for health insurance is so important to many of us.

I'm really sorry to hear about your wife, and hope you are able to find a solution to getting the cost down for the medicine she needs.

On edit: did you try this?
https://www.healthcare.gov/what-if-i-want-to-change-marketplace-plans-after-i-enroll/

[jamzrockz]

186. Any chance u can give a little bit more info

about your situation, which insurance company, which drugs etc etc. Maybe someone around here with the knowledge could help you figure this out. ACA is not perfect but we have to chill down and work this out like adults.

[spin]

188. Reading through this thread I find myself somewhat amazed that even on a very liberal ...

and progressive site such as DU so many are finding fault with the ACA.

I have long wished that our nation had a truly world class healthcare system and consequently that has been a main reason that I have voted for many Democrats over the years.

To me it is obvious that the supposedly most powerful and wealthy nation in the world should have a good healthcare system for all citizens. The one we had was at least twice as expensive as that in many nations and inferior to most.

So I celebrated Obama's election and hoped that those in the Democratically controlled Congress would look at all the other healthcare systems in the world and pick the best features of the best to create our own. I didn't expect it to be inexpensive but I did feel that a properly designed plan would save the average person a lot of money but deliver a higher level of care.

I'm not sure why we ended up with the plan we have but I have to admit that I was disappointed. Still I felt it might be a good first step and with some effort it might prove far better than what we had which would not be a major accomplishment.

Of course the Republicans, the party of "NO", oppose ObamaCare and are are trying to repeal it. Considering their opposition to any policies that Obama advocates this is not surprising. Most Americans wish to keep the ACA but many wish to improve it so it is far better and cheaper.

This thread greatly disturbs me. When a long term poster such as WilliamPitt finds serious fault with the ACA and many other posters here agree with him, I fear we have a serious problem. How can we rectify this and how do we win seats in the midterm election or put another Democrat in the White House after the next Presidential election if ObamaCare is widely unpopular even with progressive liberals?

I was hoping for something like Medicare for all. I currently am retired and on Medicare with an excellent Medicare Advantage Plan. While not cheap, I find it affordable.

Last year I had a fairly serious operation which required me to stay in cardiac intensive care overnight and also involved a lot of expensive tests and office visits prior to the procedure. My out of pocket expenses for all the office visits, the tests and the operation and overnight stay was $0.00.

I now understand that the costs of Medicare and Medicare Advantage Programs will likely rise significantly in the future to help finance the costs of the ACA. If so, and I have another major medical issue, I may end up with no funds and living on cat food. I guess if there are major changes to Medicare, I best hope that I have a major heart attack and die in my sleep. Admittedly I have lived a good life and currently am currently contributing little to our society or the wealth of the rich and powerful who run it. Since I am an unproductive citizen why should my government waste money on me while it can spend that money on a far more productive citizen. The fact that I served in the military during the Vietnam era and worked all my life and paid taxes is totally irrelevant.

[Lars39]

195. You could be going to VA for medical care.

[spin]

249. I tried a few years ago. ....

I filled out all the paperwork twice over two years but was rejected because the VA felt I had too much money in my 401K. (I'm far from rich.) I also am only a Vietnam era vet and didn't serve in a war zone but was stationed stateside during my entire enlistment. (I have few war stories to tell my grandkids. I have tremendous respect for anyone who actually served in Vietnam. In my opinion they deserve VA care far more than I do.)

I have to admit that I somewhat disappointed as when I enlisted I seem to remember that I was promised lifetime healthcare. Perhaps I would have had this care had I signed up right after I left the service but I was always had a excellent healthcare plan through my employer for a very reasonable price.

I recently had a conversation with an employee of a local VA healthcare center. She told me to bring my DD Form 214 to the VA hospital and try applying again. I should take her advise and likely will if major changes occur to Medicare. Perhaps things have changed over the last five years.

[Lars39]

260. I think there is an income requirement, but Viet Nam era vets are eligible.

My brother was one, too.

[Hoyt]

203. I find myself feeling much the same. Many DUers are opposed to Medicare Advantage plans, yet they

are quite popular. Traditional Medicare without a supplemental policy has no out-of-pocket cap, and lacks the coordination of care that is so important nowadays. Traditional Medicare does not cover everything either, nor do health systems in many countries like Canada and Britain.

I think Obama got the best he could get as far ACA with the Republican opposition. Something had to pass, or we'd be stuck with the status quo for decades just like what happened when Hillarycare was defeated.

I'm not optimistic about midterms or 2016 or what will happen if Republicans take charge.

With this issue, I think some information is missing, but because OP had a post hidden, he can't respond.

[spin]

254. I had an excellent healthcare plan when I was working and it continued after I retired until ...

I was eligible for Medicare.

Medicare with the Medicare Advantage Plan I have is even better and while it is not cheap the cost is very reasonable. I've had excellent care with Medicare and my operation was preformed at a highly rated university hospital. I have no idea how much all the office visits, tests and the operation would have cost, but I'm sure they would have put a major strain on my assets.

I will agree that I have great hopes for the ACA and feel that eventually it will live up to its promise. Unfortunately that far less likely to occur if the Republicans win big in the midterms and the next Presidential election.

[Skittles]

251. worthy of its own thread

yes indeed

[Aerows]

636. The main problem in our country

is that there are no price controls whatsoever on health care. Ask me about an $18,000 hospital bill that I walked into the emergency room for, walked out of it an hour later, and then got 4 shots that took five minutes a piece.

And of course, the health insurance company declined it. Homeowner's insurance declined it. Unless a deity comes down and declares that it is covered, you are denied.

Having insurance is great - unless you actually use it.

Health insurance has absolutely nothing to do with receiving health care. You basically pay into a system that might do something for you if it doesn't cost very much, but when it comes to catastrophe, you are on your own.

I can tell you stories about Worker's Compensation claims being denied because a procedure was $900. Apparently, getting a piece of metal embedded in your arm if you work as a mechanic is outside the realm of coverage, and "nobody could have foreseen that happening" despite paying a shit-ton in premiums for years with no claims.

[truedelphi]

357. The ACA waw written the way it was through the efforts of two people:

Rahm Emanuel and Liz Fowler.

They spent the summer of 2009 meeting with insurance and pharmaceutical industry CEO's, sometimes in the WH basement and sometimes at offices down the street fromt he WH.

In return for their hard work, Emanuel will never have to worry about campaign contributions to run for any office he wants, and currently he is the mayor of Chicago.

And Fowler was awarded a plum and cushy spot inside WellPoint Insurance as soon as Congress and the President got the 2,000 page travesty passed and signed.

I wish I could be optimistic that some day soon, we will have ourselves some real health care reform, but with the insurance industry now having even more money than before, so it can buy even more Congressional puppets,. I am not holding my breath.

[RobinA]

393. This Thread Disturbs Me Too

A long time poster writes that his wife is having a hard time getting a drug she needs for her serious, chronic disease and a significant percentage of the responses take him to task for calling the President a bad word. Yikes. This has become a truly nasty place.

[pnwmom]

459. I'm shocked that someone as smart and informed as Will was so seriously misled.

That insurance agent-friend fed him a pile of crap and he swallowed it.

No wonder there are so many people who don't understand the law, if even Will could be misled.

The lies Will swallowed:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686037

There are ten different health insurance companies in NH. According to the independent (family friend, ally) insurance adjuster I spoke to at length this afternoon, pursuing coverage with any of them would be a waste of time. Why? Because - according to dude - the whole "You cannot deny coverage to people with pre-existing conditions" thing only applies to insurance companies within the ACA network. You heard all that shit about "Grandfathering." Well, this is that, and all of them will turn us down because they still can.

I am in the process of running down the facts of the matter, but family friend and ally was confident enough to basically tell us not to bother.

So yeah, that, too.

___________________

The facts:


http://www.nytimes.com/2013/10/26/your-money/health-insurance-options-arent-limited-to-obamacare-exchanges.html?_r=0

In general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and can’t deny you coverage if you’re already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.


http://www.insure.com/articles/healthinsurance/buying-health-insurance-outside-exchange.html?WT.qs_osrc=fxb-182807210

Drug coverage

Drug coverage is yet another variable. You may find you have more options when it comes to drug coverage if you shop off-exchange. Like provider networks, health plans can limit the drugs that are covered, or reimburse more for generics than brand-names, or reimburse more for drugs you buy mail-order than from your local pharmacy.
If you have a health condition and use a particular drug, you should check that it's covered under the plan in which you want to enroll, whether that plan is on the exchange or off-exchange, Coleman advises.
Remember, too, he says, the cap on out-of-pocket expenses doesn't apply to drugs not on a health plan's list of covered medications.

[brush]

491. it amazes me too that there are so many Obama haters . . .

on this allegedly progressive site.

It's really now more like 50% progressive. I won't say what the rest are but this place has certainly changed over the years — especially the last 5 years 2 months.

[laundry_queen]

191. This probably won't make you feel any better

but I'm in Canada, with single payer and we still have to deal with the assholes at the insurance company for meds. Most meds aren't covered unless you are very poor, or a senior, or a kid in poverty. However, at least we have some cost control so that when we do have to pay out of pocket for a med, it's normally somewhat affordable. Still, there was a bit on the news not too long ago that showed how having cancer could basically ruin someone financially in Canada due to oral chemo not being covered 100% like IV chemo in the hospital is. Single payer should include drug and dental coverage too, IMO. Insurance companies are a pox on society. Hope you find a solution soon.

[Lex]

194. We've all always had to deal with insurance companies not wanting to cover certain meds.

Even before Obamacare certainly. It sucks.

[TrollBuster9090]

197. Just out of curiosity, what medications did you ask for that were denied?

As I understand it, there is no cure or treatment for Multiple Sclerosis, and its etiology is not fully understood. There are only treatments for the symptoms, and they are usually pretty standard and cheap (ie-corticosteroids during episodes etc.). If you asked for an experimental drug that hasn't yet been conclusively proven to be effective, of course they wouldn't pay for it. They wouldn't pay for it even in a country that had a single payer healthcare system.

Just curious. So, what specifically did you ask for that was denied?

[Lex]

201. Rebif, for example, is a standard drug and is about $16,000 per year.

Copaxone, Avonex and Betaseron are all standard meds for MS and run about 16K or so per year, if not more.

[TrollBuster9090]

211. Those are brand name formulations of things like beta-interferon. Not to be naive, but is it

possible that insurance companies will pay for generic versions, but not brand name formulations?

[Lex]

223. Don't know of any generic versions.

Insurance pays for my partner's Rebif, and before that, paid for her Avonex.

There could be generics now, but not sure.

[TrollBuster9090]

226. Or there could be alternative treatments that are cheaper and shown to be equally effective.

I don't know either. But this sort of thing happens a lot when someone switches from one plan to another, and the new provider won't pay for the drug they're used to; but will pay for either a cheaper formulation, or an alternative (cheaper) treatment that's been proven to be roughly as effective. People automatically think they're being 'denied treatment' because they're being denied the specific thing they're used to, as opposed to something that is considered 'equivalent' but cheaper. And that happened long before Obamacare. *Shrug*

[Lex]

228. Best to appeal with a doctor's letter requiring

that particular drug, and that the patient tried the other medicine on the patient and it didn't work as well. Appeals can work.

[blindersoff]

639. as far as I know

there are no generics for any of the disease modifying drugs as far as I know. The cost of producing them is far less than they charge the patient (Avonex cost to the patient without insurance would be about $4000/mo). But I think that most of the companies who produce these drugs want patients to stay on them and so are willing to assist with copays. My copay for Avonex is $10/mo after being $175/mo. All I had to do was request it, they reviewed it and I got it!

[TrollBuster9090]

642. Good!

Glad that worked out for you. I'm just wondering if their 'review' of your copay was related to the copay limit that was imposed on them by the ACA. I suspect it was.

[Oilwellian]

215. Lovely, just lovely

Using this thread to take pot shots at Will is BEYOND disgusting.

[Whisp]

221. and calling the President a piece of shit belongs in freeperland.

as if Obama personally intruded to make life harder for the OP.

jesus.

[panader0]

261. Unbelievable

You can call Obama a piece of shit and not get hidden. But offend Will and......

[1000words]

239. I'm amused by those who are suddenly above name-calling.

Taking the opportunity to tell Will to "grow up" and lecturing him on how to properly express his anger.

[brush]

492. Calling the President a "piece of shit" is what's disgusting

This is not freeperville.

[the_sly_pig]

210. I agree with Will

One's health is important. We have bought into this falsehood of 'choice'. Choice regarding healthcare is a myth. I choose to go to a doctor to improve my health, end of story.

It doesn't matter what doctor, it doesn't matter the prescription. Go to a doctor, get a prescription, get healthy or at least maintain your health.

Any plan that doesn't cover this or doesn't cover that is trickery as is 'choice'.

We're missing the big picture here. Health care is not a choice, it's a right. The sick are profitable, and those making money from the sick are scum.

[Oilwellian]

212. I'm so sorry, Will

I could just cry.

[djean111]

216. Obamacare really should have been called The Affordable Insurance Act.

Having insurance does not mean you will get affordable health care.
You will just have insurance.

[steve2470]

217. Maybe this page from NH will help you, Pitt ?

http://www.nh.gov/insurance/consumers/health.htm

[obliviously]

230. I think this is covered

http://www.amazon.com/Passion-Natural-Water-Based-Lubricant-Gallon/dp/B005MR3IVO/ref=sr_1_1?ie=UTF8&qid=1395186516&sr=8-1&keywords=bulk+lube

[MineralMan]

232. An ill-advised comment, Will.

I recommend a self deletion.

[greytdemocrat]

241. Has Skinner...

Asked for your head yet???

I hope it works out for your wife.

[Glimmer of Hope]

242. It is standard practice of insurance companies to deny medications or claims.

They do this intentionally because they know some will give up out of frustration or not follow-up. You have to push them until they give what you need.

It is the insurance industry that is a POS.

[rudolph the red]

243. Anybody else would have gotten an instant tombstone.

It's almost like you are magic, man.

[Whisp]

270. that is right. special rules apply with this one

I wish we were all that special.

[panader0]

244. I sold a used car three weeks ago

I carefully informed the buyer of it's pre-existing conditions. Am I a POS now too?

[lostincalifornia]

252. The argument I suspect that will be made is the restrictions were hidden or ambiguous. My only

Suggestion would be is if appeals do not work he should try a Canadian pharmacy

[Hissyspit]

276. What?

1.) Your analogy makes no sense at all. The pre-existing condition relates to the buyer.
2.) OP is clearly referring to dishonest car sales tactics.

[panader0]

289. It's not an analogy--I really did sell a used car

I'm blown away that apparently now, anyone can say anything on DU. Or at least, some people. I notice that Pirate Smile's post was hidden--was it more offensive than the OP?
PS, not all used car salesmen are POS.

[KoKo]

248. I'm so sorry Will...

Last edited Tue Mar 18, 2014, 09:17 PM - Edit history (1)

thought your wife could have gotten her meds by now and to see this from you...

What can one say?


THIS SHOULD NOT BE!

[Holly_Hobby]

255. Try this pharmacy in Canada...

My husband gets his gout med here and it saves us $529/month! Very nice people, easy to work with.

http://www.northwestpharmacy.com/

[Indykatie]

256. Who Was Paying For Your Wife's MS Drug Before ACA?

Was it covered by insurance or deemed investigational or not covered for some other reason?

[magical thyme]

323. it was covered by a different insurance company/plan

but they lived in Massachusetts at the time.

[MADem]

391. MA had "Commonwealth Care"--our local ACA---for years, since the Mittsy days.

MA has state income taxes, though--NH does not.

[Texasgal]

259. ACA is not perfect.

In fact it has many flaws. I am so sorry for your wife. I hope you can find the help she needs.

I never thought ACA was the end all to all of our healthcare issues. It's an okay program not perfect by any stretch.

[bvar22]

269. People who live in civilized countries don't have to worry about that,

but WE had to have a "Uniquely American Solution"
where access to Health Care is a COMMODITY to be SOLD to Americans by For Profit Corporations.

These opportunities like we had in 2008 come along only once in a generation.
WE are going to be stuck with this Uniquely American Solution for a LONG time.
FDR and LBJ are crying in their graves.


[font color=white]......[/font][font size=4]Obama's Army for “CHANGE”, Jan. 21, 2009[/font]

[font color=white].....................[/font][font size=4]"Oh, What could have been."[/font]

[JEB]

277. +1,000

[leftstreet]

287. +1

[woo me with science]

410. + 10000000000000

[jsr]

432. Yeah, but we didn't have 99 Democrats in the Senate

etc. etc.

[marble falls]

539. Best post on the whole thread.

[Cofitachequi]

271. Congratulations Mr. Pitt. You are the Free Republic's favorite DUmmie today!!!!

http://www.freerepublic.com/focus/f-chat/3134713/posts

Their Freepathon is over, but you will have an opportunity to contribute in the next few weeks.

[Hissyspit]

278. Yes, that's helpful to post here.

[lostincalifornia]

290. And it's helpful to have a post saying "fuck you Obama?"

[Whisp]

294. of course it is! that is, if you 'wrote a book', you can say and do

all kinds of shit with blessing.

[bobduca]

305. what would be helpful is if you can

tell everyone why Will is wrong to feel the way he does about his experience.

[lostincalifornia]

310. There have been numerous posts in this thread with suggestions, most not being responded to by the

OP

[LiberalAndProud]

473. The OP has been silenced.

Post hidden and OP locked out. There won't be any more responses on this thread from him.

[lostincalifornia]

478. Oh

[brush]

493. He has the right to feel horrible about his wife's illness and the difficulties in . . .

getting her medication.

On DU he SHOULD NOT have the right to call the President "a piece of shit."

That's not that hard to understand. He's also went off mistakenly before on the President. See post 476.

[AnalystInParadise]

314. If it was my wife suffering due to this law

saying F.U. is the least I would do. Cut the guy some fucking slack, I swear it is like people have their god damn humanity removed when someone attacks a sacred totem of any stripe.

I don't even like Will Pitt, we do not get along, but this is his wife suffering because of the ACA, I can't fault his anger and fear.

[bvar22]

320. Nailed It.

*

[ProSense]

325. The ACA has

"I don't even like Will Pitt, we do not get along, but this is his wife suffering because of the ACA, I can't fault his anger and fear."

...absolutely nothing to do with "his wife suffering." It's a horrible situation, but this OP is simply an attack on the President from an uninformed perspective.

Formularies are not determined by the President, and existed before ACA. They exist in Medicare Part D.

The bizarre thing about attacking the President and Obamacare is that the law did improve the situation.

Appealing Health Plan Decisions

The Affordable Care Act ensures your right to appeal health insurance plan decisions--to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”

http://www.hhs.gov/healthcare/rights/appeal/appealing-health-plan-decisions.html

[AnalystInParadise]

328. You know

if you didn't act like a know it all jackhole, I would take you more seriously, but you literally can never be wrong, even when people beat you in the head with the truth and facts.

Good day sir.

[ProSense]

330. "Good day sir." I'm a woman. n/t

[AnalystInParadise]

333. Ironic

n/t

[ProSense]

337. Yes, clearly you're not a "know it all..." n/t

[AnalystInParadise]

341. I don't claim to be

and don't seem to have a fetish to defend the indefensible. But I await your next piece of performance art comedy gold where you lie, spin and do anything you can to deny admitting you are ever wrong. Cheers.

[sheshe2]

359. Your posts are pretty insulting

and damn close to an alert if it has not already been done.

if you didn't act like a know it all jackhole, I would take you more seriously, but you literally can never be wrong, even when people beat you in the head with the truth and facts.

Good day sir.

jackhole
Portmanteau of "Jackass" and "Asshole".

Originated as a name by radio personalities Kevin and Bean (from KROQ-FM in Los Angeles) as a way of calling somebody a nasty name without actually breaking FCC edicts against foul language.


http://www.urbandictionary.com/define.php?term=jackhole

I don't claim to be

and don't seem to have a fetish to defend the indefensible. But I await your next piece of performance art comedy gold where you lie, spin and do anything you can to deny admitting you are ever wrong. Cheers.

Re read your posts and consider deleting them. You just called ProSense a Jackhole that lies and spins a story. You just called out a DUer. Do you care to reconsider your statements?

I await your response.

[AnalystInParadise]

371. I will delete nothing

You doing what you THREATEN proves my point, so please take your threats elsewhere.

[sheshe2]

399. You did a blatant call out.

That is a fact. And it is against DU rules.

I did not threaten you, I tried to explain some facts. You are over the line here. How putting threaten in caps proves your point, I have no clue.

[AnalystInParadise]

405. Thank you

Point proven, and thanks for playing.

[sheshe2]

409. Ah, you play games and like to score points.

You answered it all.

It is all a game to you. Got it.

[ProSense]

381. Apparently,

"But I await your next piece of performance art comedy gold where you lie, spin and do anything you can to deny admitting you are ever wrong. "

...you think the drivel you post are gems of wisdom. I'll admit I'm "wrong" when I'm wrong. As of this post, the OP is still fly paper for those who want to attack the President based on inaccurate information.

I'm sure that's why you're making it known that...

"I don't even like Will Pitt, we do not get along..."
http://www.democraticunderground.com/10024685964#post314

"I don't like Will"
http://www.democraticunderground.com/10024685964#post372

[AnalystInParadise]

390. So in your mind

links to the original post are a rebuttal to a complex discussion? I am not even upset with you, now I just feel sorry for you and your can't color inside the lines third grade logic. It's all good Prosense, I understand now.

[ProSense]

401. LOL!

"I am not even upset with you"

[JEB]

356. Much more generous and humane response than any insurance fucks

are capable of.

[bvar22]

286. Who CARES what FR thinks?

I would rather shoot myself in the head than to start running MY life based on what FreeRepublic, or Rush,
or what The Republicans think.

Nice to know you are spending your time there.

[Whisp]

291. it doesn't bother you that the OP uses FR words insulting the President

but it bothers you for the Name to be even spoken here?

meh, Freeper links are a staple here for a long time. Funny how it's suddenly a verboten site to link to.

[AnalystInParadise]

335. What are FR words?

Does that site have a trademark on certain words, or is this some bullshit character assassination thing you are peddling....

[Whisp]

340. the OP did the character assasination on the President.

but maybe you are right, Freepers probably don't call the President a piece of shit used car salesman. I'm just guessing, I sure could be wrong but I see what the OP said.

[truedelphi]

376. Perhaps if the President had offered up a few fights for the middle class on any of the following:

Real true health care reform

Punishing the war criminals of the Bus/Cheney regime
Punishing the Big Bankers and Big Financial People, instead of handing Main Street's wealth over to them
Etcetera
Then it would not be happening that people would be using "anger words" in reference to him.

Some of us lived during the FDR era. Others here remember our parents and grandparents talking about FDR. He actually went into the halls of Congress and called for a 100 day Congressional session to address what was happening in terms of the Depression-era economy. This President pretends there is no Depression.

[bvar22]

347. I believe that Will found his own words to express exactly what he was feeling...

....without having to rely on FreeRepublic.

But if YOU need to use FR as a vocabulary and idea resource, I won't stop you.
Go get you some!!!
Don't be surprised if I or other Liberals at DU don't care what you find on your expeditions.
Maybe you can confine FR reposts to The BOG where we won't have to see it.

I really, REALLY don't care what FR or other Conservatives have to say,
and MY life won't change one whit based on what is written there.
I can't speak for Will,
but I will bet that he doesn't care either.

[Whisp]

348. yeh, let's all speak like the OP did/does...

yah, right.
only the chosen can do that.

[1000words]

295. Exactly my thought, bvar.

I know I just happened to come upon FR threads all the time.

[lostincalifornia]

288. I am sure the over the top post is all over the RW groups. It is really sad that instead of

Discussing the problems of the ACA that one has to call the President names and say some of the most disgusting expletives about the President, instead of criticizing it in a normal way

This isn't the first time I have seen it, and it does a disservice to DU

[Whisp]

297. Exactly, it could have been a post asking for advice,

whether others have gone through the same thing. It could have been a very valuable learning process (lots and lots of good advice here in this thread) but what it is is a big pile of stinkin' shit.

[lostincalifornia]

299. Agreed

[AnalystInParadise]

319. Are you 12?

Who gives two flying fucks what the "kids" in the other clique think? The man's wife is suffering and the ACA is at least part to blame. Since this is PBO's signature achievement, I don't consider it flawed for the man to vent a primal scream at the law and the President because his wife is suffering. People alerting on him and calling him out because his wife is suffering and he is upset, fearful and stressed make me want to fucking vomit. Yeah some of you are real fucking progressives.......I would not have said what he said, but I understand the pain and fear he is displaying and will cut the guy some slack.

[jeff47]

443. Well, he had two options

1) Post an angry rant screaming at everyone.

2) Talk about his problem and ask for advice.

He did 1, got locked out of his own thread, and ended up with a thread full of shit.

If he did 2, he would have had the posts showing him where to go to appeal the decision and get the drug. There's a few of them sprinkled in this thread, but they're hard to find among the shit.

#2 would have solved his problem. He did #1.

[bobduca]

300. When did links to FR become cool to post on DU?

also why the fuck are you over there?

[lostincalifornia]

306. Why do some DU members watch faux? To see what the enemy is saying. Saying "fuck you Obama" is

Over the top

That is not the way to criticize a program or the President

[bobduca]

317. it seems like a case of strange bedfellows to go scanning FR for what they say about "dummies"

but then many Du'ers also know the score and ignore fox.

hint: the enemy of the 99%, its not just Brit Hume.

[lostincalifornia]

326. I don't watch any of that garbage, however, that is the reason I have been told when I inquired.

Whatever the reason it isn't because they subscribe to those views. Perhaps to convey to those who don't watch that crap just how over the top they are

As for your question, you will find various posts from DUers linking those sites. It does not appear rampant but it does happen, and it is even more frequent on faux links

[Whisp]

309. FR links have always been allowed here. n/t

[Hissyspit]

311. No, they haven't.

On edit:

If I'm recalling correctly, at one time you were not allowed to link there, but it may have been a ban on mentioning the name. I just don't quite remember, but others probably will.

[LiberalAndProud]

474. FR links have been here as long as I have.

There is a cave that was not allowed to be mentioned or linked.

[bobduca]

313. Thanks!

I guess I have just missed those threads... and now i need a shower and an anti-virus scan for clicking on that.

[Whisp]

315. They have been allowed to laugh at

is what I understand.

kind of a Hatfield and McCoy rivalry thing.

[DebJ]

411. I can give you somewhat of an answer on your first question.

i joined DU in October, 2003, after many months of 'lurking'. FR posts used to be linked to quite regularly here.
They were a source of some amusement combined with disgust and ultimately sometimes fear that such people actually
exist in this country. I clicked on the link because I haven't seen their site for many years now, and I wanted to see
if it was still in that hideously primitive condition.........it is. At one point I think they were about to shut down from lack
of funding.

Anyway, it was no big deal then. I don't understand why it is a big deal now............. who cares?

[hrmjustin]

383. Huh! interesting you chose to post that.

[passiveporcupine]

272. Will, here is something you might want to check out

For More Information

For more information, please contact MSAA's Client Services Helpline at [phone], extension 154, or email [email protected].

http://mymsaa.org/about-ms/aca/non-medicare/

[Whisp]

285. I would dump that 'friend' of yours who advised you nothing can be done.

he/she sounds like a ron paul fucker or a repug to mislead and misinform.

[pnwmom]

332. Yup. He's either ignorant of his own product or he just told a big fat fib. n/t

[pnwmom]

293. Is it too late to switch companies if you can find a better one?

And are you going to appeal? There is an appeals process.

I'm so sorry to hear about this happening to you. This is terrible.

[pnwmom]

437. No, but it means it's worth the effort, despite what the agent said, to check the formularies

of the other insurers, both on and off the exchange.

[DebJ]

509. Thanks for checking me there...you can only change coverage thru the 31st IF the

plan you signed up for has not yet begun, only if the effective date is still pending.

I'm going to delete my original post so no one picks up my bad info, thanks!

[phleshdef]

298. The ACA has been saving a lot of lives. So fuck your childish, petty, "fuck you".

I feel bad for your wife. But your uncalled for attitude and lack of critical thinking when writing your OP can eat a bag of dicks.

[lostincalifornia]

302. I would not be surprised if your post gets hidden, while the ops didn't. This is not a constructiv

Thread from the OP, and more of flame bait then useful criticism, and then figuring out what options exist

[phleshdef]

303. Yea, it will probably be the first one I've had hidden in a long time.

But its worth it. The OP crossed the line for me because I know that he knows better. And I believe there are probably options that would allow his wife to get what she needs, but he doesn't wanna talk about that. He wants to use it as an opportunity to talk down to Barack Obama using subhuman terminology.

[lostincalifornia]

308. It seems that way

[phleshdef]

312. Yea, I mean fuck Obama for expanding Medicaid and buying Medicare 8 more years.

Fuck Obama for helping millions of people get access to imperfect insurance that still saves a lot of lives when it matters.

Fuck that piece of shit car salesman for funding thousands of free clinics, for establishing the best access to birth control women have ever had, fuck that dirty DINO trash for the ACA... obviously because it didn't solve all of Will Pitt's problems, it means Obama is nothing but a corporate whore that didn't do anything for anyone.

[Hoyt]

418. People do seem to judge things only by how it directly affects them, not unlike 1%ers.

However, I do understand anger over what a family member is going through and hope the drug situation gets worked out.

Obama has helped a lot of folks, and it took guts to even tackle health care after what happened to Hillarycare. The people that deserve ridicule are the ignorant voters who didn't call their conservative representatives supporting better legislation.

[Raven]

321. Oh, you are so wrong!

[pnwmom]

331. Actually, Will blew it. I know why he's panicking but he's been given false information

and now he's repeating it here. The fact is that all insurers, both on and off the exchange, must take all comers. They can no longer deny people due to preexisting conditions. But the only place you can get a subsidy is on the state or Federal exchange.

I completely understand how stressed out by this situation with his wife, but he needs to take some positive steps now.

Investigate the drug formularies of all the plans that are available to him, both on and off the exchange. If he finds one that works better, than cancel this policy and buy a new one. He still has some time but he has to act fast.

Immediately appeal this insurer's decision, if he hasn't already done so.

With so little time, I'd work on both fronts.

http://www.nytimes.com/2013/10/26/your-money/health-insurance-options-arent-limited-to-obamacare-exchanges.html?_r=0

In general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and can’t deny you coverage if you’re already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.


http://www.insure.com/articles/healthinsurance/buying-health-insurance-outside-exchange.html?WT.qs_osrc=fxb-182807210

Drug coverage
Drug coverage is yet another variable. You may find you have more options when it comes to drug coverage if you shop off-exchange. Like provider networks, health plans can limit the drugs that are covered, or reimburse more for generics than brand-names, or reimburse more for drugs you buy mail-order than from your local pharmacy.
If you have a health condition and use a particular drug, you should check that it's covered under the plan in which you want to enroll, whether that plan is on the exchange or off-exchange, Coleman advises.
Remember, too, he says, the cap on out-of-pocket expenses doesn't apply to drugs not on a health plan's list of covered medications.

[JEB]

345. Too many complex variables and deceptions to actually make sense.

[DebJ]

417. Actually the OP didn't say coverage was denied, but the opposite, that coverage was given

for his wife, but coverage for the life-saving medicine she requires is denied, so he ends up in almost the same situation
as if he didn't have the coverage.

I might be having a senior moment here, but didn't Will post at one point that his wife had to use this specific medicine and that it wasn't a common one, that other meds didn't work for her? Lots of people are posting about a wider array of meds available for MS, but I think he already said those didn't work for her.

Not that I defend his attack on the President.

I do, however, have great empathy for the absolute terror of not having the medicines or medical care that is desperately needed, particularly when the difference is life-and-death. Been there, done that, and may soon face it again.

[pnwmom]

426. The OP didn't say that. But this later post of his is incorrect:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686037

"There are ten different health insurance companies in NH. According to the independent (family friend, ally) insurance adjuster I spoke to at length this afternoon, pursuing coverage with any of them would be a waste of time. Why? Because - according to dude - the whole "You cannot deny coverage to people with pre-existing conditions" thing only applies to insurance companies within the ACA network. You heard all that shit about "Grandfathering." Well, this is that, and all of them will turn us down because they still can.

"I am in the process of running down the facts of the matter, but family friend and ally was confident enough to basically tell us not to bother.

"So yeah, that, too."

[phleshdef]

336. ?

[JVS]

367. Raven is Will's mom and therefore has more insight into her daughter in law's situation than you do.

[phleshdef]

397. There are plenty of folks out there with MS who are getting their medications covered.

What is different about this situation and how is it that Obama is to blame?

[Logical]

404. Great news, links please! nt

[pnwmom]

431. The difference is that his friend the insurance agent gave him false information

and Will was understandably disturbed.

He needs a new agent.

What the agent said:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686037

What the facts are:

http://www.democraticunderground.com/10024687956

[phleshdef]

452. Understandably disturbed yes. But the rhetoric wasn't really justifiable.

[pnwmom]

454. No, but M.S. is a really scary disease. I hope Will doesn't give up and gets this solved now. n/t

[pnwmom]

428. Yes, she is. But apparently they've both been given false information by their friend the insurance

agent.

They need to fire that broker and find another one, quickly. He lied to them about insurers outside of the exchange being able to bar people with preexisting conditions.

http://www.democraticunderground.com/10024687956

[SidDithers]

699. Good posts throughout these series of threads...

Sid

[msanthrope]

572. No--it is Will's friend who is wrong. Pwnmom has detailed how Will was given the wrong

advice by this 'agent' and he should thank her for it.

[Logical]

402. Ahhh, how adorable! nt

[alarimer]

339. Any "reform" that left the insurance companies in the loop was a loser from the get-go.

I'm afraid we were sold a bill of goods. And people will suffer as a result.

My sister has MS as well. He company dropped drug coverage a while back, to avoid the high costs of covering people like her. She must have found a way because she seems to be doing all right.

[JEB]

354. Disaster capitalism is not much fun

when you or your family is the disaster. The array of complex and deceiving policies are all designed to maximize profit when disaster hits.

[killbotfactory]

388. Would you be better off without the ACA? nt

[JEB]

406. Wow. So many posters seem more concerned

about a offensive remark toward the President than they do about the life and well being of a living breathing person. Shameful.

[pa28]

413. Some perfunctory words of sympathy for Will Pitt's wife and then the usual PR from the usual people.

I'm glad you called it shameful because surprising would be the wrong word.

[Bobbie Jo]

507. Along with some perfunctory words of

"concern" and "disgust" from the usual people. Equality unsurprising and hollow.

[jsr]

433. +1

[pa28]

408. Hall of fame bullshit artist. Yes indeed. Obama is just that.

Last edited Wed Mar 19, 2014, 01:37 AM - Edit history (1)

The ACA is a Republican concept. It's not going to be fixed or repaired.

"Nixoncare" aka "Heritagecare" was conceived to head off a government run, single player healthcare system by institutionalizing private insurers.

The part that needs fixing is the actual foundation of the plan. Private, for profit insurance companies exist to deny care. That's the point and it's going to stay that way.

Healthcare should be a basic right in any advanced economy. We had our chance to clean out the scum and we blew it.

[minivan2]

412. Ok buddy time out

I understand why you're upset, I would be too. But calling the president a "piece of shit used-car salesman." Is way too much. I think that you should delete your post, take a breather and apologize for the rant.

[woo me with science]

415. I appreciate your telling the truth,

especially when it involves so much personal pain.

Nothing changes until we are collectively honest about the level of corruption we *really* face, and the pain it *really* causes...all the propaganda be damned.

I can't express enough how sorry, and angry, I am that this is happening to your wife and your family.

[Cali_Democrat]

470. I don't know what's funnier

This pathetic OP or the fact that you're running around with a Bernie Sanders sig even though he voted for the bill.

[woo me with science]

536. Exhibit A

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4688420

[Cha]

416. My my my.. looky here.. at these ODSers.. using

this misplaced anger on the President to get their raging "fuck you" hate on..

[Lars39]

421. That's ugly, Cha.

Hope to goddess you're never faced with their rock or hard place situation.

[Cha]

422. Yes, the OP is an Ugly Piece of Hate.. and my pointing it out

is fair game.

[Lars39]

424. Empathy should be learned early.

You have groused more about a man venting at his wife's reality than you have shown compassion for their predicament.

[Cha]

427. "Fuck you, Mr. President, you piece of shit used-car salesman. From my heart and soul, fuck you."

Yeah, really something to be REC.. Ignorance is not bliss.

[Lars39]

429. Can you not even understand that his wife's health is at stake?

I don't believe you comprehend that this isn't a game.

[Cha]

442. This post said it best..

"Or... you can carry on without insurance, never getting to see a doctor, and die from the high blood pressure you didn't know you had.

I have been denied insurance for over 12 years. Scratch that...I was offered a 'plan' for $1200/mo that included a rider that excluded coverage for pretty much everything except falling out of my car. I now have a plan for $75/mo that doesn't exclude a damned thing and also covers meds for 50% of cost. Granted, it's been so long since I've been able to see a doctor that I'm absolutely terrified to go, now. But, I will...eventually. And, I will be grateful that I have insurance that will cover any catastrophic issues that may come up.

What Will is going through is tough, but he's received some helpful advice that he doesn't seem to want. I guess it's easier to be angry than actually fight. A lot of people are seeing real benefits from the ACA. Like everything else, this will be improved over time.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686725

Bolding is mine.

[Lars39]

457. You are getting feedback that you don't like.

"Tough" ? Devastating, when the cost of a family's insurance and medicine will keep them poor or near enough.

[Cha]

461. I'm getting a lot of Great Feedback.. thank you!

[Aerows]

643. Have you actually USED your insurance yet?

Because you are probably in for an unpleasant surprise.

[rudolph the red]

425. he's the Magic Man

He gets a pass.

[Cha]

430. Yeah, the OP got a pass but a post in the thread got a Hide.

His Magic Man Fans weren't on that jury.

[JI7]

438. he is probably upset he can't profit off a disaster presidency like during Bush's days

considering his recent threads i think he is just looking for attention and hoping for support from a certain crowd.

as others have pointed out this case with the meds has always happened, even before Obama. and he is living in a state without state income taxes. maybe he should consider getting some change in that area so they can support more govt programs to help with these type of things.

[Cha]

448. I do have "empathy" for his wife.. but, that does not excuse a raging

misplaced ugly, bitter, insulting temper tantrum on Pres Obama.

Sounds like New Hampshire does need some changes to help those who can't afford expensive meds. No income tax?! how do they fix roads, have libraries, pay teachers..?

[Whisp]

450. if the ugly was for the first time then I could pass on it

but it's been fucking consistent against the President for a long time now. Dripping with rage and hate and misinformation. Grabbing at any chance to shit on him.

so no, no pass.
there is something going on here with this one.

[Cha]

451. Unfortunately yes.. but, this one was so ignorantly over the top ..

I wouldn't give him a pass if it were his very first raging "Fuck You, Obama" screed. And, they're always from his "heart and soul", right. fooking drama monger.

[giftedgirl77]

518. I find it ironic that all his hate & anger is focused towards

the POTUS, yet conveniently forgets to lay any of the blame with the damn pharmaceutical companies that not only monopolize these specialty medications but fix the prices as well.

P.S. love teh kitteh

[Vashta Nerada]

434. A lot of ugly posts and lack of empathy in this thread.

Shame.

[AnalystInParadise]

653. For once we agree completely

And I mean that sincerely.

[ucrdem]

436. WilliamPitt, as I understand it you live in MA, so direct your outrage to Gov. Romney.

Now I'm told you're locked out of this thread so I'll say no more.

[JI7]

440. according to other posts he lives in New Hampshire now

[MisterP]

441. they said "it'll be fixed, don't worry": now they're telling us to not even acknowledge

it needs fixing at all

it's like sitting on a cactus

[ohheckyeah]

447. I can't afford what the government

seems to think I can afford. And of course, since I'm a smoker I don't in their eyes deserve to have health insurance. They don't ask if you drink or how much you weigh, just if you smoke. The ACA doesn't do me a damn bit of good.

And save the sermons about cigarettes...you don't know my situation.

[VanillaRhapsody]

453. Live in a Red state I presume???

[ohheckyeah]

593. Purple....

Virginia isn't as red as it used to be.

[Drunken Irishman]

460. What initiative did you take?

It sounds like you didn't do your due diligence. It sucks, but you're a smart guy, I would expect that you would have looked up what the plan covered before plopping down $700 a month on it. If you had any questions, you could have gone to a broker would would've been able to guide you through the process so you didn't enroll in a plan that doesn't work for you.

Moreover, what did you do between the time you enrolled in the plan and the plan started? Because there is a wide window for you to research the plan to make sure it's the right one and then make the needed changes so that you can get a plan that covers your wife's medication.

I know this because plans do not start the second you enroll. If you enrolled between Oct. 1st and Dec. 24th, your plan started on the 1st of the year - that gave you a pretty significant window to shop for the right plan. If you enrolled after Dec. 24th and through to Jan. 15th, your coverage wouldn't have begun until February 1st. That gave you two and a half weeks to make sure everything was covered in your plan before its plan start date. If you enrolled any time between January 16th and February 15th, your coverage began on March 1st - which, again, gives you roughly two weeks at the latest to change your plan. The same goes for February 16th to March 15th (for your plan to start on April 1st).

You should have checked the plan and spoke with your doctor, and your pharmacist, everything was covered. It's not that hard.

[JEB]

463. Hours on hold only to talk with some underling with canned answers while a loved on is ill

is very hard. Insurance agents are only interested in selling, selling, selling their favored products. A shifting sea of variables and deceitful language. $700 hundred fucking dollars should provide for any coverage needed. Fucking criminal.

[Drunken Irishman]

464. There are multiple avenues one can take...

It's not that hard. You can even look up the information on your own through healthcare.gov. It looks like the OP pretty much just enrolled without even checking to see what the plan covered. It sucks, but he had plenty of time to make sure it was the right plan.

[JEB]

468. Here in Oregon, it is not that easy.

Tried numerous times via the computer. Hours wasted. Drove an hour and a half each way to an event to try and enroll. Called various State officials, called various insurance agents. Called various insurance companies. Received someone elses application from Cover Oregon. Called Cover Oregon, waited for over an hour on hold. Was told everything would be fixed and to expect the correct papers in the mail. Waited two weeks called again waited over an hour again. Finally got someone who seemed to know what to do. I signed up for the cheapest thing they offered (very high deductible). Never received anything from the insurance company. Called them, waiting over 45 minutes to be reassured everything was on track. Still haven't received a bill. Was shooting for January first coverage.

[Drunken Irishman]

471. Lots of bugs, but this isn't one of 'em...

It's unfortunate, but it's the nature of the beast. I guess he'd rather we just go back to the old system where EVERYONE was fucked.

Basically, it's all or nothing with some people.

[JEB]

542. No, I think he wants his very ill wife

to get the medicine she needs.

[pnwmom]

490. Unfortunately, some drugs cost tens of thousands of dollars a year.

This is a cost that must be reined in, but it's one more thing that the Rethugs are resisting. We tried to pass a bill allowing Medicare/Medicaid to negotiate with drug companies for better prices (as Canada does) and the Rethugs opposed it.

[Puzzledtraveller]

466. As someone who peddles the ACA daily

to real consumers and clients, I give a hearty K&R.

[pnwmom]

487. Why didn't you explain to him that his agent-friend gave him the wrong information

when he claimed that insurers outside the exchange can reject people for preexisting conditions? If you are really marketing these plans you must know that isn't true, right?

And you are aware that both private insurance plans and single payer plans (such as Medicare, Canadian Single payer, and UK single payer) use formularies? That, under the ACA, there is now an internal appeals process, and external appeals process, and a process for requesting exceptions? I hope so, if you really do sell these plans all day.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4686037

There are ten different health insurance companies in NH. According to the independent (family friend, ally) insurance adjuster I spoke to at length this afternoon, pursuing coverage with any of them would be a waste of time. Why? Because - according to dude - the whole "You cannot deny coverage to people with pre-existing conditions" thing only applies to insurance companies within the ACA network. You heard all that shit about "Grandfathering." Well, this is that, and all of them will turn us down because they still can.

I am in the process of running down the facts of the matter, but family friend and ally was confident enough to basically tell us not to bother.

So yeah, that, too.

http://thinkprogress.org/health/2013/12/10/3042741/drugs-obamacare-coverage/

But yes, there are certain limits: a formulary, for instance, may cover three drugs for treating a certain condition but not two others. Obamacare — like all insurers currently operating in the market — has a fix for that. ACA regulations demand that a health plan must have an “exceptions process” in place that allows patients to request and gain access to clinically appropriate drugs that aren’t covered by the health plan (in addition to internal and external appeal processes). So, if a health plan does not cover a particular drug that a patient absolutely needs, their doctor can certify medical necessity to extend coverage. Insurers have relied on drug formularies before the law went into effect and already have exceptions processes in place, meaning that most “will not have to implement significant changes.”

In his piece, Gottlieb illustrates the narrowness of some formularies this way: “I found one plan in North Carolina that doesn’t cover Actonel for osteoporosis, Aubagio for multiple sclerosis, or Xeljanz for severe rheumatoid arthritis, among other ‘non formulary’ drugs.” But as Washington & Lee law professor Tim Jost points out, “This is the way formularies work, we’ve decided we’re going to cover these drugs, but not those drugs… I don’t think you can know anything from seeing what they list as the non formulary drugs without knowing what the formulary is and how fungible those drugs are with the formulary drugs.” Jost notes that drugs within the same category and class are more or less fungible, and so for most people, the drug that’s offered will work as well as the one that isn’t — and is often far cheaper than the name brand option.

[Cha]

494. Yeah, you need to explain that.. are not people getting good benefits? You make it sound

like you really hate your job. That's too bad.. maybe you could find something more suited to you so you wouldn't have to "peddle" something you didn't like. You wouldn't have to be so fake.

[Glitterati]

500. Will, here's my suggestion

Fight! Don't stand down. The harder you fight, the more determined you are, the louder you complain the faster this is going to be resolved.

And, it WILL be resolved.

Your wife's doctor should be your strongest ally in this. S/HE should be the soldier standing at the front lines fighting for your wife's patient care beside you.

I have the same thing (not as expensive) with one of my meds - the insurance company wants me on a cheap, generic drug. But, my doctor led the fight as far as the drug companies and the cheap, generic drug was just pulled off the market, so the only drug available now is the one I am on. But, it was the medical community that went to the authorities and explained that the cheap, generic drug didn't WORK.

[SomethingFishy]

511. You know Will,

I don't understand why you don't just quit your job, and spend all your time trying to get useful insurance. From reading through your thread that seems to be the answer to your problem. You just aren't spending enough time "shopping".

If you quit your job you should have plenty of time to wade through a system specifically designed to give you as little care as possible for the most amount of money so we can maintain our "capitalist integrity" and continue to use the health of our citizens as profit making enterprise.
Commie.

[Le Taz Hot]

519. I am SO sick and tired of the apologists

telling me "you don't understand" or "you're misinterpreting it" that I could spit. I went over every inch of this program before I signed up and it's the apologists that don't or refuse to understand the "exceptions." There are so many holes in the ACA, a COMPLETE capitulation to the insurance companies, it's pathetic. I'm shelling out $300.00 a month for insurance I'll never be able to use. I know $300.00 a month doesn't sound like a lot to most people but it's an incredible sacrifice to us. The apologists like to come back with the "well, it's better than nothing!" No, not it's not. Because between having no insurance and being low income I could get FREE meds through the manufacturer and a HUGE discount on the ones that weren't free through Walgreens pharmacy. Now I have "insurance" and, because of a $6,000 a year deductible, per person, I'll have to pay full price which isn't going to happen because ONE medication is $300.00 a month. ONE. My husband takes 3 and I take 2. Full price we're looking easily at $600.00 a month or more and that's on top of the $300.00 a month give away to the insurance companies.

[ProSense]

520. Why?

"I'm shelling out $300.00 a month for insurance I'll never be able to use."

If you're not going to use it, why pay for it? Save the money and pay the penalty.

"I am SO sick and tired of the apologists"

Informing people about the facts is not being an "apologist"

Don't be deceived. Contrary to popular opinion, ALL insurers, whether on or off the exchanges
http://www.democraticunderground.com/10024687956

[Le Taz Hot]

521. Because I'm "stupid and I don't understand the ACA."

That seems to explain it all for you people. I'm done here.

[ProSense]

522. Your words. n/t

[truebrit71]

584. This was nothing more than a great big wet kiss to the health insurance companies...

...

[NCTraveler]

524. Mr. Pitt, I am truly sorry about your situation....

and the manner in which this bill was sold to the people. Lie after lie was foisted on to the American people. That being said, many people will be helped by it. Many. I have been pretty critical of the ACA. I think the whole concept goes against what Democrats should stand for. I felt the same way about HillaryCare. The political clout needed to push something so weak and against Democratic principals was simply too much. What came out in the end is too weak for what transpired. I still keep trying to go back to the fact that it will help many people. It has actually hurt someone I know yet they are willing to accept it without a fight. My heart goes out to you and your situation.

[Hissyspit]

549. Pure bullshit character assassination post.

Ugly. Says way more about you then Will Pitt.

Even if one doesn't agree with what the OP says.

[joshcryer]

552. Eh, I'm just glad I'm not on his ignore.

He actually responded to a post I wrote today. I respect his opinion.

But he got banned from DU for threatening the life of another poster. It was one of the very rare (handful of?) instances where a ban was overturned.

I sincerely mean it. Emotions expressed on a forum are nothing. If there is even a 10% amplification in real life, some people here need to control it.

[ScreamingMeemie]

563. That's over the line.

[Vashta Nerada]

568. Ugly post.

[TBF]

570. Wow. nt

[fleabiscuit]

534. Troubling.

We have had the experience where our insurance covered a med for wife with $50 co-pays, then with a stroke of a pen it went to $1000. Back to alternative that didn't work as good. I don't think there is a county in the world that will cover all medication, especially new or experimental ones. Sigh.

[wordpix]

545. try cannabinoids, even Nat. Cancer Inst. admits they work in multitude of med conditions

http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page4

This is about cancer but check it out for MS.

[Autumn]

556. Goodness Will. You have caused an angst filled shit storm of epic proportions.

It's really quite hilarious to see the contortions to prove you are wrong and just BAD. BAD

[rtracey]

560. this joint

Man...this joint is becoming too radical for me...I'm heading out the door on Democratic Underground. When I joined, this place was always respectable to our leaders... but not now....screaming F.U. to our president, really....hey you can have it. The administration on this site has taken a back set to a lot of stuff....too bad......seeya

[LexVegas]

562. Your pain and frustration is understandable.

However, I don't see how the President is in any way responsible for the denial of coverage on the meds.

[AngryAmish]

566. This is a very long thread.

[ramapo]

567. What could be worse than the ACA?

The answer is easy, no ACA.

There are many deficiencies in the ACA, chief of which is it goes nowhere near far enough to reign in the insurance companies.

There are no requirements that they offer individual policies in a state where they write group insurance. So here in NJ we have a distinct lack of choice. There is little to require broad networks and nothing to require PPOs which provide out-of-network choice.

It is still too easy for insurance companies to deny claims and make life difficult at best for someone who needs specific care or medication.

And the definition of affordable often strains the definition.

Unfortunately this bill was the best that our corrupt, dysfunctional Congress could write and pass. It is nowhere near what most of us would like to have been the result.

Perhaps Obama, if he had been a more experienced arm twister, could have gotten a better bill written. We are damn lucky we got what we did and to lay the blame on Obama is just an understandably emotional rant.

Sure throw Obama and the rest of the Dems under the bus. You think it can't get worse? Sure it can.

Our 'representative' government sucks. Most people are uninformed. Politicians just throw shit on the wall and whatever sticks they go with. Who here thinks the Republicans will enhance the ACA vs. gutting it? They're busy throwing a lot of shit and if enough sticks then we can get back to the good old pre-ACA days.

And you won't be able to kick Obama around anymore.

[grahamhgreen]

573. Sorry Will. We'll keep working toward single payer or better.

I take it you've looked into getting the drugs overseas... India. Thailand, etc.

[theboss]

574. Is this one of those Will Pitt rants that will be completely retracted in two days?

Those are fun.

[lostincalifornia]

701. I doubt it. This thread should have never been allowed because of the disgraceful names the

President was called

[unionguy]

589. It's sad but I have to agree with you Will.

I have never voted for anyone with a R next to their name and never will. I agree that the ACA has and will help millions of people. That said , this president has some responsibility for how the ACA has come about. Call me old fashioned but I still believe that a leader leads by example. In my opinion the president should have, on day one, took his hand off the bible, walked over to John Bonehead shook his hand and then kicked him square in the nuts. Then did the same to Mitch the little Bitch. The President is the leader of their party. His example reflects the position and direction that party takes. He had a Dem majority for 2 years. Did he take the lead against Rethug aggression and interference? No he did not. Instead he spent 3 years kissing their asses trying to compromise. You be nice to a Rethug and all you get is mugged for your trouble. He has also spent the whole time kissing Corporate Ass, hence the ACA as it is written. I'm on a medication that costs $10,000.00 a month, no that's not a typo. Thank god and my union that I still have insurance coverage. They are self- insured with a local insurance company administering the plans. I have been eligible for Medicare for 3 years, but because of Part D, I found it cheaper to stay on my Union Retirees insurance, which still costs me over $900.00 a month. An ACA plan that is even close costs $1050.00 a month with higher deductibles. It sure would have been nice if I could get the help of subsidies to off set some of my medical expenses. I now pay almost 50% of my income for medical expense. If I buy an ACA plan I can get 3-$400.00 a month from the government to help, but because I have a plan from my union (which is better and cheaper ) than a ACA plan, I get no help. The President and the Dems screwed us union people big time. The only union people who could get the subsidies, because of income, would be early retired (62) , or disabled & early retired,(as is my case). I'm not very happy with this situation myself. Will, I feel for you, without the support of my union I would be in even worse shape. Keep up the good fight.

[Sunlei]

594. the drug corps price gouge in the USA on long term treatment, all meds. Same thing with aids meds.

About 20,000 a year retail in medication costs.

Yet when Doctors without borders gets the same aids medicine to help treat people in other countries, they pay maybe hundred a year total. I think they get their drugs from India.

I wish there was someway we could cut out the 'for profit' middlemen from insurance & medicine sales. They price gouge everyone, including our Federal funds we hand over to them!

[Ms. Toad]

597. Always check the formulary.

We have several medications which are covered by some companies, and not by others. Whenever we change insurance companies, the first thing we do is check to see if the critical doctors and care facilities are on the new plan. The second is to check the formulary. The third is to check the less critical doctors.

MS medication, medication for IBD (which my daughter has), and often AIDS medications are ones which a fair number of insurance companies have classified as specialty medications (typically biologics). I am surprised it caught you off guard - because it isn't the ACA, it is insurance companies in general. The last 3 insurance plans I have been on have classified my almost off patent, non-biologic, medication as a specialty drug - which means it is covered, but at a % of the cost rather than a flat fee. The current plan (as of January) has it back as a formulary-name brand drug. More expensive than most, but better. She's also on a prescription probiotic - nearly as expensive as your wife's medication. Fortunately, two of the last three have covered it - but the two prior to that didn't.

Appeal. Most insurance companies have an appeal mechanism based on medical need. You will need strong doctor advocates on your side - and you may have to step through (or document that you already have) first/second tier medications to prove they don't work and your wife needs the medication she is on. We've had to do it both ways - repeating trials of medicines or procedures that hadn't worked, and merely documenting that we had already tried it. That run-around is partly because they figure no one will bother and it saves them money - but there is a medically valid reason as well. Doctors are susceptible to marketing - and they may be prescribing medication that is more costly (and sometimes less proven) than other less splashy medicines with big advertising bucks behind it. Having a process of walking through a protocol verifies that the pricier medication is really the best balance of cost v. benefit.

Finally - check to see if the pharmaceutical companies have a compassionate care program. They often offer free or substantially reduced cost prescriptions.

Good luck - and when open enrollment comes around, check the formulary!

[bvar22]

627. Have YOU tried to purchase insurance on the HealthCare.Gov website?

...or over the telephone from The Exchange?

I don't remember an option that let me check "The Formulary".
Of the 5 Million who have bought the new ObamaCare Insurance,
how many do you believe checked the Formulary
or even know what that means?


This is not something we should have to do,
and not something that the majority of Americans are equipped to do.

[REP]

629. People with chronic conditions know what "check the formulary" means

It has nothing to do with the ACA or the website. You can obtain a formulary from the website of the insurer or call and request one.

Things I check for in insurance: formulary, DME, labs and imaging, surgery and hospitalization co-pays.

[bvar22]

645. Of the 5 Million or so MANDATED New "Customers" that have signed up...

...through the Healthcare.gov website or over the phone,
HOW many of them do YOU believe "checked the formulary",
or even KNOW what that means?

If YOU and a small handful of others have learned that this is important,
GOOD FOR YOU!!!!!!!
...but what about the MILLIONS who don't have the benefit of YOUR experience or ability?

People who live in civilized countries do NOT have to do this.
ObamaCare was something that was supposed to be GOOD for those who have been unable to afford insurance,
not "throwing them into a Shark Tank with a Pork Chop tied around their necks." (thanks, Will)

We couldn't get through our State's Website, so we had to sign up over the phone.
My Wife and I are educated, intelligent, informed, professional Americans.
Until yesterday, I had no idea what a "formulary" was,
or that I should "check it",
and the option to do so was NOT offered by ANY of the avenues we tried in our effort to get covered.

I will again give you this challenge:

[font size=3]HOW many of the 5 million new mandated Obamacare "customers" do YOU believe "checked the formulary",
or even KNOW what that means.

[Ms. Toad]

631. Call the company.

The contact information for any plan sold through the exchanges is easy to find. If I had a condition that required costly medicines, I would have spent considerable time comparing my options - as I did for the last set of plans I had to choose between in the same time frame (October, then again in January). Although the mechanism for signing on the dotted line is different, the process of choosing between plans is identical.

It sucks to be chronically ill.

But anyone with a chronic, costly, illness, has to become equipped to deal with the medical system - whatever the structure. From care through payment. It is a matter of survival. My daughter has been chronically ill since she was 4 (she's nearly 24 now), and my spouse has less serious, but still chronic, illnesses. I would not dream of buying insurance without making sure their drugs and critical doctors were covered, or without estimating what the annual out of pocket spend would be. Medicare - which everyone touts as the model for single payer - has similar challenges and options for drug coverage - well covered in the news for anyone who has not been sleeping for the past decade (at least). I shouldn't have had to diagnose my daughter's most recent chronic illness - but I did. That sucks too. I shouldn't have had to find a drug trial when no approved medical treatments were available. She shouldn't have to be battling her way back from a mental health hell hole her psychiatrist left her in.

But that is the reality of living with a chronic illness - you have to deal with things no one else has to deal with. And unless Will Pitt's wife was diagnosed after they purchased health insurance, it was medical and financial suicide not to take that obligation seriously. And the reality of formularies, or the failure to verify what meds are covered, has nothing to do with the ACA

And if you aren't equipped to sort it out, there are navigators to help you out.

[Zorra]

651. You basically just said "Let them eat cake". (Updated)

on edit: And the process of choosing plans is not identical by any stretch of the imagination.. My healthcare.gov website page never worked. I had to do everything over the phone. Because every individual is offered different plans according to state and circumstances, I had certain plans available to me. All I had to go on in choosing a plan was the healthcare.gov supervisor, telling me the basic benefits of the plans available to me. It took 2 1/2 hours on the phone for me to choose a plan. This was after 63 days of determined, persistent work on my part to finally get to the point where I finally had a possibility of being successful.

Blah blah blah, and I actually have some of the conversations with healthcare.gov recorded. It's too bad I didn't get it all, it would probably be worth a fortune as a comedy skit

No offense, but no one except someone who did not experience the intense, illogical, nonsensical prolonged core stupidity of the fubar healthcare.gov system can understand how "Call the company!"is a roflmao, "let them eat cake" moment for those of us who ran the gauntlet and survived with our reason still somewhat intact.

I kid you not, many of my conversations on the phone with healthcare.gov were more ludicrous than this monte python skit below. I'm serious.

[Ms. Toad]

655. Let me assure you that the cake is considerably tastier and more nourshing

post ACA than it was before. Speaking as someone with a child whose medical bills are $60,000 a year - in a good year. As much as I would love to wave my magic wand and make everything better, it ain't gonna happen.

People with chronic health conditions have more challenges than those who don't - for a whole host of reasons. Nothing that anyone can do will change that. And people with chronic health conditions have to protect themselves because people and systems created by people are imperfect - and no one else is in a position to protect them, or will. Even with the best of intentions, and good training, my daughter's doctors are going to be two steps behind her, and a step behind me in assessing what changes in how her body mean she may have acquired one of the dozen or so cancers she is at risk for. No matter how perfectly the insurance companies perform in claims processing, people (and computers programmed by people) make mistakes. Even if we get a Medicare like system, there will still be mistakes - my father has been battling over a coverage dispute for months. And, no matter which system we have, no one is going to spoon feed you that cake. And when the cake doesn't make it to your mouth, and you have a chronic illness, it hurts more.

You can give up and let things happen to you (and then get mad when not even cake makes it to your mouth), or you can be proactive and utilize what is available to the greatest extent possible.

I've been living with this reality daily for two decades - "them" is me. And I'm thrilled to finally at least have more nourishing cake - and a bit cranky at people who don't take simple steps to protect themselves (like checking formularies - which anyone with a chronic illness who has had health insurance should be well acquainted with) and then blast the cake - because blowing it to smithereens only serves those who want things to go back to what they were. Which sucked a whole lot more.

[Zorra]

679. You missed my point. I believe the ACA is beneficial to many, including myself.

I'm simply telling the truth. As for myself, I prevailed, against all odds.

For many people, like me, negotiating the program was a seriously fucked up nightmare, to put it nicely. And I am far more educated, in more ways than just academia, than the general population of the US.

"Calling the company", before I was a verified cash cow for them, was a fruitless enterprise.

You want to know why so many people who seriously need insurance are not signing up for the ACA?

It's because they have no clue, on this formerly green earth, what a formulary is. Nada. Or why they should ask about formualries, and other such pharmaspeak blah blah blah.

The process, especially in red states like mine, has been scary and/or seemingly impossible for far too many people. I know, I sign up poor folks for Medicaid, or ACA plans income dictating, at every opportunity.

I'm not trying to blow the ACA to smithereens, I'm only recounting my experiences, in order that someone who should fix it will fix it.

Denying that something is kind of a mess won't fix the mess.

And the bottom line here is, the real mess originates with for profit health insurance corporations.

We need a simple public health care system, like Canada has.

I have many friends from Canada. I make it a point to ask them, "How do you like your healthcare system?"...

The common answer is "what's not to like, eh?

It's free."

[Ms. Toad]

681. But this thread is a rant

by someone who has the intellectual resources to negotiate the system, and every reason to know what a formulary is (unless his wife was just diagnosed), who has a following, and who certainly seems to be trying to blow it to smithereens.

That is different from acknowledging that it is imperfect. And as much as we need a public health care system, it would never have passed in the first place and - if by some miracle it did pass, the challenges to implementing it would have made the living on the edge of terror that I have been doing waiting for 2014 and praying that the law was not gutted before them seem like a mere speed bump.

And - as far as calling the company before I was a verified cash cow - I have had to do that with nearly every insurance policy I have had for the last 15 years (at least a half dozen policies). Never once has one refused to answer questions about the formulary, or the doctors, I would have access to. And I do it because I know that my daughter's life depends on having access to specific medications and, to a lesser extent, the doctors who have been treating her for years. And when I have issues with coverage, I work the system. I don't go into a public forum, with full knowledge of the weight my name carries, and call the person who put his political reputation on the line to obtain this significant step forward a "piece of shit used-car salesman" and start a second nearly identical thread when I've said something so offensive that I'm locked out of this one.

[Zorra]

692. I'm very sorry for your many years of having to work the system when dealing with for profit

health insurance companies. That's really tragic; hopefully, the ACA will be the doorway through which we can eliminate this working the system nonsense forever. My ACA subsidized plan is excellent, relatively speaking. But my premiums after subsidy generally cost between 6% and 8% of my net monthly income. My net monthly income is variable month to month. A reasonable value, that I feel fortunate to be able to afford without significant hardship.

I am pleased that folks are sharing their experiences in public forums, as a way to generate discussion, raise awareness, and elicit ideas for possible solutions to the problems of having to work the system in order to insure that they or their loved ones would get adequate health care.

I suspect most of those who have been frustrated by the system empathize with emotional rants, they know how authentic they are, most having probably at some point smashed a small household item or two when frustrated by dealing with the bureaucracies related to the for profit health care industry

With all due respect, I believe you may possibly be jaded by this long experience in learning to be an expert at dealing with insurance companies. If I was to go around and ask ten of my neighbors what a formulary is, nine of them would probably have absolutely no clue. A major problem with the ACA, IMO, seems to be the official assumption that everyone understands the rules and the ins and outs of working the health insurance system, that everyone has good reading comprehension skills, and that everyone has knowledge of how to use a computer, and how to negotiate cyberspace effectively. This is a mistake, these things frighten people who are ignorant about them, and these are formidable obstacles which they avoid because it all seems like rocket science to them.

Effectively, it really is rocket science for them.

You are very fortunate to have been so well accommodated over the phone by these companies it has been my experience that many people do not always have that kind of experience. In fact, when I am conversing with intake staff in the offices of health care providers, I often mention the problems I have had with health insurance companies. I have seen many of them roll their eyes, and tell me that they know the drill and could tell me stories.

I talk to people about insurance and the ACA in my daily life. I carry the phone number of the local ACA navigator at all times. I call the navigator and set up appointments for people on the spot. I give out the healthcare.gov number to people who potentially have the wherewithal to negotiate the system over the phone, barring programmatic requirements or system failure. I helped my closest neighbor sign up for Medicaid. I helped the disabled man who works on my guitars sign up for Medicaid. I helped co-workers and friends get signed up for much needed semi-affordable health insurance coverage.

The reason I do this is because I understand that they are afraid. Some have been propagandized by the RW, others are afraid of looking stupid, or afraid of failure. They don't know what to do, and I do know what to, so I do it for them, without much personal time expended. If I asked all the folks I have assisted what a formulary is, 90% of them wouldn't the slightest clue.

I know for a fact that it is a huge mistake to assume that people understand the ins and outs of working the health insurance, system, because most really don't.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=4696750

[krawhitham]

688. Why YES I have, and I was able to find the The Formulary list for all 5 companies on the exchange

This was for Ohio

[Zorra]

695. Could you please post a link to the page with the formularies, if

it is convenient? Even if it is just a link for Ohio, it might be a key to finding them in my state.

I help people sign up for the ACA, and if I could find the way to access the formularies for different companies and their plans, it would be very helpful.

Thanks!

[chompers]

599. The crowning achievement of our fearless leader.

Puke. A few years back, the OP would have been crucified for the FBHO bit. I fully agree.

[pansypoo53219]

600. PRIVATE insurance LOVES finding loopholes.

complain about it. to congresscritter or media.

[Catherina]

611. I'm so sorry Will

Your wife is lucky to have you be her side and fighting for her. I hope this nightmare ends soon so you don't have this added, cruel burden to deal with and can peacefully devote your time to her instead. I'm so sorry.

[Whisp]

612. Now where have we seen this kind of language before:

oh, I know..... !

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[Cha]

630. I feel sorry for Pitt having to resort to this kind of hate at the wrong person.. "anger"

turns out can just be misguided.

[gulliver]

634. Just sad. A total self-involvement tailspin.

I'm embarrassed for you. Yeesh.

[LittleBlue]

647. William, I know how that's like

My mother had MS before she passed.

I hope your wife gets the medicine she needs. It's a fucking crime the way this system is run.

[truedelphi]

662. It is a rotten disease.

And it is especially galling to think that these pathetic situations of people finally getting "insurance coverage" but then having to be wiped out economically in order to get drugs, that this is all occurring after the system was supposedly "reformed."

[tritsofme]

650. I don't know why Freeper trash like this is tolerated.

I hope you take your own advice, and attempt the anatomically impossible, within the next 24 business hours.

[jazzimov]

668. Wait a minute. so the Insurance company YOU picked

finds and takes advantage of a loophole in the ACA, and you automatically say FU to the President for trying to do the right thing?

I agree with the FU to the insurance industry. BUT you lost me when you said FU to the one guy who fought with blood and tears trying to do the right thing for all of us.

[Riftaxe]

670. Let's skip over the fact that in NH more then half the hospitals

are off limit to ACA plans.

Actually why should we do that? The fucking huge increase in deductible is fucking untenable, fortunately Senator Reid solved that by calling us all liars...

You want me to vote what again in 2014?

Some of the younger people will wonder why they can't be an asshole all the time, and watch gains turn into loses...this is why.

You know well why i hate you WilliamPitt, but on this travesty I do believe we can be united.

[MineralMan]

689. Still feeling that way, Will?

If not, why not self-delete this. I know you can't post in the thread, but I believe you can still self-delete it. That would be a good thing, I believe, and it could drop out of sight and not embarrass you any further.

[Logical]

693. Why? The Drug Company solved the issue, not the insurance company. nt

[MineralMan]

694. And either way, President Obama had nothing to do with it

at all. Did you miss that part of the OP?

[questionseverything]

704. overhauling the healthcare/insurance system

without addressing cost containments was a mistake so it all has something to do with potus

you wrote a good op addressing the high cost of drugs and listing some possible solutions, can't we build from that and let potus know it needs fixed instead of going back to this denial thing?

[Cirque du So-What]

691. Momentarily

nobody will remember that you wasted a few minutes to register for this site - much less your aptly-chosen username. Dunces are a dime-a-dozen, yunno.

[itsrobert]

698. I'm glad your wife will be getting her meds afterall

n/t

[crimeariver1225]

700. it is amazing this has over 100 recommends

[donheld]

703. Calling the President a piece of shit used-car salesman very much should be allowed.

People don't have to believe he is that, but people, even at DU, should have a right to say it.

[Whisp]

705. Ted Nugent and his fan base approve your message. n/t

[riversedge]

707. you most likely

Hit the spot with your post. While it is good to vent the anger--the IP will help the opposition also.

[Babel_17]

710. My sympathy for your family's dilemma

I can't say I wouldn't say the same thing if I was in a similar situation. The POTUS is going to be getting blessed, and cursed, a lot as the ACA gets implemented. Max Baucus should be sharing in that but he wasn't that public a figure.

It's a credit to the DU that we don't censor, what is painful to hear, because it is expedient.

The pain and suffering here is something we need to take into account.

[BoulderNative]

712. Who is William Pitt?

William Pitt. Who are you? Are you one of us?

I am from Boulder and I am the fearless leader of all the people there.