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712 replies	Author	Time	Post
This message was self-deleted by its author (Original post)	WilliamPitt	Mar 2014	OP
Hall-of-Fame Bullshit artist...	truebrit71	Mar 2014	#1
I long for a time machine.	WilliamPitt	Mar 2014	#3
My wife is a breast cancer survivor...	truebrit71	Mar 2014	#11
I'm a cancer patient---without ACA I would have NO insurance	wordpix	Mar 2014	#546
I hope your recovery is 100% successful...	truebrit71	Mar 2014	#550
Wm Pitt---pls. inform your Congressional rep about this	wordpix	Mar 2014	#554
Sounds like good advice, hopefully that may help Will's wife.	Jefferson23	Mar 2014	#565
This is great advice	Dorian Gray	Mar 2014	#709
My copay (medicare part d) for my MS med is 1650 a month	Mojorabbit	Mar 2014	#23
For which medication? Just curious.	TrollBuster9090	Mar 2014	#204
Aubagio. I was in the experimental trial for several years and then the FDA approved it	Mojorabbit	Mar 2014	#220
I looked up Aubagio to help out Pitt	steve2470	Mar 2014	#222
But I think she is saying she could afford it for a while,	truedelphi	Mar 2014	#358
But how much does it actually "cost" to make the drug?	Pharaoh	Mar 2014	#538
excellent point nt	steve2470	Mar 2014	#541
While drugs are too high, it's not like you do a google search and make it in the kitchen.	Hoyt	Mar 2014	#579
Sorry but I don't buy all that shit	Pharaoh	Mar 2014	#654
Then, why don't a couple of unemployed PhDs down the street make them and sell at half the price.	Hoyt	Mar 2014	#658
They would be arrested.	Pharaoh	Mar 2014	#659
but you can get a generic in Canada for about 3 bucks.	Pharaoh	Mar 2014	#660
So, it is more difficult than you suggest. Like I said,	Hoyt	Mar 2014	#661
Medicare part d was the prelude to heritage care	Doctor_J	Mar 2014	#389
Definitely better before 2006- no drug coverage, elderly doing without, cutting pills in thirds, etc	Hoyt	Mar 2014	#656
cannabinoids show promise for MS	wordpix	Mar 2014	#548
I knew we were screwed	Mnpaul	Mar 2014	#172
but it's all Lieberman's fault	Doctor_J	Mar 2014	#392
The National Health system in the UK has a formulary.	pnwmom	Mar 2014	#590
On the NHS if you need meds, you get meds.	truebrit71	Mar 2014	#591
You get meds if they're listed as available on the formulary.	pnwmom	Mar 2014	#592
I have two elderly parents that use the NHS all the time.	truebrit71	Mar 2014	#595
That's because the doctors are choosing medicines off the formulary.	pnwmom	Mar 2014	#596
Exactly	OwnedByCats	Mar 2014	#608
I've been told otherwise by more than one Brit.	HuckleB	Mar 2014	#609
Only if it's been approved by NICE	Spider Jerusalem	Mar 2014	#682
Anger IS a gift, my dear Will, and one you use most effectively.	CaliforniaPeggy	Mar 2014	#2
"fuck you mr president you piece of shit used car salesman" is an "excellent rant"?	uppityperson	Mar 2014	#207
And if I did?	CaliforniaPeggy	Mar 2014	#208
If you did, it makes me sad to see 2 long term duers like you and he think that is ok	uppityperson	Mar 2014	#235
I regret that you're sad. But I do stand with Will on this topic. n/t	CaliforniaPeggy	Mar 2014	#238
I wish we'd gotten single payer, but can not understand calling him that. Or putting all the blame	uppityperson	Mar 2014	#240
Miserable fucking crap shoot dealing with Insurance vultures.	JEB	Mar 2014	#283
NH does not offer many options for insurance	magical thyme	Mar 2014	#301
Look. Obama was so pathetic on this issue that even Jon Stewart called him out.	truedelphi	Mar 2014	#369
So you agree President Obama is a "piece of shit used-car salesman" deserving "fuck you" on DU?	uppityperson	Mar 2014	#370
Thoe were not my words,	truedelphi	Mar 2014	#379
My apologies, I edited to remove the unneeded snark. Yes, there are a hell of a lot of problems,	uppityperson	Mar 2014	#382
because greater of two evils	hfojvt	Mar 2014	#559
They should have pushed for single payer with all their might.	Enthusiast	Mar 2014	#503
+ 1	red dog 1	Mar 2014	#706
Thanks, red dog 1.	Enthusiast	Mar 2014	#708
No, the insurance companies are not legalized gambling, they're mass murderers for profit.	Scuba	Mar 2014	#517
Sorry for your situation and sorry that you feel that way about the President. But the blame goes	kelliekat44	Mar 2014	#532
Hi, did you mean to reply to Will?	uppityperson	Mar 2014	#569
Pitt has done that before	brush	Mar 2014	#476
"Too subtle for Pitt.." that's about it. Went right over his head which was	Cha	Mar 2014	#479
nothing was missed, Pitt is just playing to a certain crowd looking to be popular	JI7	Mar 2014	#480
Guess it's the Obama haters. nt	brush	Mar 2014	#481
Yep and yep!	Kahuna	Mar 2014	#498
Damn him for "playing" at having a real life problem.	quakerboy	Mar 2014	#613
He'd be okay	Jakes Progress	Mar 2014	#616
It's an "excellent rant" to those who don't care that his rage is misplaced.. it would be a	Cha	Mar 2014	#455
THIS	sobenji	Mar 2014	#525
Post removed	Post removed	Mar 2014	#558
A-fucking-men! Well said!	truebrit71	Mar 2014	#564
it was a great post.	kath	Mar 2014	#582
The apologists can't handle the truth I guess...	truebrit71	Mar 2014	#585
This	quakerboy	Mar 2014	#615
I too was amazed that it was hidden...	truebrit71	Mar 2014	#618
Thank You, sobenji!	Cha	Mar 2014	#635
Oh My, that post that was hidden addressed to you,	Cha	Mar 2014	#638
Well said! +100	Auntie Bush	Mar 2014	#711
No. How could those bastards do that?	Autumn	Mar 2014	#4
Heh.	WilliamPitt	Mar 2014	#8
Those mother fuckers covered all the bases didn't they.	Autumn	Mar 2014	#10
I'm pretty sure that is not true.	Nye Bevan	Mar 2014	#53
Excellent advice.	QuestForSense	Mar 2014	#96
It's super advice but, dammit,	crim son	Mar 2014	#649
''with a polite but insistent appeal that this drug be covered.''	Whisp	Mar 2014	#115
" not once have I ever failed to eventually get coverage "	Lex	Mar 2014	#127
I meant the polite part ain't gonna happen.	Whisp	Mar 2014	#132
Oh, I see. Yeah, probably.	Lex	Mar 2014	#143
Ranting on the DU about how awful Obama is won't change anything	ConservativeDemocrat	Mar 2014	#170
It's not like Obama is happy	Lex	Mar 2014	#174
Some think he is. They truly believe it makes him happy that people suffer	Whisp	Mar 2014	#279
Unless, of course,	ohheckyeah	Mar 2014	#456
Great catch!...nt	Jesus Malverde	Mar 2014	#486
it's already gotten him some sound advice	magical thyme	Mar 2014	#307
True enough, but I think he could have gotten the same without screaming	ConservativeDemocrat	Mar 2014	#633
I agree he could have gotten it without the screaming	magical thyme	Mar 2014	#637
we should not have to spend our lives begging insurance companies to	Doctor_J	Mar 2014	#395
what I think is moronic is	Whisp	Mar 2014	#403
And cruel.	woo me with science	Mar 2014	#407
Cruel	ctsnowman	Mar 2014	#508
You only think that	ohheckyeah	Mar 2014	#458
"do what they are supposed to do."	NCTraveler	Mar 2014	#526
We got our annual benefits pitch from the insurance rep	Doctor_J	Mar 2014	#529
"It has nothing to do with keeping me healthy."	NCTraveler	Mar 2014	#533
While your advice is good advice, considering the system we have, it is truly sad that sick people	sabrina 1	Mar 2014	#213
I'm one of the more pro-free market, pro-capitalism DUers	Nye Bevan	Mar 2014	#236
Thank you! I support the free Market also, but not when it is abused, and imo, HC should	sabrina 1	Mar 2014	#449
insurance companies will when forced cover what is in the contract	questionseverything	Mar 2014	#250
On three occasions my insurer has denied coverage for a drug for a family member.	Nye Bevan	Mar 2014	#253
the squeaking wheel definitely gets the grease	steve2470	Mar 2014	#257
are you saying the ins paid for meds not covered in contract?	questionseverything	Mar 2014	#263
My policies (and I believe most policies) have "non-formulary exception" provisions	Nye Bevan	Mar 2014	#273
with that language he probably has a case	questionseverything	Mar 2014	#280
Yeah, they are (deliberately, I think) vague about coverage prior to you taking out the policy.	Nye Bevan	Mar 2014	#344
yes some drug companies have good plans to help	questionseverything	Mar 2014	#575
I have never had an insurance company refuse to provide the formulary	Ms. Toad	Mar 2014	#604
what i posted is the formulary	questionseverything	Mar 2014	#606
From the first two pages of the formulary at the link you posted:	Ms. Toad	Mar 2014	#617
if you have been reading what will has written	questionseverything	Mar 2014	#620
I have won plenty of appeals for things which were not in the language of the contract.	Ms. Toad	Mar 2014	#624
extra ordinary claims require proof	questionseverything	Mar 2014	#640
Half the people in this thread defending the ACA	Aerows	Mar 2014	#646
Right. Like I am going to post my medical documentation on the internet.	Ms. Toad	Mar 2014	#648
ok since you took the time for all that i will try and address it	questionseverything	Mar 2014	#657
All three are outside the language of the policy -	Ms. Toad	Mar 2014	#663
maybe this exchange will help you understand	questionseverything	Mar 2014	#697
Yes. The insurance company paid for meds not in the contract.	Ms. Toad	Mar 2014	#702
Connecticut??? Huh.	bullsnarfle	Mar 2014	#540
agree about going to state insurance agency---also go to your Congresscritters	wordpix	Mar 2014	#557
You are not required to stay in a grandfathered plan.	thesquanderer	Mar 2014	#92
Will, you have been grossly misinformed by your friend and ally.	pnwmom	Mar 2014	#324
Yes, the main thing to bear in mind is that there is no premium subsidy with an off-exchange plan.	Nye Bevan	Mar 2014	#349
Message auto-removed	Name removed	Mar 2014	#686
I repeat: I refuse to die until I have first danced on the mass grave of for profit health	Zorra	Mar 2014	#5
Can i join you in waiting for that dance	truedelphi	Mar 2014	#360
Me too.	Enthusiast	Mar 2014	#505
Me three.	Brigid	Mar 2014	#571
Unfortunately I won't outlive Heritage Care	Doctor_J	Mar 2014	#530
This might help a little...	C_U_L8R	Mar 2014	#6
More people need to be made aware that this can happen! This needs to go viral, because	loudsue	Mar 2014	#7
You didnt check to see if an ongoing medication was covered before you signed up?	Egnever	Mar 2014	#9
Blaming the victim is worse than foolish,	bvar22	Mar 2014	#47
LOL	Egnever	Mar 2014	#74
ok i'll bite	questionseverything	Mar 2014	#234
I looked on that pdf file and can't find certolizumab pegol yet nt	steve2470	Mar 2014	#245
It's called a formulary and every insurance company has them. It is	sinkingfeeling	Mar 2014	#544
yes it is a formulary, that was the point	questionseverything	Mar 2014	#583
We need more consumer protection to protect us from insurance companies	LiberalEsto	Mar 2014	#587
Then why can anybody go online and get a copy of the specialty drugs?	sinkingfeeling	Mar 2014	#602
no where in that link does it say what is covered	questionseverything	Mar 2014	#605
I can't explain it to you. It's how all drug coverage insurance works. Not all drugs	sinkingfeeling	Mar 2014	#607
people were saying will was wrong for not checking the formulary	questionseverything	Mar 2014	#610
The online link for some specialty drugs	Ms. Toad	Mar 2014	#619
This message was self-deleted by its author	REP	Mar 2014	#632
That is not correct.	Ms. Toad	Mar 2014	#614
I was able to make a drug list on the wesite - of any and all level drugs -	Control-Z	Mar 2014	#644
"Being a victim is beyond foolish"	Hissyspit	Mar 2014	#266
Every single insurance company should be regarded	JEB	Mar 2014	#334
Could you please tell me what medications I'm going to on	Boudica the Lyoness	Mar 2014	#446
You are dead wrong. There may be alternative medications that work as well.	bluestate10	Mar 2014	#119
Excuse me, Dr. Bluestate.	lapislzi	Mar 2014	#262
"If a patient insists on a particular medication when other therapies will work" and there is the	uppityperson	Mar 2014	#352
"Everyone who has ever been deceived by an insurance company is a fool!"	Zorra	Mar 2014	#94
There was no deception	Egnever	Mar 2014	#99
Maybe YOU have the knowlege and skills to do all of that,	bvar22	Mar 2014	#126
Post removed	Post removed	Mar 2014	#145
Yeah, I know.	bvar22	Mar 2014	#258
Pretty well sums up my experience as well.	JEB	Mar 2014	#296
A master obfuscater.	Enthusiast	Mar 2014	#506
Message auto-removed	Name removed	Mar 2014	#687
Insurance companies have the art of deception down through omission,	Zorra	Mar 2014	#144
Not sure what any of that has to do with checking the formulary before you purchase a plan	Egnever	Mar 2014	#156
As I understand it, no insurance company is required to pay for a medication that hasn't been proven	TrollBuster9090	Mar 2014	#224
I was not permitted access to the formulary before I purchased my plan. nt	Zorra	Mar 2014	#284
Thank you for relating the realities of the situation.	truedelphi	Mar 2014	#497
You touched on something important..	freebrew	Mar 2014	#555
Yeah, "the insurance company".. maybe pitt should have been "fuck" "fuck" "fuck" "fuck" "fuck"	Cha	Mar 2014	#180
WTF?!	Demo_Chris	Mar 2014	#118
The poster made a valid observation. nt	bluestate10	Mar 2014	#124
stating somebody was a fool for not reviewing the formulary before signing up	magical thyme	Mar 2014	#318
Third Way Free Marketeers value profit over human well being, so they	Zorra	Mar 2014	#316
Wow, I did not see that happen.	PowerToThePeople	Mar 2014	#322
There is not enough information posted on the providers' websites to garner this information.	MoonchildCA	Mar 2014	#462
What if my medicine isn't on a plan's formulary?	itsrobert	Mar 2014	#12
I don't think we are getting all the details and facts here...	Whisp	Mar 2014	#13
Indeed. He's giving up on a new plan because some insurance adjuster advised him not to bother	itsrobert	Mar 2014	#17
If the nation's citizenry had been offered real health care reform and not	truedelphi	Mar 2014	#385
Because he is Will Pitt	theboss	Mar 2014	#577
I agree, why would an Obamacare plan	treestar	Mar 2014	#79
They darn sure do. Medicare has no out-of-pocket cap, for example.	Hoyt	Mar 2014	#90
The accusation does sound somewhat suspicious and was delivered emotionally.	bluestate10	Mar 2014	#130
Someone's sort of stuck on permanent anger at this point. No, we don't have all the facts.	Hekate	Mar 2014	#233
Good post...	SidDithers	Mar 2014	#386
"he signed up for a lifetime of reading the fine print and doing the research"	wickerwoman	Mar 2014	#477
Lucky you. But in the OP's case, he is a highly articulate professional writer, activist, & teacher	Hekate	Mar 2014	#483
I am from America	wickerwoman	Mar 2014	#484
I realized about two years ago that being enraged	truedelphi	Mar 2014	#496
Appealing the decision doesn't guarantee coverage, just a review, and it can still be denied...	Humanist_Activist	Mar 2014	#42
Yeah, it also can be approved	itsrobert	Mar 2014	#51
I'm assuming what the OP meant by a 3 month fight is that they already...	Humanist_Activist	Mar 2014	#66
I'm assuming nothing	itsrobert	Mar 2014	#73
The President ends up responsible for all the bad things that happen	treestar	Mar 2014	#80
Happens all the time in the Miltiary Tricare System	itsrobert	Mar 2014	#82
They are about a 100 times easier to deal with than say any BCBS	TheKentuckian	Mar 2014	#683
I don't blame the President personally, this system predates him by about 40 years...	Humanist_Activist	Mar 2014	#84
Yes. That's about all I got out of the whine.	lumpy	Mar 2014	#151
Via HHS.gov	JoeyT	Mar 2014	#49
Later today I'm sending the Koch brothers a letter appealing their decision	MannyGoldstein	Mar 2014	#510
Are prescription drug plans the same in every state?	itsrobert	Mar 2014	#14
My heart goes out to you and your wife, Will.	Baitball Blogger	Mar 2014	#15
How do I know if a health plan will cover the medicines I take?	itsrobert	Mar 2014	#16
Thats nice.	bvar22	Mar 2014	#50
What? For profit health care screwing people for profit?	progressoid	Mar 2014	#18
80% of what people pay is supposed to go toward health care	marzipanni	Mar 2014	#72
No.	progressoid	Mar 2014	#114
No. That's two separate issues.	Recursion	Mar 2014	#444
Two separate issues - same wallet.	progressoid	Mar 2014	#472
Yes, that's what deductibles are	Recursion	Mar 2014	#475
Imagine that	Jack for Sanders	Mar 2014	#19
Yeh, I'm so sure Obama gets a jolly laugh out of peope not getting their medication	Whisp	Mar 2014	#131
Message auto-removed	Name removed	Mar 2014	#20
What's the medication and what is your plan you are on?	itsrobert	Mar 2014	#21
Blaming the victim - that makes it better.	TBF	Mar 2014	#38
I'm just asking questions	itsrobert	Mar 2014	#46
People really aren't that stupid itsrobert -	TBF	Mar 2014	#55
A better question would be why aren't the formularies standard from one policy to the next.	Lars39	Mar 2014	#86
Fuck you, Mr. President, you piece of shit used-car salesman. From my heart and soul, fuck you.	one_voice	Mar 2014	#22
+1	Wait Wut	Mar 2014	#24
Thanks for kicking my thread.	WilliamPitt	Mar 2014	#25
"explain that away, apologist"? WTF. It would seem someone with your ability to use words would	uppityperson	Mar 2014	#32
The OP's behavior was fucking insulting and wrong. I happen to live in the same state	bluestate10	Mar 2014	#146
Thank you for a boots on the ground assessment. I think we'd all like more details to see if there	okaawhatever	Mar 2014	#373
The raging anger at the President gets in the way even if it isn't Obama's	Cha	Mar 2014	#165
I feel for your wife Will..	one_voice	Mar 2014	#78
Psst. The president didn't write the law.	Orsino	Mar 2014	#171
Manny, are you saying only pre-existing conditions that have never been exposed to insurance.....	marble falls	Mar 2014	#523
Manny. LOL.	tridim	Mar 2014	#531
Seriously, wtf. If that is not alerted on or hidden, is calling Pres Obama that is ok per	uppityperson	Mar 2014	#29
He hasn't fucked you over.	WilliamPitt	Mar 2014	#30
What does the President have to do with your insurance company's formulary?	ProSense	Mar 2014	#34
I can see getting angry at an insurance company adjustor	treestar	Mar 2014	#70
It's a habit of his. Obamacare has absolutely nothing to do with this crisis but	Cha	Mar 2014	#193
Well, maybe if Obama had TOLD the insurance companies what to do instead of	Lydia Leftcoast	Mar 2014	#83
Formularies are not determined by the President, and existed before ACA	ProSense	Mar 2014	#88
True, formularies existed, but that doesn't mean they SHOULD exist	Lydia Leftcoast	Mar 2014	#93
Well the	ProSense	Mar 2014	#117
Canada has formularies. The UK has formularies. Single payer doesn't work without them.	Recursion	Mar 2014	#445
Prescription medications are not covered in Canadian Health Care...	SidDithers	Mar 2014	#603
EXACTLY!!! I related that fact in an earlier post. My sense is that the OP is	bluestate10	Mar 2014	#159
So how would THAT work ...	1StrongBlackMan	Mar 2014	#198
As opposed to having the companies tell HIM what to do?	Lydia Leftcoast	Mar 2014	#400
Well ...	1StrongBlackMan	Mar 2014	#513
Most importantly Presidents execute the laws and enforce them. Thats why its called the executive ..	marble falls	Mar 2014	#527
My complaint is not about what Obama's legal powers. It's about	Lydia Leftcoast	Mar 2014	#586
You are not the only person here making sensible claims and	truedelphi	Mar 2014	#398
What is sensible about claims and statements like this ...	1StrongBlackMan	Mar 2014	#561
What they are trying to emphasize in a statement like that one,	truedelphi	Mar 2014	#598
Okay. eom	1StrongBlackMan	Mar 2014	#601
Thank you!	Lydia Leftcoast	Mar 2014	#684
Details.. everything is President Obama's fault when it comes to one	Cha	Mar 2014	#123
You miss the point of calling him "a used car salesman piece of shit".	uppityperson	Mar 2014	#35
+1 nt	Dreamer Tatum	Mar 2014	#43
Post removed	Post removed	Mar 2014	#59
Message auto-removed	Name removed	Mar 2014	#246
Is he the insurance adjustor?	treestar	Mar 2014	#69
He handed the proces over to them.	WilliamPitt	Mar 2014	#75
That is a bullshit claim. Congress passed the ACA, the President is doing his best to	bluestate10	Mar 2014	#166
Maybe you shouldn't have left MA for "tax free NH?" It's nice up there but you get what you pay	MADem	Mar 2014	#350
And the President of the United States personally fucked you over?	brush	Mar 2014	#482
Jury left it 3-3...	one_voice	Mar 2014	#31
I was wondering what the results were.	Autumn	Mar 2014	#33
I wasn't the original alerter.	one_voice	Mar 2014	#122
The jury on your post was 3-3	The Straight Story	Mar 2014	#37
Wow...	one_voice	Mar 2014	#62
I voted to leave (for obvious reasons)	The Straight Story	Mar 2014	#63
Yeah I agree...	one_voice	Mar 2014	#81
Incredible.	uppityperson	Mar 2014	#41
Oh he thinks he can throw any fucking insult he wants against the President ..	Cha	Mar 2014	#135
ROFL	alcibiades_mystery	Mar 2014	#368
Hopefully that post and this overall thread will result in some admin attention	Number23	Mar 2014	#465
It's the Knee Jerk Obama Syndrome.. and this	Cha	Mar 2014	#469
jury Left it.	Whisp	Mar 2014	#136
Thank you. "a little over the top"	uppityperson	Mar 2014	#142
Well, the pitt fans weren't on this jury.. and he wouldn't know "truth" if it gobsmacked him	Cha	Mar 2014	#378
I agree. In the past calling the President a "POS" would have been a clear violation. One thing	lostincalifornia	Mar 2014	#176
Really. Misplaced anger.. but the President is always handy when it comes time	Cha	Mar 2014	#182
I find your anger misplaced	Oilwellian	Mar 2014	#209
I'm not Raging at the President for something that isn't his fault. Throwing all kinds of idiotic	Cha	Mar 2014	#218
Lashing out in this fashion doesn't do any good	mythology	Mar 2014	#669
Amazing and oh so tolerant	AnalystInParadise	Mar 2014	#267
typical as well to defend that OP	Whisp	Mar 2014	#362
I don't like Will	AnalystInParadise	Mar 2014	#372
I don't like him either because he tends to *ahem, exaggerate things	Whisp	Mar 2014	#374
If there is proof	AnalystInParadise	Mar 2014	#377
See post 476. Pitt has went off mistakenly on the President before	brush	Mar 2014	#485
And before today	AnalystInParadise	Mar 2014	#652
Seems to show a pattern	brush	Mar 2014	#664
Yeah this sucks.	dilby	Mar 2014	#26
It's a fucking shark tank.	WilliamPitt	Mar 2014	#27
After all that fighting, we end up with insurance companies	NightWatcher	Mar 2014	#28
Sometimes you just have to take a pain pill	obliviously	Mar 2014	#36
At least put in an appeal.	Lex	Mar 2014	#39
That should be the first course of actions. In fact if a physician says the patient absolutely	lostincalifornia	Mar 2014	#181
Same here. Every single year I print out my original letter detailing what the generic does to me...	Hekate	Mar 2014	#247
Getting the Website UP, and getting people Signed Up was the EASY part.	bvar22	Mar 2014	#40
"The Affordable care Act provides NO Watch Dog Agency"	Aerows	Mar 2014	#621
I'd feel angry too. But was she on this med before, and are there any alternatives?	Hoyt	Mar 2014	#44
My partner's MS drug is covered under the state employee plan in NC	Lex	Mar 2014	#97
I think there is a way with this one. At least I hope. Sorry they are going through this.	Hoyt	Mar 2014	#105
He shouldn't have to "appeal" to get her medicine!!!!	Doctor_J	Mar 2014	#551
"Shouldn't have to" is a different issue altogether. nt	Lex	Mar 2014	#553
A lot of medicines do essentially the same thing	theboss	Mar 2014	#580
I suspect that cheaper alternatives were offered and rejected. Some alternatives,	bluestate10	Mar 2014	#175
If the DOCTOR agrees that the drug is needed, the insurance companies will go with the doctor.	MADem	Mar 2014	#361
I agree, something is missing. I'm not sure insurance companies always go with docs, especially	Hoyt	Mar 2014	#363
If the doctor puts his or her foot down, the insurance companies will fold.	MADem	Mar 2014	#375
I get it. Most folks here would really get po'd if faced with formularies in Canada, England, etc.	Hoyt	Mar 2014	#387
We needed (and asked for) a public service. They gave us a consumer product.	1000words	Mar 2014	#45
Single Payer isn't going to happen until republicans are either proven completely	bluestate10	Mar 2014	#177
Crumbs	1000words	Mar 2014	#189
Your last sentence is a collection of words that have no logical basis.	bluestate10	Mar 2014	#206
One thing is dead certain..	sendero	Mar 2014	#281
It wasn't The Republicans who stopped the Public Option.	bvar22	Mar 2014	#264
You may as well be speaking with tongues.	djean111	Mar 2014	#501
Capitalism has to go -	TBF	Mar 2014	#48
Pay us or DIEEEE!!!11!!	PowerToThePeople	Mar 2014	#106
This article might be of help?	Lex	Mar 2014	#52
You should not call people pieces of shit.	bravenak	Mar 2014	#54
I think Will's account has been hacked. There is no other explanation. nt	tridim	Mar 2014	#61
Nope.	WilliamPitt	Mar 2014	#64
Then it's just the gift of anger.	tridim	Mar 2014	#67
And he should not be angry when his wife's life is at stake.	zeemike	Mar 2014	#183
He is angry ALL THE TIME, at Obama. nt	tridim	Mar 2014	#512
And you are hyperbolic ALL THE TIME. nt	zeemike	Mar 2014	#514
Genius response in this shit thread.	tridim	Mar 2014	#515
Sometimes being a mirror is all you can do.	zeemike	Mar 2014	#516
I am feeling a bit scared for him if that is him.	bravenak	Mar 2014	#76
I hope it's resolved.	CJCRANE	Mar 2014	#120
I think we can figure out a way if he is interested.	bravenak	Mar 2014	#129
That's a great idea.	Wait Wut	Mar 2014	#140
Good idea.	bravenak	Mar 2014	#148
Not me.. I recognize his raging knee jerk reaction for Pres Obama..	Cha	Mar 2014	#225
But, i bet we could help him if he wants our help.	bravenak	Mar 2014	#268
Yes, bravenak.. I believe this poster said it best..	Cha	Mar 2014	#282
He should take the advice on this and rail about another issue.	bravenak	Mar 2014	#292
Well he did this one "piece of shit used car salesman" Hidden and will wouldn't know "the truth" if	Cha	Mar 2014	#304
Open enrollement does not end until the 31st, look for a new plan	Motown_Johnny	Mar 2014	#56
It's New Hampshire.	WilliamPitt	Mar 2014	#68
But you said in a post above that NH has ten options, have you tried the other nine?	sheshe2	Mar 2014	#100
Since health-care costs can't be deducted from taxes unless you run up an enormous bill,	bluestate10	Mar 2014	#184
First, edit your OP. This is a state issue	Motown_Johnny	Mar 2014	#265
We have Anthem and use eScripts as their mail order pharmacy	Purrfessor	Mar 2014	#502
Have you gone to the National Multiple Sclerosis Society web site?	JoePhilly	Mar 2014	#57
I found this on their website as well	steve2470	Mar 2014	#205
Kudos for you too!	DebJ	Mar 2014	#396
Cool! Nice to see some real assistance being offered!	DebJ	Mar 2014	#394
Misplaced anger is the downfall of many great people. nt	tridim	Mar 2014	#58
Misplaced loyalty, too.	1000words	Mar 2014	#77
Even moreso. n/t	Aerows	Mar 2014	#622
aca is not about health care, it is about health insurance companies health care may or may not be	msongs	Mar 2014	#60
So it was covered before, and now isn't?	treestar	Mar 2014	#65
You're missing the point.	WilliamPitt	Mar 2014	#71
+1	ChazII	Mar 2014	#101
I you feel there are no alternatives, or your physician's authorization cannot remedy it, then start	lostincalifornia	Mar 2014	#185
She asked you a simple question. WAS the drug covered by you plan before	bluestate10	Mar 2014	#196
Your agent falsely told you a non-exchange insurer may deny someone for preexisting conditions.	pnwmom	Mar 2014	#435
Are other MS medications covered?	theboss	Mar 2014	#578
that is the problem with using the existing insurance companies	dembotoz	Mar 2014	#85
A long shot and possibly illegal	Lydia Leftcoast	Mar 2014	#87
Just use the prescription that the U.S. doctor wrote, and have it filled by a reliable pharmacy in	lostincalifornia	Mar 2014	#190
Or go for a drive. It's not like he's all that far from the border.	MADem	Mar 2014	#364
Medication from Canada	Aerows	Mar 2014	#623
One argument that has been used is that we are subsidizing the other countries costs for the drugs,	lostincalifornia	Mar 2014	#626
It's a bullshit argument	Aerows	Mar 2014	#628
Regardless a lot of the problem is Congress	lostincalifornia	Mar 2014	#666
No arguments from me	Aerows	Mar 2014	#667
So should I self-delete?	lostincalifornia	Mar 2014	#672
I was just teasing	Aerows	Mar 2014	#673
I didn't take you seriously, though I did repost the same response, just in case	lostincalifornia	Mar 2014	#675
Seriously, I really didn't mean anything by it	Aerows	Mar 2014	#677
I know. LOL	lostincalifornia	Mar 2014	#678
You never know	Aerows	Mar 2014	#680
Regardless, a lot of the problem is Congress	lostincalifornia	Mar 2014	#674
A lot of the problem	Aerows	Mar 2014	#676
Does RomneyCare have the same problem in Mass?	Common Sense Party	Mar 2014	#89
The OP lives in New Hampshire. Until LePage took over in Maine, NH was the	bluestate10	Mar 2014	#202
The plan in MA is very good. I've got friends and family with complex medical issues and they	MADem	Mar 2014	#365
calm down Will, have a stiff drink. nt	dionysus	Mar 2014	#91
If only we could get them	Mr.Bill	Mar 2014	#109
yeah it's probably out of network.	dionysus	Mar 2014	#199
If there is any research or other assitance any of us could provide, please ask no matter	Bluenorthwest	Mar 2014	#95
Did anyone expect insurance companies to allow their profits to be fucked with?	Auggie	Mar 2014	#98
I cerntainly didn't.	dilby	Mar 2014	#108
I hope you're able to resolve this, Will.	CJCRANE	Mar 2014	#102
This message was self-deleted by its author	nadinbrzezinski	Mar 2014	#103
New Jersey?	rudolph the red	Mar 2014	#178
You are right, my mistake, he should call his delegation from Massachusetts.	nadinbrzezinski	Mar 2014	#179
And I was right. Will lives in New Jersey.	nadinbrzezinski	Mar 2014	#329
The OP lives in New Hampshire.	rudolph the red	Mar 2014	#338
My apologies, he should still contact his delegation	nadinbrzezinski	Mar 2014	#342
Agreed	rudolph the red	Mar 2014	#346
true.. but no "mainstream" candidate for President in the last 30 years would dare disobey	Douglas Carpenter	Mar 2014	#104
I'm so sorry, Will.	LiberalAndProud	Mar 2014	#107
It's these kind of inexcusable problems with the ACA	seveneyes	Mar 2014	#110
It's simply not true that nobody read the health care bill before it was passed.	cheapdate	Mar 2014	#423
The most basic...letting a doctor decide which medicine, not an insurance company	seveneyes	Mar 2014	#504
As has been pointed out by others on this thread,	cheapdate	Mar 2014	#665
It isn't what was promised, we were lied to, and people are suffering for it.	Skip Intro	Mar 2014	#111
No one "lied" about the problem in the OP.	ProSense	Mar 2014	#128
The President's personal choice is probably single payer.	Lex	Mar 2014	#153
no it wasn't	Doctor_J	Mar 2014	#419
Sure	Lex	Mar 2014	#420
In 2008, Camnpaign Obama said that he preferred Single Payer,	bvar22	Mar 2014	#581
Oh please.	Skip Intro	Mar 2014	#274
What	ProSense	Mar 2014	#327
It's all a parsing and spin game with you, Prosense.	Skip Intro	Mar 2014	#343
This thread isn't about facts.	ProSense	Mar 2014	#351
Little here is about facts when those facts "hurt" Obama.	Skip Intro	Mar 2014	#353
It has become so very obvious over the years.	Rex	Mar 2014	#696
Good news! No matter how bad they fuck you, thanks to Obama you still have to buy it. nt	Demo_Chris	Mar 2014	#112
I don't need expensive medication, but sometimes I get rejected for a maintenance medication	bluestate10	Mar 2014	#113
Quick question	Aerows	Mar 2014	#625
While you are at it you should fuck the 5,000,000 who now have insurance & didn't before.	Bernardo de La Paz	Mar 2014	#116
Having insurance is not the same as having healthcare.	dilby	Mar 2014	#121
Or...	Wait Wut	Mar 2014	#137
Thanks for your post.	Number23	Mar 2014	#467
True. But Obama made affordable insurance the law of the land.	Bernardo de La Paz	Mar 2014	#139
Single Payer would have been better.	dilby	Mar 2014	#152
I bet the President would have definitely preferred single payer, but	Lex	Mar 2014	#154
Well now it never will.	dilby	Mar 2014	#158
"Healthcare tax" phrasing is Republican framing of the issues.	Bernardo de La Paz	Mar 2014	#162
No, this mediocre ACA is a step on the road to eventual single payer once	Lex	Mar 2014	#163
Nope, the ACA makes it more likely	jeff47	Mar 2014	#439
Of course, but too many scared Dem congresspeople would have voted it down.	Bernardo de La Paz	Mar 2014	#160
+100. n/t	Skip Intro	Mar 2014	#366
When those five million go to use the insurance, then	truedelphi	Mar 2014	#380
Not true and you know it	brush	Mar 2014	#488
I get it. Insurance is not health care. But they will get more care than they got before.	Bernardo de La Paz	Mar 2014	#499
Oh hell! I'm so sorry, Will. n/t	Duval	Mar 2014	#125
Message auto-removed	Name removed	Mar 2014	#133
You live in MA right?	boston bean	Mar 2014	#134
He moved to tax free NH, there are fewer options up there. nt	MADem	Mar 2014	#384
WRP, if it were	Duval	Mar 2014	#138
Just what mankind needs, more hate. That will sure come in handy in obtaining pills for Mrs.Pitt.	lumpy	Mar 2014	#192
I have had many a fight with Anthem about non-approved medication	naturallyselected	Mar 2014	#141
fu	kardonb	Mar 2014	#147
What would have been different	meanit	Mar 2014	#187
Let me get this straight...	Hissyspit	Mar 2014	#275
ANY medication that a physician prescribes should be covered by health insurance	Agony	Mar 2014	#149
I completely agree	steve2470	Mar 2014	#168
I understand Will's anger.	pacalo	Mar 2014	#150
I could too if it weren't for a certain history of	Whisp	Mar 2014	#161
I agree with you to a certain extent, Whisp.	pacalo	Mar 2014	#169
Not to call the President "a piece of shit" though. He's got anger issues — and with the President	brush	Mar 2014	#489
We don't know at this point that Will won't regret his choice of words.	pacalo	Mar 2014	#495
Not in that childish and disrespectful way.	Whisp	Mar 2014	#543
IMO he should regret it. You can express anger issues without being digustingly disrespectful	brush	Mar 2014	#588
The language may be over the top but the opinions aren't. I look forward to his posts.	marble falls	Mar 2014	#535
check with the company that makes the medication	blindersoff	Mar 2014	#155
I thought "covers preexisting conditions" meant that you would be able to get affordable insurance	tarheelsunc	Mar 2014	#157
Hi Will, I just looked up Aubagio...	steve2470	Mar 2014	#164
I found some info...	Wait Wut	Mar 2014	#214
yes good point	steve2470	Mar 2014	#219
Maybe we should be pissed off at the pharmaceutical companies...	Wait Wut	Mar 2014	#227
It is a serious issue	steve2470	Mar 2014	#229
It is, but...	Wait Wut	Mar 2014	#231
Maybe we should be pissed off at the pharmaceutical companies	one_voice	Mar 2014	#237
You mean we aren't pissed at Big Pharm already.	marble falls	Mar 2014	#537
I remember not that long ago...	Wait Wut	Mar 2014	#576
Canada has price controls	Aerows	Mar 2014	#641
It's insane.	Wait Wut	Mar 2014	#685
find another insurer under the exchange that will cover it. If they do then find out if you can	lostincalifornia	Mar 2014	#167
Did you look at the insurer's formulary?	Politicub	Mar 2014	#173
Any chance u can give a little bit more info	jamzrockz	Mar 2014	#186
Reading through this thread I find myself somewhat amazed that even on a very liberal ...	spin	Mar 2014	#188
You could be going to VA for medical care.	Lars39	Mar 2014	#195
I tried a few years ago. ....	spin	Mar 2014	#249
I think there is an income requirement, but Viet Nam era vets are eligible.	Lars39	Mar 2014	#260
I find myself feeling much the same. Many DUers are opposed to Medicare Advantage plans, yet they	Hoyt	Mar 2014	#203
I had an excellent healthcare plan when I was working and it continued after I retired until ...	spin	Mar 2014	#254
worthy of its own thread	Skittles	Mar 2014	#251
The main problem in our country	Aerows	Mar 2014	#636
The ACA waw written the way it was through the efforts of two people:	truedelphi	Mar 2014	#357
This Thread Disturbs Me Too	RobinA	Mar 2014	#393
I'm shocked that someone as smart and informed as Will was so seriously misled.	pnwmom	Mar 2014	#459
it amazes me too that there are so many Obama haters . . .	brush	Mar 2014	#491
This probably won't make you feel any better	laundry_queen	Mar 2014	#191
We've all always had to deal with insurance companies not wanting to cover certain meds.	Lex	Mar 2014	#194
Just out of curiosity, what medications did you ask for that were denied?	TrollBuster9090	Mar 2014	#197
Rebif, for example, is a standard drug and is about $16,000 per year.	Lex	Mar 2014	#201
Those are brand name formulations of things like beta-interferon. Not to be naive, but is it	TrollBuster9090	Mar 2014	#211
Don't know of any generic versions.	Lex	Mar 2014	#223
Or there could be alternative treatments that are cheaper and shown to be equally effective.	TrollBuster9090	Mar 2014	#226
Best to appeal with a doctor's letter requiring	Lex	Mar 2014	#228
as far as I know	blindersoff	Mar 2014	#639
Good!	TrollBuster9090	Mar 2014	#642
Post removed	Post removed	Mar 2014	#200
Lovely, just lovely	Oilwellian	Mar 2014	#215
and calling the President a piece of shit belongs in freeperland.	Whisp	Mar 2014	#221
Unbelievable	panader0	Mar 2014	#261
I'm amused by those who are suddenly above name-calling.	1000words	Mar 2014	#239
Calling the President a "piece of shit" is what's disgusting	brush	Mar 2014	#492
I agree with Will	the_sly_pig	Mar 2014	#210
I'm so sorry, Will	Oilwellian	Mar 2014	#212
Obamacare really should have been called The Affordable Insurance Act.	djean111	Mar 2014	#216
Maybe this page from NH will help you, Pitt ?	steve2470	Mar 2014	#217
I think this is covered	obliviously	Mar 2014	#230
An ill-advised comment, Will.	MineralMan	Mar 2014	#232
Has Skinner...	greytdemocrat	Mar 2014	#241
It is standard practice of insurance companies to deny medications or claims.	Glimmer of Hope	Mar 2014	#242
Anybody else would have gotten an instant tombstone.	rudolph the red	Mar 2014	#243
that is right. special rules apply with this one	Whisp	Mar 2014	#270
I sold a used car three weeks ago	panader0	Mar 2014	#244
The argument I suspect that will be made is the restrictions were hidden or ambiguous. My only	lostincalifornia	Mar 2014	#252
What?	Hissyspit	Mar 2014	#276
It's not an analogy--I really did sell a used car	panader0	Mar 2014	#289
I'm so sorry Will...	KoKo	Mar 2014	#248
Try this pharmacy in Canada...	Holly_Hobby	Mar 2014	#255
Who Was Paying For Your Wife's MS Drug Before ACA?	Indykatie	Mar 2014	#256
it was covered by a different insurance company/plan	magical thyme	Mar 2014	#323
MA had "Commonwealth Care"--our local ACA---for years, since the Mittsy days.	MADem	Mar 2014	#391
ACA is not perfect.	Texasgal	Mar 2014	#259
People who live in civilized countries don't have to worry about that,	bvar22	Mar 2014	#269
+1,000	JEB	Mar 2014	#277
+1	leftstreet	Mar 2014	#287
+ 10000000000000	woo me with science	Mar 2014	#410
Yeah, but we didn't have 99 Democrats in the Senate	jsr	Mar 2014	#432
Best post on the whole thread.	marble falls	Mar 2014	#539
Congratulations Mr. Pitt. You are the Free Republic's favorite DUmmie today!!!!	Cofitachequi	Mar 2014	#271
Yes, that's helpful to post here.	Hissyspit	Mar 2014	#278
And it's helpful to have a post saying "fuck you Obama?"	lostincalifornia	Mar 2014	#290
of course it is! that is, if you 'wrote a book', you can say and do	Whisp	Mar 2014	#294
what would be helpful is if you can	bobduca	Mar 2014	#305
There have been numerous posts in this thread with suggestions, most not being responded to by the	lostincalifornia	Mar 2014	#310
The OP has been silenced.	LiberalAndProud	Mar 2014	#473
Oh	lostincalifornia	Mar 2014	#478
He has the right to feel horrible about his wife's illness and the difficulties in . . .	brush	Mar 2014	#493
If it was my wife suffering due to this law	AnalystInParadise	Mar 2014	#314
Nailed It.	bvar22	Mar 2014	#320
The ACA has	ProSense	Mar 2014	#325
You know	AnalystInParadise	Mar 2014	#328
"Good day sir." I'm a woman. n/t	ProSense	Mar 2014	#330
Ironic	AnalystInParadise	Mar 2014	#333
Yes, clearly you're not a "know it all..." n/t	ProSense	Mar 2014	#337
I don't claim to be	AnalystInParadise	Mar 2014	#341
Your posts are pretty insulting	sheshe2	Mar 2014	#359
I will delete nothing	AnalystInParadise	Mar 2014	#371
You did a blatant call out.	sheshe2	Mar 2014	#399
Thank you	AnalystInParadise	Mar 2014	#405
Ah, you play games and like to score points.	sheshe2	Mar 2014	#409
Apparently,	ProSense	Mar 2014	#381
So in your mind	AnalystInParadise	Mar 2014	#390
LOL!	ProSense	Mar 2014	#401
Much more generous and humane response than any insurance fucks	JEB	Mar 2014	#356
Who CARES what FR thinks?	bvar22	Mar 2014	#286
it doesn't bother you that the OP uses FR words insulting the President	Whisp	Mar 2014	#291
What are FR words?	AnalystInParadise	Mar 2014	#335
the OP did the character assasination on the President.	Whisp	Mar 2014	#340
Perhaps if the President had offered up a few fights for the middle class on any of the following:	truedelphi	Mar 2014	#376
I believe that Will found his own words to express exactly what he was feeling...	bvar22	Mar 2014	#347
yeh, let's all speak like the OP did/does...	Whisp	Mar 2014	#348
Exactly my thought, bvar.	1000words	Mar 2014	#295
I am sure the over the top post is all over the RW groups. It is really sad that instead of	lostincalifornia	Mar 2014	#288
Exactly, it could have been a post asking for advice,	Whisp	Mar 2014	#297
Agreed	lostincalifornia	Mar 2014	#299
Are you 12?	AnalystInParadise	Mar 2014	#319
Well, he had two options	jeff47	Mar 2014	#443
When did links to FR become cool to post on DU?	bobduca	Mar 2014	#300
Why do some DU members watch faux? To see what the enemy is saying. Saying "fuck you Obama" is	lostincalifornia	Mar 2014	#306
it seems like a case of strange bedfellows to go scanning FR for what they say about "dummies"	bobduca	Mar 2014	#317
I don't watch any of that garbage, however, that is the reason I have been told when I inquired.	lostincalifornia	Mar 2014	#326
FR links have always been allowed here. n/t	Whisp	Mar 2014	#309
No, they haven't.	Hissyspit	Mar 2014	#311
FR links have been here as long as I have.	LiberalAndProud	Mar 2014	#474
Thanks!	bobduca	Mar 2014	#313
They have been allowed to laugh at	Whisp	Mar 2014	#315
I can give you somewhat of an answer on your first question.	DebJ	Mar 2014	#411
Huh! interesting you chose to post that.	hrmjustin	Mar 2014	#383
Will, here is something you might want to check out	passiveporcupine	Mar 2014	#272
I would dump that 'friend' of yours who advised you nothing can be done.	Whisp	Mar 2014	#285
Yup. He's either ignorant of his own product or he just told a big fat fib. n/t	pnwmom	Mar 2014	#332
Is it too late to switch companies if you can find a better one?	pnwmom	Mar 2014	#293
This message was self-deleted by its author	DebJ	Mar 2014	#414
No, but it means it's worth the effort, despite what the agent said, to check the formularies	pnwmom	Mar 2014	#437
Thanks for checking me there...you can only change coverage thru the 31st IF the	DebJ	Mar 2014	#509
The ACA has been saving a lot of lives. So fuck your childish, petty, "fuck you".	phleshdef	Mar 2014	#298
I would not be surprised if your post gets hidden, while the ops didn't. This is not a constructiv	lostincalifornia	Mar 2014	#302
Yea, it will probably be the first one I've had hidden in a long time.	phleshdef	Mar 2014	#303
It seems that way	lostincalifornia	Mar 2014	#308
Yea, I mean fuck Obama for expanding Medicaid and buying Medicare 8 more years.	phleshdef	Mar 2014	#312
People do seem to judge things only by how it directly affects them, not unlike 1%ers.	Hoyt	Mar 2014	#418
Oh, you are so wrong!	Raven	Mar 2014	#321
Actually, Will blew it. I know why he's panicking but he's been given false information	pnwmom	Mar 2014	#331
Too many complex variables and deceptions to actually make sense.	JEB	Mar 2014	#345
Actually the OP didn't say coverage was denied, but the opposite, that coverage was given	DebJ	Mar 2014	#417
The OP didn't say that. But this later post of his is incorrect:	pnwmom	Mar 2014	#426
?	phleshdef	Mar 2014	#336
Raven is Will's mom and therefore has more insight into her daughter in law's situation than you do.	JVS	Mar 2014	#367
There are plenty of folks out there with MS who are getting their medications covered.	phleshdef	Mar 2014	#397
Great news, links please! nt	Logical	Mar 2014	#404
The difference is that his friend the insurance agent gave him false information	pnwmom	Mar 2014	#431
Understandably disturbed yes. But the rhetoric wasn't really justifiable.	phleshdef	Mar 2014	#452
No, but M.S. is a really scary disease. I hope Will doesn't give up and gets this solved now. n/t	pnwmom	Mar 2014	#454
Yes, she is. But apparently they've both been given false information by their friend the insurance	pnwmom	Mar 2014	#428
Good posts throughout these series of threads...	SidDithers	Mar 2014	#699
No--it is Will's friend who is wrong. Pwnmom has detailed how Will was given the wrong	msanthrope	Mar 2014	#572
Ahhh, how adorable! nt	Logical	Mar 2014	#402
Any "reform" that left the insurance companies in the loop was a loser from the get-go.	alarimer	Mar 2014	#339
Disaster capitalism is not much fun	JEB	Mar 2014	#354
This message was self-deleted by its author	krawhitham	Mar 2014	#355
Would you be better off without the ACA? nt	killbotfactory	Mar 2014	#388
Wow. So many posters seem more concerned	JEB	Mar 2014	#406
Some perfunctory words of sympathy for Will Pitt's wife and then the usual PR from the usual people.	pa28	Mar 2014	#413
Along with some perfunctory words of	Bobbie Jo	Mar 2014	#507
+1	jsr	Mar 2014	#433
Hall of fame bullshit artist. Yes indeed. Obama is just that.	pa28	Mar 2014	#408
Ok buddy time out	minivan2	Mar 2014	#412
I appreciate your telling the truth,	woo me with science	Mar 2014	#415
I don't know what's funnier	Cali_Democrat	Mar 2014	#470
Exhibit A	woo me with science	Mar 2014	#536
My my my.. looky here.. at these ODSers.. using	Cha	Mar 2014	#416
That's ugly, Cha.	Lars39	Mar 2014	#421
Yes, the OP is an Ugly Piece of Hate.. and my pointing it out	Cha	Mar 2014	#422
Empathy should be learned early.	Lars39	Mar 2014	#424
"Fuck you, Mr. President, you piece of shit used-car salesman. From my heart and soul, fuck you."	Cha	Mar 2014	#427
Can you not even understand that his wife's health is at stake?	Lars39	Mar 2014	#429
This post said it best..	Cha	Mar 2014	#442
You are getting feedback that you don't like.	Lars39	Mar 2014	#457
I'm getting a lot of Great Feedback.. thank you!	Cha	Mar 2014	#461
Have you actually USED your insurance yet?	Aerows	Mar 2014	#643
he's the Magic Man	rudolph the red	Mar 2014	#425
Yeah, the OP got a pass but a post in the thread got a Hide.	Cha	Mar 2014	#430
he is probably upset he can't profit off a disaster presidency like during Bush's days	JI7	Mar 2014	#438
I do have "empathy" for his wife.. but, that does not excuse a raging	Cha	Mar 2014	#448
if the ugly was for the first time then I could pass on it	Whisp	Mar 2014	#450
Unfortunately yes.. but, this one was so ignorantly over the top ..	Cha	Mar 2014	#451
I find it ironic that all his hate & anger is focused towards	giftedgirl77	Mar 2014	#518
A lot of ugly posts and lack of empathy in this thread.	Vashta Nerada	Mar 2014	#434
For once we agree completely	AnalystInParadise	Mar 2014	#653
WilliamPitt, as I understand it you live in MA, so direct your outrage to Gov. Romney.	ucrdem	Mar 2014	#436
according to other posts he lives in New Hampshire now	JI7	Mar 2014	#440
they said "it'll be fixed, don't worry": now they're telling us to not even acknowledge	MisterP	Mar 2014	#441
I can't afford what the government	ohheckyeah	Mar 2014	#447
Live in a Red state I presume???	VanillaRhapsody	Mar 2014	#453
Purple....	ohheckyeah	Mar 2014	#593
What initiative did you take?	Drunken Irishman	Mar 2014	#460
Hours on hold only to talk with some underling with canned answers while a loved on is ill	JEB	Mar 2014	#463
There are multiple avenues one can take...	Drunken Irishman	Mar 2014	#464
Here in Oregon, it is not that easy.	JEB	Mar 2014	#468
Lots of bugs, but this isn't one of 'em...	Drunken Irishman	Mar 2014	#471
No, I think he wants his very ill wife	JEB	Mar 2014	#542
Unfortunately, some drugs cost tens of thousands of dollars a year.	pnwmom	Mar 2014	#490
As someone who peddles the ACA daily	Puzzledtraveller	Mar 2014	#466
Why didn't you explain to him that his agent-friend gave him the wrong information	pnwmom	Mar 2014	#487
Yeah, you need to explain that.. are not people getting good benefits? You make it sound	Cha	Mar 2014	#494
Will, here's my suggestion	Glitterati	Mar 2014	#500
You know Will,	SomethingFishy	Mar 2014	#511
I am SO sick and tired of the apologists	Le Taz Hot	Mar 2014	#519
Why?	ProSense	Mar 2014	#520
Because I'm "stupid and I don't understand the ACA."	Le Taz Hot	Mar 2014	#521
Your words. n/t	ProSense	Mar 2014	#522
This was nothing more than a great big wet kiss to the health insurance companies...	truebrit71	Mar 2014	#584
Mr. Pitt, I am truly sorry about your situation....	NCTraveler	Mar 2014	#524
Post removed	Post removed	Mar 2014	#528
This message was self-deleted by its author	Hissyspit	Mar 2014	#547
Pure bullshit character assassination post.	Hissyspit	Mar 2014	#549
Eh, I'm just glad I'm not on his ignore.	joshcryer	Mar 2014	#552
That's over the line.	ScreamingMeemie	Mar 2014	#563
Ugly post.	Vashta Nerada	Mar 2014	#568
Wow. nt	TBF	Mar 2014	#570
Troubling.	fleabiscuit	Mar 2014	#534
try cannabinoids, even Nat. Cancer Inst. admits they work in multitude of med conditions	wordpix	Mar 2014	#545
Goodness Will. You have caused an angst filled shit storm of epic proportions.	Autumn	Mar 2014	#556
this joint	rtracey	Mar 2014	#560
Your pain and frustration is understandable.	LexVegas	Mar 2014	#562
This is a very long thread.	AngryAmish	Mar 2014	#566
What could be worse than the ACA?	ramapo	Mar 2014	#567
Sorry Will. We'll keep working toward single payer or better.	grahamhgreen	Mar 2014	#573
Is this one of those Will Pitt rants that will be completely retracted in two days?	theboss	Mar 2014	#574
I doubt it. This thread should have never been allowed because of the disgraceful names the	lostincalifornia	Mar 2014	#701
It's sad but I have to agree with you Will.	unionguy	Mar 2014	#589
the drug corps price gouge in the USA on long term treatment, all meds. Same thing with aids meds.	Sunlei	Mar 2014	#594
Always check the formulary.	Ms. Toad	Mar 2014	#597
Have YOU tried to purchase insurance on the HealthCare.Gov website?	bvar22	Mar 2014	#627
People with chronic conditions know what "check the formulary" means	REP	Mar 2014	#629
Of the 5 Million or so MANDATED New "Customers" that have signed up...	bvar22	Mar 2014	#645
Call the company.	Ms. Toad	Mar 2014	#631
You basically just said "Let them eat cake". (Updated)	Zorra	Mar 2014	#651
Let me assure you that the cake is considerably tastier and more nourshing	Ms. Toad	Mar 2014	#655
You missed my point. I believe the ACA is beneficial to many, including myself.	Zorra	Mar 2014	#679
But this thread is a rant	Ms. Toad	Mar 2014	#681
I'm very sorry for your many years of having to work the system when dealing with for profit	Zorra	Mar 2014	#692
Why YES I have, and I was able to find the The Formulary list for all 5 companies on the exchange	krawhitham	Mar 2014	#688
Could you please post a link to the page with the formularies, if	Zorra	Mar 2014	#695
The crowning achievement of our fearless leader.	chompers	Mar 2014	#599
PRIVATE insurance LOVES finding loopholes.	pansypoo53219	Mar 2014	#600
I'm so sorry Will	Catherina	Mar 2014	#611
Now where have we seen this kind of language before:	Whisp	Mar 2014	#612
I feel sorry for Pitt having to resort to this kind of hate at the wrong person.. "anger"	Cha	Mar 2014	#630
Just sad. A total self-involvement tailspin.	gulliver	Mar 2014	#634
William, I know how that's like	LittleBlue	Mar 2014	#647
It is a rotten disease.	truedelphi	Mar 2014	#662
I don't know why Freeper trash like this is tolerated.	tritsofme	Mar 2014	#650
Wait a minute. so the Insurance company YOU picked	jazzimov	Mar 2014	#668
Post removed	Post removed	Mar 2014	#671
Let's skip over the fact that in NH more then half the hospitals	Riftaxe	Mar 2014	#670
Still feeling that way, Will?	MineralMan	Mar 2014	#689
Why? The Drug Company solved the issue, not the insurance company. nt	Logical	Mar 2014	#693
And either way, President Obama had nothing to do with it	MineralMan	Mar 2014	#694
overhauling the healthcare/insurance system	questionseverything	Mar 2014	#704
Post removed	Post removed	Mar 2014	#690
Momentarily	Cirque du So-What	Mar 2014	#691
I'm glad your wife will be getting her meds afterall	itsrobert	Mar 2014	#698
it is amazing this has over 100 recommends	crimeariver1225	Mar 2014	#700
Calling the President a piece of shit used-car salesman very much should be allowed.	donheld	Mar 2014	#703
Ted Nugent and his fan base approve your message. n/t	Whisp	Mar 2014	#705
you most likely	riversedge	Mar 2014	#707
My sympathy for your family's dilemma	Babel_17	Mar 2014	#710
Who is William Pitt?	BoulderNative	Apr 2014	#712

Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:24 PM

truebrit71 (20,805 posts)

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

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

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Response to truebrit71 (Reply #1)

Tue Mar 18, 2014, 04:26 PM

WilliamPitt (58,179 posts)

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.

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Response to WilliamPitt (Reply #3)

Tue Mar 18, 2014, 04:37 PM

truebrit71 (20,805 posts)

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...

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Response to truebrit71 (Reply #11)

Wed Mar 19, 2014, 10:02 AM

wordpix (18,652 posts)

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

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Response to wordpix (Reply #546)

Wed Mar 19, 2014, 10:08 AM

truebrit71 (20,805 posts)

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

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

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Response to truebrit71 (Reply #550)

Wed Mar 19, 2014, 10:15 AM

wordpix (18,652 posts)

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.

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Response to wordpix (Reply #554)

Wed Mar 19, 2014, 10:48 AM

Jefferson23 (30,099 posts)

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

All the best to you with your recovery.

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Response to wordpix (Reply #554)

Sun Mar 23, 2014, 08:46 AM

Dorian Gray (13,211 posts)

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.

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Response to WilliamPitt (Reply #3)

Tue Mar 18, 2014, 05:07 PM

Mojorabbit (16,020 posts)

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.

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Response to Mojorabbit (Reply #23)

Tue Mar 18, 2014, 07:26 PM

TrollBuster9090 (5,930 posts)

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?)

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Response to TrollBuster9090 (Reply #204)

Tue Mar 18, 2014, 07:37 PM

Mojorabbit (16,020 posts)

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.

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Response to Mojorabbit (Reply #220)

Tue Mar 18, 2014, 07:40 PM

steve2470 (37,427 posts)

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 !

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Response to steve2470 (Reply #222)

Tue Mar 18, 2014, 10:48 PM

truedelphi (32,324 posts)

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

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

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Response to steve2470 (Reply #222)

Wed Mar 19, 2014, 09:22 AM

Pharaoh (8,209 posts)

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.......

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Response to Pharaoh (Reply #538)

Wed Mar 19, 2014, 09:31 AM

steve2470 (37,427 posts)

541. excellent point nt

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Response to Pharaoh (Reply #538)

Wed Mar 19, 2014, 12:15 PM

Hoyt (54,770 posts)

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.

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Response to Hoyt (Reply #579)

Wed Mar 19, 2014, 08:23 PM

Pharaoh (8,209 posts)

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!

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Response to Pharaoh (Reply #654)

Wed Mar 19, 2014, 08:52 PM

Hoyt (54,770 posts)

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

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Response to Hoyt (Reply #658)

Wed Mar 19, 2014, 08:54 PM

Pharaoh (8,209 posts)

659. They would be arrested.

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Response to Hoyt (Reply #658)

Wed Mar 19, 2014, 08:55 PM

Pharaoh (8,209 posts)

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

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Response to Pharaoh (Reply #660)

Wed Mar 19, 2014, 09:04 PM

Hoyt (54,770 posts)

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.

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Response to Mojorabbit (Reply #23)

Tue Mar 18, 2014, 11:29 PM

Doctor_J (36,392 posts)

389. Medicare part d was the prelude to heritage care

Krugman called it the middleman multiplication act.

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Response to Doctor_J (Reply #389)

Wed Mar 19, 2014, 08:33 PM

Hoyt (54,770 posts)

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

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Response to Mojorabbit (Reply #23)

Wed Mar 19, 2014, 10:08 AM

wordpix (18,652 posts)

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.

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Response to WilliamPitt (Reply #3)

Tue Mar 18, 2014, 06:50 PM

Mnpaul (3,655 posts)

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.

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Response to Mnpaul (Reply #172)

Tue Mar 18, 2014, 11:35 PM

Doctor_J (36,392 posts)

392. but it's all Lieberman's fault

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

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Response to truebrit71 (Reply #1)

Wed Mar 19, 2014, 01:25 PM

pnwmom (108,301 posts)

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.

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Response to pnwmom (Reply #590)

Wed Mar 19, 2014, 01:27 PM

truebrit71 (20,805 posts)

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

Very simple.

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Response to truebrit71 (Reply #591)

Wed Mar 19, 2014, 01:29 PM

pnwmom (108,301 posts)

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.

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Response to pnwmom (Reply #592)

Wed Mar 19, 2014, 01:33 PM

truebrit71 (20,805 posts)

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...

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Response to truebrit71 (Reply #595)

Wed Mar 19, 2014, 01:35 PM

pnwmom (108,301 posts)

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.

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Response to truebrit71 (Reply #591)

Wed Mar 19, 2014, 03:10 PM

OwnedByCats (805 posts)

608. Exactly

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

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Response to truebrit71 (Reply #591)

Wed Mar 19, 2014, 03:25 PM

HuckleB (35,773 posts)

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

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Response to truebrit71 (Reply #591)

Thu Mar 20, 2014, 06:44 AM

Spider Jerusalem (21,786 posts)

682. Only if it's been approved by NICE

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

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:25 PM

CaliforniaPeggy (146,912 posts)

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

K&R for this most excellent rant.

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Response to CaliforniaPeggy (Reply #2)

Tue Mar 18, 2014, 07:29 PM

uppityperson (115,572 posts)

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.

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Response to uppityperson (Reply #207)

Tue Mar 18, 2014, 07:30 PM

CaliforniaPeggy (146,912 posts)

208. And if I did?

I'm just agreeing with Will.

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Response to CaliforniaPeggy (Reply #208)

Tue Mar 18, 2014, 08:01 PM

uppityperson (115,572 posts)

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

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Response to uppityperson (Reply #235)

Tue Mar 18, 2014, 08:05 PM

CaliforniaPeggy (146,912 posts)

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

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Response to CaliforniaPeggy (Reply #238)

Tue Mar 18, 2014, 08:10 PM

uppityperson (115,572 posts)

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.

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Response to uppityperson (Reply #240)

Tue Mar 18, 2014, 09:35 PM

JEB (4,748 posts)

283. Miserable fucking crap shoot dealing with Insurance vultures.

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

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Response to uppityperson (Reply #240)

Tue Mar 18, 2014, 09:50 PM

magical thyme (14,881 posts)

301. NH does not offer many options for insurance

it's Anthem or nothing, iirc.

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Response to uppityperson (Reply #240)

Tue Mar 18, 2014, 11:05 PM

truedelphi (32,324 posts)

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?

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Response to truedelphi (Reply #369)

Tue Mar 18, 2014, 11:07 PM

uppityperson (115,572 posts)

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.

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Response to uppityperson (Reply #370)

Tue Mar 18, 2014, 11:18 PM

truedelphi (32,324 posts)

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.

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Response to truedelphi (Reply #379)

Tue Mar 18, 2014, 11:22 PM

uppityperson (115,572 posts)

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.

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Response to truedelphi (Reply #369)

Wed Mar 19, 2014, 10:26 AM

hfojvt (37,573 posts)

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.

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Response to uppityperson (Reply #240)

Wed Mar 19, 2014, 07:09 AM

Enthusiast (50,983 posts)

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.

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Response to Enthusiast (Reply #503)

Sat Mar 22, 2014, 04:41 PM

red dog 1 (26,212 posts)

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/

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Response to red dog 1 (Reply #706)

Sun Mar 23, 2014, 08:31 AM

Enthusiast (50,983 posts)

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.

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Response to uppityperson (Reply #240)

Wed Mar 19, 2014, 08:26 AM

Scuba (53,475 posts)

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

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Response to uppityperson (Reply #240)

Wed Mar 19, 2014, 09:02 AM

kelliekat44 (7,759 posts)

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?

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Response to kelliekat44 (Reply #532)

Wed Mar 19, 2014, 11:17 AM

uppityperson (115,572 posts)

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

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Response to uppityperson (Reply #235)

Wed Mar 19, 2014, 03:00 AM

brush (49,911 posts)

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.

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Response to brush (Reply #476)

Wed Mar 19, 2014, 03:15 AM

Cha (289,490 posts)

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.

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Response to brush (Reply #476)

Wed Mar 19, 2014, 03:18 AM

JI7 (88,265 posts)

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

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Response to JI7 (Reply #480)

Wed Mar 19, 2014, 03:23 AM

brush (49,911 posts)

481. Guess it's the Obama haters. nt

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Response to JI7 (Reply #480)

Wed Mar 19, 2014, 05:43 AM

Kahuna (27,310 posts)

498. Yep and yep!

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Response to JI7 (Reply #480)

Wed Mar 19, 2014, 03:51 PM

quakerboy (13,729 posts)

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!

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Response to quakerboy (Reply #613)

Wed Mar 19, 2014, 04:03 PM

Jakes Progress (11,090 posts)

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.

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Response to uppityperson (Reply #207)

Wed Mar 19, 2014, 01:42 AM

Cha (289,490 posts)

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.

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Response to Cha (Reply #455)

Wed Mar 19, 2014, 08:51 AM

sobenji (313 posts)

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.

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Response to sobenji (Reply #525)

Post removed

Response to Post removed (Reply #558)

Wed Mar 19, 2014, 10:47 AM

truebrit71 (20,805 posts)

564. A-fucking-men! Well said!

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

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Response to truebrit71 (Reply #564)

Wed Mar 19, 2014, 12:38 PM

kath (10,565 posts)

582. it was a great post.

Too bad it was hidden.

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Response to kath (Reply #582)

Wed Mar 19, 2014, 12:58 PM

truebrit71 (20,805 posts)

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

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

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Response to truebrit71 (Reply #564)

Wed Mar 19, 2014, 03:57 PM

quakerboy (13,729 posts)

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.

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Response to quakerboy (Reply #615)

Wed Mar 19, 2014, 04:12 PM

truebrit71 (20,805 posts)

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..

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Response to sobenji (Reply #525)

Wed Mar 19, 2014, 05:54 PM

Cha (289,490 posts)

635. Thank You, sobenji!

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Response to sobenji (Reply #525)

Wed Mar 19, 2014, 05:57 PM

Cha (289,490 posts)

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

was a nasty piece of ignorant work.

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Response to sobenji (Reply #525)

Thu Mar 27, 2014, 11:40 PM

Auntie Bush (17,528 posts)

711. Well said! +100

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:29 PM

Autumn (43,403 posts)

4. No. How could those bastards do that?

can you look into another plan that might cover it?

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Response to Autumn (Reply #4)

Tue Mar 18, 2014, 04:35 PM

WilliamPitt (58,179 posts)

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.

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Response to WilliamPitt (Reply #8)

Tue Mar 18, 2014, 04:37 PM

Autumn (43,403 posts)

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

I'm so sorry Will.

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Response to WilliamPitt (Reply #8)

Tue Mar 18, 2014, 05:29 PM

Nye Bevan (25,406 posts)

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.

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Response to Nye Bevan (Reply #53)

Tue Mar 18, 2014, 05:57 PM

QuestForSense (653 posts)

96. Excellent advice.

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

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Response to QuestForSense (Reply #96)

Wed Mar 19, 2014, 07:20 PM

crim son (27,429 posts)

649. It's super advice but, dammit,

none of it should be necessary.

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Response to Nye Bevan (Reply #53)

Tue Mar 18, 2014, 06:14 PM

Whisp (24,096 posts)

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

that ain't gonna happen.

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Response to Whisp (Reply #115)

Tue Mar 18, 2014, 06:21 PM

Lex (34,106 posts)

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

so it has worked

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Response to Lex (Reply #127)

Tue Mar 18, 2014, 06:26 PM

Whisp (24,096 posts)

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

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Response to Whisp (Reply #132)

Tue Mar 18, 2014, 06:35 PM

Lex (34,106 posts)

143. Oh, I see. Yeah, probably.

Persistence is key. And being the squeaky wheel.

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Response to Lex (Reply #143)

Tue Mar 18, 2014, 06:50 PM

ConservativeDemocrat (2,720 posts)

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

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Response to ConservativeDemocrat (Reply #170)

Tue Mar 18, 2014, 06:51 PM

Lex (34,106 posts)

174. It's not like Obama is happy

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

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Response to Lex (Reply #174)

Tue Mar 18, 2014, 09:28 PM

Whisp (24,096 posts)

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.

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Response to Lex (Reply #174)

Wed Mar 19, 2014, 01:42 AM

ohheckyeah (9,314 posts)

456. Unless, of course,

the preferred drug for a chronic health issue is marijuana.

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Response to ohheckyeah (Reply #456)

Wed Mar 19, 2014, 03:53 AM

Jesus Malverde (10,274 posts)

486. Great catch!...nt

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Response to ConservativeDemocrat (Reply #170)

Tue Mar 18, 2014, 09:54 PM

magical thyme (14,881 posts)

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.

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Response to magical thyme (Reply #307)

Wed Mar 19, 2014, 05:49 PM

ConservativeDemocrat (2,720 posts)

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

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Response to ConservativeDemocrat (Reply #633)

Wed Mar 19, 2014, 05:56 PM

magical thyme (14,881 posts)

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.

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Response to Whisp (Reply #115)

Tue Mar 18, 2014, 11:41 PM

Doctor_J (36,392 posts)

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?

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Response to Doctor_J (Reply #395)

Tue Mar 18, 2014, 11:46 PM

Whisp (24,096 posts)

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.

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Response to Doctor_J (Reply #395)

Tue Mar 18, 2014, 11:53 PM

woo me with science (32,139 posts)

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.

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Response to woo me with science (Reply #407)

Wed Mar 19, 2014, 07:29 AM

ctsnowman (1,903 posts)

508. Cruel

is the right word.

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Response to Doctor_J (Reply #395)

Wed Mar 19, 2014, 01:44 AM

ohheckyeah (9,314 posts)

458. You only think that

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

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Response to Doctor_J (Reply #395)

Wed Mar 19, 2014, 08:53 AM

NCTraveler (30,481 posts)

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.

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Response to NCTraveler (Reply #526)

Wed Mar 19, 2014, 08:57 AM

Doctor_J (36,392 posts)

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.

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Response to Doctor_J (Reply #529)

Wed Mar 19, 2014, 09:02 AM

NCTraveler (30,481 posts)

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.

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Response to Nye Bevan (Reply #53)

Tue Mar 18, 2014, 07:33 PM

sabrina 1 (62,325 posts)

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.

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Response to sabrina 1 (Reply #213)

Tue Mar 18, 2014, 08:02 PM

Nye Bevan (25,406 posts)

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.

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Response to Nye Bevan (Reply #236)

Wed Mar 19, 2014, 01:26 AM

sabrina 1 (62,325 posts)

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.

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Response to Nye Bevan (Reply #53)

Tue Mar 18, 2014, 08:31 PM

questionseverything (9,408 posts)

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)

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Response to questionseverything (Reply #250)

Tue Mar 18, 2014, 08:38 PM

Nye Bevan (25,406 posts)

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.

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Response to Nye Bevan (Reply #253)

Tue Mar 18, 2014, 08:47 PM

steve2470 (37,427 posts)

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.

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Response to Nye Bevan (Reply #253)

Tue Mar 18, 2014, 09:06 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #263)

Tue Mar 18, 2014, 09:20 PM

Nye Bevan (25,406 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.

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Response to Nye Bevan (Reply #273)

Tue Mar 18, 2014, 09:32 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #280)

Tue Mar 18, 2014, 10:29 PM

Nye Bevan (25,406 posts)

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!

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Response to Nye Bevan (Reply #344)

Wed Mar 19, 2014, 12:08 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #280)

Wed Mar 19, 2014, 02:29 PM

Ms. Toad (32,656 posts)

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.

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Response to Ms. Toad (Reply #604)

Wed Mar 19, 2014, 02:48 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #606)

Wed Mar 19, 2014, 04:07 PM

Ms. Toad (32,656 posts)

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.

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Response to Ms. Toad (Reply #617)

Wed Mar 19, 2014, 04:30 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #620)

Wed Mar 19, 2014, 05:15 PM

Ms. Toad (32,656 posts)

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.

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Response to Ms. Toad (Reply #624)

Wed Mar 19, 2014, 06:08 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #640)

Wed Mar 19, 2014, 07:00 PM

Aerows (39,961 posts)

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.

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Response to questionseverything (Reply #640)

Wed Mar 19, 2014, 07:18 PM

Ms. Toad (32,656 posts)

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.

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Response to Ms. Toad (Reply #648)

Wed Mar 19, 2014, 08:51 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #657)

Wed Mar 19, 2014, 09:44 PM

Ms. Toad (32,656 posts)

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.

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Response to Ms. Toad (Reply #663)

Thu Mar 20, 2014, 05:02 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #697)

Fri Mar 21, 2014, 02:06 AM

Ms. Toad (32,656 posts)

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.

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Response to Nye Bevan (Reply #53)

Wed Mar 19, 2014, 09:29 AM

bullsnarfle (254 posts)

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.

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Response to Nye Bevan (Reply #53)

Wed Mar 19, 2014, 10:19 AM

wordpix (18,652 posts)

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

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Response to WilliamPitt (Reply #8)

Tue Mar 18, 2014, 05:53 PM

thesquanderer (11,725 posts)

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.

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Response to WilliamPitt (Reply #8)

Tue Mar 18, 2014, 10:12 PM

pnwmom (108,301 posts)

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.

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Response to pnwmom (Reply #324)

Tue Mar 18, 2014, 10:33 PM

Nye Bevan (25,406 posts)

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.

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Response to WilliamPitt (Reply #8)

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:34 PM

Zorra (27,670 posts)

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

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Response to Zorra (Reply #5)

Tue Mar 18, 2014, 10:52 PM

truedelphi (32,324 posts)

360. Can i join you in waiting for that dance

To begin?

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Response to truedelphi (Reply #360)

Wed Mar 19, 2014, 07:18 AM

Enthusiast (50,983 posts)

505. Me too.

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Response to truedelphi (Reply #360)

Wed Mar 19, 2014, 11:26 AM

Brigid (17,621 posts)

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.

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Response to Zorra (Reply #5)

Wed Mar 19, 2014, 08:59 AM

Doctor_J (36,392 posts)

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.

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:34 PM

C_U_L8R (44,356 posts)

6. This might help a little...

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

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:34 PM

loudsue (14,087 posts)

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.

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:37 PM

Egnever (21,506 posts)

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

Seems pretty foolish.

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Response to Egnever (Reply #9)

Tue Mar 18, 2014, 05:25 PM

bvar22 (39,909 posts)

47. Blaming the victim is worse than foolish,

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

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Response to bvar22 (Reply #47)

Tue Mar 18, 2014, 05:37 PM

Egnever (21,506 posts)

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?

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Response to Egnever (Reply #74)

Tue Mar 18, 2014, 07:59 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #234)

Tue Mar 18, 2014, 08:16 PM

steve2470 (37,427 posts)

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

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Response to questionseverything (Reply #234)

Wed Mar 19, 2014, 09:52 AM

sinkingfeeling (49,393 posts)

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

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Response to sinkingfeeling (Reply #544)

Wed Mar 19, 2014, 12:53 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #583)

Wed Mar 19, 2014, 01:05 PM

LiberalEsto (22,845 posts)

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?

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Response to questionseverything (Reply #583)

Wed Mar 19, 2014, 02:11 PM

sinkingfeeling (49,393 posts)

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

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Response to sinkingfeeling (Reply #602)

Wed Mar 19, 2014, 02:40 PM

questionseverything (9,408 posts)

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.

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Response to questionseverything (Reply #605)

Wed Mar 19, 2014, 02:49 PM

sinkingfeeling (49,393 posts)

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.

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Response to sinkingfeeling (Reply #607)

Wed Mar 19, 2014, 03:26 PM

questionseverything (9,408 posts)

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

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Response to questionseverything (Reply #610)

Wed Mar 19, 2014, 04:26 PM

Ms. Toad (32,656 posts)

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.

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Response to questionseverything (Reply #610)

REP This message was self-deleted by its author.

Response to questionseverything (Reply #583)

Wed Mar 19, 2014, 03:52 PM

Ms. Toad (32,656 posts)

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.

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Response to questionseverything (Reply #583)

Wed Mar 19, 2014, 06:39 PM

Control-Z (15,681 posts)

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.

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Response to Egnever (Reply #74)

Tue Mar 18, 2014, 09:13 PM

Hissyspit (45,788 posts)

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.)

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Response to Egnever (Reply #74)

Tue Mar 18, 2014, 10:23 PM

JEB (4,748 posts)

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

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Response to Egnever (Reply #74)

Wed Mar 19, 2014, 01:19 AM

Boudica the Lyoness (2,899 posts)

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

in the future.

Thank you.

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Response to bvar22 (Reply #47)

Tue Mar 18, 2014, 06:18 PM

bluestate10 (10,942 posts)

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.

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Response to bluestate10 (Reply #119)

Tue Mar 18, 2014, 08:56 PM

lapislzi (5,762 posts)

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.

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Response to bluestate10 (Reply #119)

Tue Mar 18, 2014, 10:37 PM

uppityperson (115,572 posts)

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.

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Response to Egnever (Reply #9)

Tue Mar 18, 2014, 05:54 PM

Zorra (27,670 posts)

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.)

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Response to Zorra (Reply #94)

Tue Mar 18, 2014, 06:00 PM

Egnever (21,506 posts)

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.

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Response to Egnever (Reply #99)

Tue Mar 18, 2014, 06:21 PM

bvar22 (39,909 posts)

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!

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Response to bvar22 (Reply #126)

Post removed

Response to Post removed (Reply #145)

Tue Mar 18, 2014, 08:47 PM

bvar22 (39,909 posts)

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".

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Response to bvar22 (Reply #258)

Tue Mar 18, 2014, 09:44 PM

JEB (4,748 posts)

296. Pretty well sums up my experience as well.

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Response to bvar22 (Reply #258)

Wed Mar 19, 2014, 07:23 AM

Enthusiast (50,983 posts)

506. A master obfuscater.

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Response to bvar22 (Reply #258)

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Response to Egnever (Reply #99)

Tue Mar 18, 2014, 06:35 PM

Zorra (27,670 posts)

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.

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Response to Zorra (Reply #144)

Tue Mar 18, 2014, 06:41 PM

Egnever (21,506 posts)

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.

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Response to Egnever (Reply #156)

Tue Mar 18, 2014, 07:43 PM

TrollBuster9090 (5,930 posts)

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.

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Response to Egnever (Reply #156)

Tue Mar 18, 2014, 09:35 PM

Zorra (27,670 posts)

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

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Response to Zorra (Reply #144)

Wed Mar 19, 2014, 04:47 AM

truedelphi (32,324 posts)

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.

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Response to truedelphi (Reply #497)

Wed Mar 19, 2014, 10:16 AM

freebrew (1,917 posts)

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.

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Response to Zorra (Reply #94)

Tue Mar 18, 2014, 06:58 PM

Cha (289,490 posts)

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

them.

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Response to Egnever (Reply #9)

Tue Mar 18, 2014, 06:16 PM

Demo_Chris (6,234 posts)

118. WTF?!

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Response to Demo_Chris (Reply #118)

Tue Mar 18, 2014, 06:20 PM

bluestate10 (10,942 posts)

124. The poster made a valid observation. nt

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Response to bluestate10 (Reply #124)

Tue Mar 18, 2014, 10:06 PM

magical thyme (14,881 posts)

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.

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Response to Demo_Chris (Reply #118)

Tue Mar 18, 2014, 10:04 PM

Zorra (27,670 posts)

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.

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Response to Zorra (Reply #316)

Tue Mar 18, 2014, 10:12 PM

PowerToThePeople (9,610 posts)

322. Wow, I did not see that happen.

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

Interesting...

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Response to Egnever (Reply #9)

Wed Mar 19, 2014, 01:48 AM

MoonchildCA (1,297 posts)

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...

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:37 PM

itsrobert (14,157 posts)

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

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Response to itsrobert (Reply #12)

Tue Mar 18, 2014, 04:40 PM

Whisp (24,096 posts)

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

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Response to Whisp (Reply #13)

Tue Mar 18, 2014, 04:55 PM

itsrobert (14,157 posts)

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?

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Response to itsrobert (Reply #17)

Tue Mar 18, 2014, 11:24 PM

truedelphi (32,324 posts)

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.

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Response to itsrobert (Reply #17)

Wed Mar 19, 2014, 12:12 PM

theboss (10,491 posts)

577. Because he is Will Pitt

He do what he do.

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Response to Whisp (Reply #13)

Tue Mar 18, 2014, 05:40 PM

treestar (82,088 posts)

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.

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Response to treestar (Reply #79)

Tue Mar 18, 2014, 05:50 PM

Hoyt (54,770 posts)

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.

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Response to Whisp (Reply #13)

Tue Mar 18, 2014, 06:24 PM

bluestate10 (10,942 posts)

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.

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Response to Whisp (Reply #13)

Tue Mar 18, 2014, 07:59 PM

Hekate (86,320 posts)

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.

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Response to Hekate (Reply #233)

Tue Mar 18, 2014, 11:25 PM

SidDithers (44,228 posts)

386. Good post...

Sid

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Response to Hekate (Reply #233)

Wed Mar 19, 2014, 03:10 AM

wickerwoman (5,662 posts)

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?

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Response to wickerwoman (Reply #477)

Wed Mar 19, 2014, 03:35 AM

Hekate (86,320 posts)

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.

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Response to Hekate (Reply #483)

Wed Mar 19, 2014, 03:42 AM

wickerwoman (5,662 posts)

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.

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Response to Hekate (Reply #483)

Wed Mar 19, 2014, 04:38 AM

truedelphi (32,324 posts)

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.

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Response to itsrobert (Reply #12)

Tue Mar 18, 2014, 05:23 PM

Humanist_Activist (7,670 posts)

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.

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Response to Humanist_Activist (Reply #42)

Tue Mar 18, 2014, 05:27 PM

itsrobert (14,157 posts)

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.

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Response to itsrobert (Reply #51)

Tue Mar 18, 2014, 05:33 PM

Humanist_Activist (7,670 posts)

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.

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Response to Humanist_Activist (Reply #66)

Tue Mar 18, 2014, 05:37 PM

itsrobert (14,157 posts)

73. I'm assuming nothing

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

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Response to itsrobert (Reply #73)

Tue Mar 18, 2014, 05:42 PM

treestar (82,088 posts)

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.

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Response to treestar (Reply #80)

Tue Mar 18, 2014, 05:44 PM

itsrobert (14,157 posts)

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.

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Response to itsrobert (Reply #82)

Thu Mar 20, 2014, 09:16 AM

TheKentuckian (23,947 posts)

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.

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Response to itsrobert (Reply #73)

Tue Mar 18, 2014, 05:47 PM

Humanist_Activist (7,670 posts)

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.

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Response to itsrobert (Reply #73)

Tue Mar 18, 2014, 06:38 PM

lumpy (13,704 posts)

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

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Response to itsrobert (Reply #12)

Tue Mar 18, 2014, 05:26 PM

JoeyT (6,785 posts)

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.

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Response to itsrobert (Reply #12)

Wed Mar 19, 2014, 07:59 AM

MannyGoldstein (34,589 posts)

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?

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:42 PM

itsrobert (14,157 posts)

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

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:43 PM

Baitball Blogger (46,116 posts)

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.

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:47 PM

itsrobert (14,157 posts)

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

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Response to itsrobert (Reply #16)

Tue Mar 18, 2014, 05:27 PM

bvar22 (39,909 posts)

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.

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:55 PM

progressoid (48,667 posts)

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.

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Response to progressoid (Reply #18)

Tue Mar 18, 2014, 05:37 PM

marzipanni (6,011 posts)

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

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Response to marzipanni (Reply #72)

Tue Mar 18, 2014, 06:13 PM

progressoid (48,667 posts)

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.

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Response to progressoid (Reply #114)

Wed Mar 19, 2014, 01:15 AM

Recursion (56,566 posts)

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.

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Response to Recursion (Reply #444)

Wed Mar 19, 2014, 02:28 AM

progressoid (48,667 posts)

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.

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Response to progressoid (Reply #472)

Wed Mar 19, 2014, 02:42 AM

Recursion (56,566 posts)

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.

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 04:57 PM

Jack for Sanders (46 posts)

19. Imagine that

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Response to Jack for Sanders (Reply #19)

Tue Mar 18, 2014, 06:25 PM

Whisp (24,096 posts)

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

disgusting.

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Response to WilliamPitt (Original post)

Name removed Message auto-removed

Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 05:03 PM

itsrobert (14,157 posts)

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?

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Response to itsrobert (Reply #21)

Tue Mar 18, 2014, 05:20 PM

TBF (31,869 posts)

38. Blaming the victim - that makes it better.

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Response to TBF (Reply #38)

Tue Mar 18, 2014, 05:25 PM

itsrobert (14,157 posts)

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!

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Response to itsrobert (Reply #46)

Tue Mar 18, 2014, 05:29 PM

TBF (31,869 posts)

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.

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Response to itsrobert (Reply #21)

Tue Mar 18, 2014, 05:48 PM

Lars39 (25,965 posts)

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

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Response to WilliamPitt (Original post)

Tue Mar 18, 2014, 05:04 PM

one_voice (20,043 posts)

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

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Response to one_voice (Reply #22)

Tue Mar 18, 2014, 05:09 PM

Wait Wut (8,492 posts)

24. +1

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Response to one_voice (Reply #22)

Tue Mar 18, 2014, 05:09 PM

WilliamPitt (58,179 posts)

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.

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Response to WilliamPitt (Reply #25)

Tue Mar 18, 2014, 05:16 PM

uppityperson (115,572 posts)

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.

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Response to uppityperson (Reply #32)

Tue Mar 18, 2014, 06:36 PM

bluestate10 (10,942 posts)

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.

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Response to bluestate10 (Reply #146)

Tue Mar 18, 2014, 11:14 PM

okaawhatever (9,436 posts)

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.

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Response to uppityperson (Reply #32)

Tue Mar 18, 2014, 06:47 PM

Cha (289,490 posts)

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..

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Response to WilliamPitt (Reply #25)

Tue Mar 18, 2014, 05:39 PM

one_voice (20,043 posts)

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.