Democratic Underground Latest Greatest Lobby Journals Search Options Help Login
Google

Kaiser Permenente + other insurance DENYING critical drugs to both my parents

Printer-friendly format Printer-friendly format
Printer-friendly format Email this thread to a friend
Printer-friendly format Bookmark this thread
This topic is archived.
Home » Discuss » Archives » General Discussion (1/22-2007 thru 12/14/2010) Donate to DU
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:05 PM
Original message
Kaiser Permenente + other insurance DENYING critical drugs to both my parents
Edited on Mon Jun-22-09 10:08 PM by Triana
The Washington "Democrats" and Repigs and the goddamned m'f'ing AMA can scaremonger all they want about the "socialized medicine" boogeyman or about how "Oh nooooooooooooo, we don't want Washington bureaucrats interfering with our health care!!"

But GUESS WHAT we've got RIGHT NOW? CORPRAT BUREAUCRATS interfering in our health care.

And that's what - BETTER? How?

In BOTH my mother's and my dad's case - THE INSURANCE COMPANY CALLED THE DOCTOR and TOLD them that they CAN NO LONGER give certain meds to Mom and Dad. In Dad's case the INSURANCE company TOLD THE DOCTOR that Dad doesn't need it anymore. :wtf: is the goddamned insurance company DOING telling a DOCTOR what he can and cannot give his patients and what the patient does or does not need? That drug is Procrit and it costs $500 per dose!

In my Mom's case, Kaiser Permenante called her doctor and told them they would no longer pay for her $600+ Advair. Kaiser then called Mom VIA RECORDED MESSAGE (after they made her punch in her SS#, and a bunch of other numbers) and told her to call her doctor and get a prescription for something ELSE. It wasn't even a HUMAN on the goddamned line when they called her.

BOTH OF THESE are classic cases of greedy corprat bureaucrats DIRECTLY INTERFERING with healthcare - WORSE - the healthcare of elderly patients in their 80s - BOTH with critical conditions that they could easily DIE from without these meds!!!

In other words, these INSURANCE COMPANIES are KILLING PEOPLE - and getting away with AND the profits they make from NOT paying for these drugs/treatments/whatever.

DON'T WHINE TO ME about "Washington bureaucrats" interfering with health care should we have national, public healthcare - NOT when we have CORPRAT BUREAUCRATS interfering with it NOW. THIS SHIT HAS GOT TO STOP!

It APPEARS these PIRATES intend to KILL and PROFIT from as many people as they CAN before health care is reformed - they certainly are on a new killing spree right now.

:grr:
:mad:

I just talked to Mom on the phone - I can hear her WHEEZING over the line when I talk to her. And NOW she won't have the Advair that helps her breath thanks to Kaiser. I SWEAR they're fucking trying to KILL my parents!
Printer Friendly | Permalink |  | Top
Kerrytravelers Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:07 PM
Response to Original message
1. Kaiser lost Mr. kt's records somewhere between San Diego and Los Angeles.
Edited on Mon Jun-22-09 10:10 PM by Kerrytravelers
We had to file them on our own. They were in a hospitol we'd never been to and filed under his first name.

They also dropped us and we didn't know until three months later.

I hate Kaiser.

Mr. kt had back problems. Their solution was to inject his back with steriods.

They messed up my simple surgery that three years later, I'm still have corrective surgeries to fix their mess.

We now have Aetna Blue Cross and are much happier. However, our doctor is all for a public plan. When that is offered, our doctor is excited to partake and we'll jump on it.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:10 PM
Response to Reply #1
3. Jeeeze. So in addition to being murderers, they're damned incompetent too! n/t
Printer Friendly | Permalink |  | Top
 
andym Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:09 PM
Response to Original message
2. The sad thing is that Kaiser is a NON-PROFIT insurer!
That's why we need a strong public-option (or better single payer) health care provider.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:11 PM
Response to Reply #2
5. I don't care what they are. They have no business telling doctors what drugs they can
and can't give to patients. Then sending pre-recorded messages to 80+ year old elderlies to tell them "f*ck you" get another prescription.

A$$holes.
Printer Friendly | Permalink |  | Top
 
andym Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:20 PM
Response to Reply #5
11. You should call a local TV/radio station in your parent's vicinity and tell them this story
Edited on Mon Jun-22-09 10:21 PM by andym
Perhaps Kaiser will change its mind. You should also relay the story to the President's Health Care Reform website.
http://www.healthreform.gov/communityreports/comments.html

Stories like yours may actually help bring about real reform, if even non-profit insurers are so unreasonable about their "bottom llne" to harm octogenarians.
Printer Friendly | Permalink |  | Top
 
napi21 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:10 PM
Response to Original message
4. My ins. had an appeals process. Did you try that?
What does their Dr. say? Is there another version of the same drug? Also sometimes Dr.s sill fight the ins co's for you or at least join you in the fight.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:14 PM
Response to Reply #4
8. Mom is checking w/ the Dr.s office to see if there's something else she can get..
She'd have to fight this - I don't know if she will or not. Honestly, she's old and doesn't get around well and likely isn't going to have the energy. Elderly people are probably prime victims - just for that reason.

And isn't it ODD how the insurance companies manage to pick JUST THE MOST CRITICAL meds the elderly patient needs most - to CUT off from them?

Huh.

Printer Friendly | Permalink |  | Top
 
napi21 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 11:24 PM
Response to Reply #8
25. I sure don't mean to defend the ins co. but don't you think they're
going after the most expensive meds first? Although I've not experienced any refusals myself, I have know several peoople who havem, and from what I've seen, the ins co seemed to pe pushing to generics and drugs that have been around for quite a while, are less expensive, but in most cases provide the same treatment.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 11:38 PM
Response to Reply #25
27. See Post #7. n/t
Printer Friendly | Permalink |  | Top
 
Learning Nomad Donating Member (94 posts) Send PM | Profile | Ignore Mon Jun-22-09 10:13 PM
Response to Original message
6. Federal jury awards local woman's estate $6.2 million.
This may be of interest to you.

From the Rapid City (SD) Journal:


"All Teri Powell wanted was "to be treated fairly" by the huge insurance company that took her premiums but refused to pay her claims.

A federal jury's $6.2 million award on Friday could force the insurance company to ante up, even though it's too late for Powell."

http://www.rapidcityjournal.com/articles/2009/06/12/news/top/doc4a332cf8276ec310063754.txt
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:35 PM
Response to Reply #6
15. I told my sister that if Dad or Mom ends up in emergency and dies from not
having these drugs I WILL SUE!!! She said SHE would too. My whole family is sick of this crap. They pulled a real STUNT on my sister and BIL a few months ago too - damn near drove them into bankruptcy! THAT was BCBS (emphasis on the BS part...)
Printer Friendly | Permalink |  | Top
 
Edith Ann Donating Member (213 posts) Send PM | Profile | Ignore Tue Jun-23-09 07:48 AM
Response to Reply #15
43. KP
Call the District Attorney in your area if something happens. Suing won't stop this. They need to be held criminally libel. Start arresting these people for wrongful death, manslaughter or in some cases murder(as this is premeditated in some cases) and some of this may stop. If I pulled the plug on my mother, I'd go to jail. If the insurance company does the same thing they should go to jail too. Whoever authorized it should go first and then go up the ladder to whoever approved it.

After the verdict, then sue. You only need the preponderance of evidence to win a civil suit, so it doesn't matter if the verdict is guilty or not guilty.
Printer Friendly | Permalink |  | Top
 
Laelth Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:15 PM
Response to Reply #6
56. Welcome to DU!
:dem:

-Laelth
Printer Friendly | Permalink |  | Top
 
Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:13 PM
Response to Original message
7. There really are no good equivalents to either Advair or Procrit.
In the case of Advair, it is dangerous to suddenly withdraw a patient from that drug.
I know that no amount of these real-life stories MATTER to Congress.
They got theirs...and they are telling us to fuck off.
I hope they all rot in hell.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:17 PM
Response to Reply #7
9. I've been told that about Procrit but didn't know about Advair - however I suspected..
Edited on Mon Jun-22-09 10:21 PM by Triana
...that'd be the case.

The doctor wanted to take Dad off the Procrit gradually - but THE INSURANCE COMPANY TOLD him that he had to take him off it immediately. They will no longer pay for it - period. Dad certainly can't at $500/dose.

Mom - I just don't know how the hell she's going to breathe. She has a hard enough time as it is.

Edit: I SWEAR these insurance pirates do this DELIBERATELY - the pick the most critical meds and refuse to pay for them anymore, KNOWING FULL WELL elderly patients on fixed income cannot pay for them - I guess they're just expected to DROP DEAD.

Yep. The health care "system" in this country is one of the most if not THE most IMMORAL one in existence.

All people's self-righteous bullshit about 'gay marriage' and 'abortion' - WHAT ABOUT THIS? What about this "health care system" that deliberately kills people to the tune of 20,000++ per year? How about poverty? THOSE are moral issues - NOT "gay marriage" and "abortion".

I think religious nuts use gay marriage and abortion to DISTRACT attention from REAL moral issues like health care and poverty - issues that they and their friends in Washington don't want to have to DO anything about.

NO GOD OF MINE approves of this, I tell ya.
Printer Friendly | Permalink |  | Top
 
Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:18 PM
Response to Reply #9
10. Check your pm. n/t
Printer Friendly | Permalink |  | Top
 
dysfunctional press Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 07:53 AM
Response to Reply #7
44. i know of a great equivalent to advair...marijuana
their commercials tout that they are the only product to combine an anti-inflammatory with a bronchial dilator, but they aren't- pot acts on the body in the same ways.
Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:26 PM
Response to Reply #7
50. Advair is a combo steroid plus a bronchodilator
Yes, it's dangerous to suddenly take any patient off steroids. But the steroid component can easily be replaced with a cheaper generic steroid.

There are also a variety of alternative, generic bronchodilators that can be used.

The patient might, in fact, do well with two different drugs -- a steroid and a bronchodilator -- as opposed to the single Advair combination.
Printer Friendly | Permalink |  | Top
 
Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:52 PM
Response to Reply #50
54. I've taken every combination
of cheap medicine--NOTHING compares to Advair. Apparently you have never suffered from breathing problems.
If a patient is well-controlled on a vital medication, then the fucking insurance company needs to just stay the fuck out of it.
Printer Friendly | Permalink |  | Top
 
handmade34 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:21 PM
Response to Original message
12. we are fighting - public funded can't come soon enough
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:31 PM
Response to Reply #12
13. agreed. They're on a killing spree/rampage right now - getting their shots in
before any change is made. Or, so it seems, anyway.

God I hate insurance companies. I H8 them! :puke:
Printer Friendly | Permalink |  | Top
 
votingupstart Donating Member (535 posts) Send PM | Profile | Ignore Mon Jun-22-09 10:35 PM
Response to Original message
14. i can only say this
i used to work for Kaiser permente and i left because they refused the appropriate medical care and diagnostic tests to a patient i was treating - i hope they go bankrupt and are thrown in jail.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:35 PM
Response to Reply #14
16. If Mom dies because she can't breath - I will HELP them end up there.
I SWEAR.
Printer Friendly | Permalink |  | Top
 
nini Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:44 PM
Response to Reply #14
20. similar situation with me
I worked there as a unit sec'y and saw so much crap happen I couldn't stay. What a hell hole that place is.

Printer Friendly | Permalink |  | Top
 
Booster Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:40 PM
Response to Original message
17. I have a relative who works for Kaiser and she needs surgery
on her upper leg due to lessions she gets every so often. Without surgery they just get bigger and burst and cause all sorts of problems. Kaiser told her she couldn't have the surgery until she quit smoking, which apparently has nothing to do with her problem; it's just Kaiser's way of getting their employees to quit smoking. In my opinion, I think she has one Hell of a case for a lawsuit if she can find out if they are allowing surgery for non-employees who smoke and have this same problem, and since she has full authority to look through their records, this shouldn't be too hard to find. Sorry, I forget the name of the problem.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:51 PM
Response to Reply #17
22. Dictators, aren't they? Seems all the health insurance pirates are...
...my Dad's certainly is. I can't BELIEVE *they* told the doctor what he could and could not do!
Printer Friendly | Permalink |  | Top
 
nini Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:41 PM
Response to Original message
18. Kaiser is the original HMO from hell
they started this whole freaking mess back in the Nixon days. The doctors are shareholders and I never trusted the SOBs to do what they should being their payoffs are an issue. I used to work at there and quit because my sense of what was right was getting shit on at every turn.

I love the fear the repukes are using about the govt making decisions and not our doctors, yet crap like you're going through is the reality today.

See if you can get some samples while you keep fighting. Good luck with this.

Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:50 PM
Response to Reply #18
21. I'm sending it to HHS (healthreform.gov) ... thanks to the suggestion above...
...I also told Mom to call the local TV/radio stations and let them know she has a health care horror story that might be of interest. Maybe if she can embarrass the shit out of those a$$holes they'll change their tune.

Printer Friendly | Permalink |  | Top
 
eridani Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 10:42 PM
Response to Original message
19. Send this to a bunch of newspapers, Obama and your congresscritters
You already have it written up--get maximum use out of it!
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 11:07 PM
Response to Original message
23. What I sent to HealthReform.gov
Edited on Mon Jun-22-09 11:21 PM by Triana
Kaiser Permenente + other insurance is DENYING critical drugs to both my parents. Let me tell you something about this:

The Washington "Democrats", Republicans, and the AMA can scaremonger all they want about the "socialized medicine" boogeyman or about how "Oh nooooooooooooo, we don't want Washington bureaucrats interfering with our health care!!"

But GUESS WHAT we've got RIGHT NOW? CORPORATE BUREAUCRATS interfering in our health care.

And that's BETTER? How?

In BOTH my mother's and my dad's case - THE INSURANCE COMPANY CALLED THE DOCTOR and TOLD them that they CAN NO LONGER give certain meds to Mom and Dad.

In Dad's case the INSURANCE apparently company TOLD THE DOCTOR that Dad doesn't need it anymore.

WHAT is the insurance company DOING telling a DOCTOR what he can and cannot give his patients and what the patient does or does not need? That drug is Procrit and it costs $500 per dose! Dad has ALREADY almost died once for lack of it.

In my Mom's case, Kaiser Permenante called her doctor and told them they would no longer pay for her $600+ Advair. Kaiser then called Mom VIA RECORDED MESSAGE (after they made her punch in her SS#, and a bunch of other numbers) and told her to call her doctor and get a prescription for something ELSE. THERE IS NOTHING ELSE that takes the place of Advair.

It wasn't even a HUMAN on the line when they called her.

BOTH OF THESE are classic cases of greedy corporate bureaucrats DIRECTLY INTERFERING with health care - WORSE - the health care of elderly patients in their 80s - BOTH with critical conditions that they could easily DIE from without these meds!!!

In other words, these INSURANCE COMPANIES are KILLING PEOPLE - and getting away with that - AND the profits they make from NOT paying for these drugs/treatments.

DON'T WHINE TO ME or any other Americans about "Washington bureaucrats" interfering with health care if we have national, public health care.

NOT when we have CORPORATE BUREAUCRATS interfering with it like this NOW.

In other words, the REALITY of the situation is not being reported because it would HURT the for-profit insurance PIRATES.

It APPEARS these PIRATES intend to KILL and PROFIT from as many people as they CAN before health care is reformed - they certainly are on a new killing spree right now, apparently.

I just talked to my Mom on the phone - I can hear her WHEEZING over the line when I talk to her. She's already on oxygen. And NOW she won't have the Advair that helps her breath - thanks to Kaiser.

These insurance companies are trying to KILL my parents! They are INTERFERING DIRECTLY with their critical health care, inserting themselves between doctor and patient and refusing to pay for much-needed drugs.

DON'T TELL ME that public, nationalized health care would be as bad or worse than this. DON'T TELL ME scaremongering stories about "bureaucrats interfering in health care" - because guess what? WE ALREADY HAVE THAT NOW.

FUNNY how no one up there in Washington, Democrat or Republican, and CERTAINLY not the insurance pirates or the AMA - mentions THAT.

The "health care" system in this country is one of the most IMMORAL on the planet if not THE most immoral.

When 20,000++ people are DYING EVERY YEAR in this country due to lack of insurance or even if they HAVE insurance - lack of CARE and needed medicines - THAT is the height of immorality.

DO SOMETHING TO FIX THIS!

The United States of America needs a VIABLE, AFFORDABLE, IMMEDIATELY AVAILABLE NATIONAL HEALTH CARE SYSTEM. That does NOT mean the US government would employ doctors or own hospitals or have "socialized" medicine. What we'd have and what we NEED is socialized INSURANCE. THAT is a different thing.

So the poor for-profit (and in Kaiser's case non-profit) private insurance companies would be hurt by that?

Guess what? In view of the fact that THEY ARE KILLING MY PARENTS, I don't think I really CARE.

Regards,

Printer Friendly | Permalink |  | Top
 
Stellabella Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 11:24 PM
Response to Original message
24. Every day I hate insurance companies more.
I sure wish there is a hell so they can burn in it.

Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 11:37 PM
Response to Reply #24
26. I'd SO like to send them on a fast train to the hottest bowels of Hell right now...
..that would just MAKE my day. :grr:
Printer Friendly | Permalink |  | Top
 
Kerrytravelers Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-22-09 11:58 PM
Response to Original message
28. Mr. kt and I have considered relocating to another country, and health care is one of the reasons.
If something doesn't happen, I may very likely be posting from another locale. We both now have pre-existing conditions that would exclude us from insurance.

It makes us sick to think that, but really, it comes down to living or dying. We're in the position to make a move. We have the qualifications that many countries are looking for (savings, income, education, etc.) and we've looked at options. How horrible to be run from your home for health care reasons.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:15 AM
Response to Reply #28
30. I wish I could do the same - have been wanting to go to France but...
...you really need some skills that are in heavy demand, from what I understand.
Printer Friendly | Permalink |  | Top
 
Kerrytravelers Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:50 AM
Response to Reply #30
36. Yes, we've really looked into this, as this isn't something to take lightly.
And we don't. We have the conversation all the time and have researched and printed all kinds of information and forms. And we've had friends who have done this are are waiting to assist us, if needed.

Again, the idea makes us sad. But we're young. Very young. And we have our whole lives to live. If something can't happen in this country, we'll be expats for a while. We have no intention of giving up our American citizenship.
Printer Friendly | Permalink |  | Top
 
G_j Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:05 AM
Response to Original message
29. relate your story to Bernie Sanders and sign the petition, if you haven't yet,
Edited on Tue Jun-23-09 12:13 AM by G_j

Our current private health insurance system is the most costly, wasteful, complicated and bureaucratic in the world. Today, 46 million people have no health insurance. Even more are underinsured with high deductibles and co-payments. Close to 20,000 Americans die each year because they dont have regular access to a doctor.

The time is now for our nation to address the most profound moral and economic issue we face.

The time is now for our country to join the rest of the industrialized world and provide cost-effective, comprehensive quality health care to every man, woman and child in our country.

The time is now to take on the powerful special interests in the insurance and pharmaceutical industries and pass a single-payer national health care program.

Sign the petition and watch Sanders video:

http://www.sanders.senate.gov/news/record.cfm?id=314528




on edit:
I can't find the link where Sanders is taking people's stories.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:16 AM
Response to Reply #29
31. I'll sign the petition, definitely. Thanks! n/t
Printer Friendly | Permalink |  | Top
 
kath Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:23 AM
Response to Original message
32. Is this in the Denver area? Kaiser out there sucks ass. The oncology care that my father-in-law
received was absolutely awful, included Kaiser's hospice care. A nightmare.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 07:29 AM
Response to Reply #32
39. California. And she's on Kaiser because GM cut off her health benefits last year. n/t
Printer Friendly | Permalink |  | Top
 
shimmergal Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:23 AM
Response to Original message
33. There's something wrong here.
My 6-year-old granddaughter is on an Advair inhaler. What she's been using so far are samples, but to purchase they'd be about 15 dollars. And that's with a health plan with a lot less members than Kaiser.

Maybe you could bypass the insurer entirely on this. Since the Advair seems to be working, contact the pharma co. (looks like it's GlaxoSmithKline) and tell them what happened. That their medication is needed to keep you mother alive, and that she can't afford to buy it under the circumstancees.

They might then put her in one of those free programs. Glaxo is spending a lot of money on TV ads to push this medication so I'm sure they wouldn't be happy to hear that as large an outfit as Kaiser has taken it off their formulary. They might well negotiate to get the tables turned. And in fact it's possible it _hasn't_ been removed from the formulary; that one of those corporate bureaucrats acting on her own has just decided to do this. In any case it can't hurt to push it from another direction too.
Printer Friendly | Permalink |  | Top
 
MiniMe Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:36 AM
Response to Reply #33
35. Sounds like a co-pay, not the total amount
But I just posted about those programs too. :hi:
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 07:30 AM
Response to Reply #33
40. Thanks for that idea. I may contact GSK directly and hope I can get someone
that can help.
Printer Friendly | Permalink |  | Top
 
MiniMe Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:32 AM
Response to Original message
34. A lot of drug manufacturers are helping out those who can't afford it now
Edited on Tue Jun-23-09 12:34 AM by MiniMe
GlaxoSmithKline (Advair) has a program to get the drugs for free, or at least at a reduced rate. Try here: http://www.gskforyou.com/10_programs_over.htm
The makers of Procrit probably have a program too.

It may or may not help, but right now, the drug manufacturers are treading really lightly, and may help your parents out. And if Kaiser has just stopped prescribing those meds, I'm sure they would want to know that too. While it isn't the answer you want, it may help out for now.

Edited to add: Ask Kaiser for something in writing giving their reason for them discontinuing coverage.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 07:31 AM
Response to Reply #34
41. Good suggestions! Thanks! Maybe her doc will give her samples too. n/t
Edited on Tue Jun-23-09 07:35 AM by Triana
Printer Friendly | Permalink |  | Top
 
Dogfur Donating Member (21 posts) Send PM | Profile | Ignore Tue Jun-23-09 02:45 AM
Response to Original message
37. They denied supplying Procrit to my father for 6 weeks
After getting the oncologists' prescription with his terminal diagnosis. After the drug finally arrived my parents received the bill for $ 4500 which of course is covered by the plan. I brought a minidisc recorder to the next checkup and asked the doc what the procedure is to actually receive the prescribed treatment - He was visibly shaken by our story and I feel was sincere in his frustration over the matter. He was completely silent when I asked him to put a dollar amount on the 15% of my fathers remaining time alive by his estimate that he was denied that therapy.

KP also refused payment several months to the oxygen suppliers in the area, had to have Mom call them every month to 'straighten it out'. I could go on, but needless to say the lack of dignity that accompanies needing full time advocacy in your final days is not how I want to go out- Kaiser Permanente will someday answer for that.
Printer Friendly | Permalink |  | Top
 
lildreamer316 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 04:13 AM
Response to Reply #37
38. Welcome to DU, btw.
:hi:

Good luck with your father's stiuation.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 07:32 AM
Response to Reply #37
42. KP needs to be put out of business - because their business - like most insurance companies..
....seems to be killing people for profit.

Hmmm..what is that called in any other situation? Oh yea. Mercenaries.
Printer Friendly | Permalink |  | Top
 
MagickMuffin Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 08:39 AM
Response to Original message
45. Your Senators need to hear about this LOUD & CLEAR
Especially Feinstein she is standing in the way of Health reform, along with Nelson, Schumer and the other Corporate Lobbyists Dems. They ARE the reason Obama is having a difficult time pushing the Health-Care reform. And why in HELL does medicine have to cost an arm and a leg. The Pharma industry is also to blame for our abysmal health-care.


Sheesh I hate the term "reform" it needs to be RESTRUCTURED, period. I know Obama has said that we can't start over, I say bullshit, it needs to be overhauled and restructured.


There are a lot of good ideas in this thread that you should follow through on. But be sure to contact Feinstein, she IS tone deaf. You should ask her if she has the Federal insurance program and how she can deny everyone else the same benefits as she has.

:grr:

Good Luck to you and your Parents.

Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 08:47 AM
Response to Original message
46. Kaiser is one of the better systems. At least they don't deny care.
If you're with Kaiser, you do get treated, although they may deny certain experimental procedures. But they have to control costs by limiting the selection of drugs on their formulary. Rather than stock expensive brand name drugs, they ask their physicians to use generic as a first-line treatment. They will occasionally make exceptions, though, for patients who don't respond to generics.


Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 09:23 AM
Response to Reply #46
47. See Post #7 n/t
Printer Friendly | Permalink |  | Top
 
Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:55 PM
Response to Reply #46
55. One of the better systems?
Surely you jest?
They are hands down one of the worst offenders in history. But then again, you don't mind people fucking with your healthcare and your medication.
Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:31 PM
Response to Reply #55
59. I've worked in a number of healthcare systems.
And my family had the Kaiser health plan for decades until we moved out of state. With every illness, every hospitalization, Kaiser was there for us. They paid for everything, including major surgeries.

My mom has macular degeneration, and Kaiser gave her an intraocular injection every two months, for years. The drug is a THOUSAND BUCKS a pop. But it's the only effective drug for that condition, so they covered it. If there'd been a cheaper alternative, I'm sure they would have opted for it, but there isn't. When she had to leave Kaiser to move across the country, the Kaiser ophthalmologist said something along the lines of, "I'm afraid you're going to miss Kaiser's coverage when you get to your new home."

I know that everyone likes to knock Kaiser, but once you're a member, your illnesses get treated. Your hospitalizations are covered. They can't kick you out. You have an emergency, you get seen. And they are leaders in preventive care, because they want to minimize the costs of major illnesses.

It may shock some people to realize this, but the Kaiser system is exactly what national health care will look like. Emphasis on prevention, lots of non-M.D.'s in the system (nurse practitioners and nurse midwives) and a drug formulary that relies on many generics. Is it platinum level healthcare with lots of rich-guy pampering? No. But for the most part it gets the job done.
Printer Friendly | Permalink |  | Top
 
Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:49 PM
Response to Reply #59
62. I have too for many many years
and Kaiser sucks. The hospitals know it, the patients know it, the doctors know it. The only ones that DENY it are those corporate parasites who make money off of it.
Kaiser is NOT the model of healthcare. Not even in your dreams.
Just google Kaiser complaints. It might educate you.
Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 09:35 AM
Response to Original message
48. Does anyone really believe that public healthcare WON'T limit its formulary?
Controlling the drug formulary is one of the easiest ways to control costs. Kaiser is simply approaching the control of healthcare costs in the most practical way. Drug companies charge huge amounts for patented brands, when very often a far cheaper generic drug will work just as well. (I am not, by the way, including Advair in this discussion -- because it may be one of those drugs that's more effective than anything generic). When patients start demanding the most expensive drugs made -- even though they're no more effective than cheaper generics-- that will break the bank, for Kaiser, and for any publicly funded healthcare system.

I'm all for single payer healthcare, but the public also has to understand that what will be delivered isn't going to be Rolls Royce healthcare that everyone seems to expect and emand. Rather, it will be more like Volkswagen healthcare -- not loaded with amenities, but it'll be adequate for what it does. We cannot expect to get the most expensive drugs around. What we can expect is that when we're sick, at least we won't go bankrupt getting treated.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:44 PM
Response to Reply #48
51. See Post #7 - and don't tell me Kaiser isn't AWARE of it.
They have NO excuse in this case.
Printer Friendly | Permalink |  | Top
 
Gormy Cuss Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 02:08 PM
Response to Reply #48
68. With single payer there shouldn't be the need to limit the formulary to the same degree.
When there's only one game in town it's amazing how much easier it is to negotiate a deal with the supplier. If the drug company faces a choice of no sale or lower price sale to a high volume consumer they tend to choose the latter.
Printer Friendly | Permalink |  | Top
 
noiretextatique Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:16 PM
Response to Original message
49. kaiser pretty much killed my dad
certainly took away his will to live. my dad developed a nasty hospital infection ( i can't recall the name right now) and those damn fools at kaiser wouldn't prescribe more than 10 days worth of antibiotics. so after the ten days, the infection would come back. finally, after about ten times of the infection returning and him going to the hospital, i called his idiot doctor and told him if he didn't figure out how to control the infection i would file a complaint with the state. then...only then, did they put him on an antibiotic for more than ten fng days. by then, he was so worn out, i don't think he had the strength to live.

there was more...before the infection, my dad had gangrene in one of his legs and needed an amputation. so the surgeon schedules the operation for almost three weeks out, while my dad is lying in bed with a rotting leg. so...i call the surgeon and ask why he didn't schedule the surgery sooner, and he said: "well, i can schedule it sooner." and i said: "well, why in the FUCK don't you do that?"
my dad had his amputation a few days later.
I HATE KAISER!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:47 PM
Response to Reply #49
52. Are you convinced that they don't KNOW what they're doing to people
or is it that they just don't care - or BOTH?

Either way, this type of corporate mercenary operation is INHUMANE and IMMORAL!
Printer Friendly | Permalink |  | Top
 
noiretextatique Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 12:49 PM
Response to Reply #52
53. i am convinced that the life of a 76 year old black man
Edited on Tue Jun-23-09 12:55 PM by noiretextatique
meant nothing to them. i am totally convinced of that. i shudder to think what would have happened if my dad didn't have anyone to advocate for him.
:hug: best wishes with your parents. there is a state agency that governs HMOs. you can contact them and file a complaint. also, kaiser hates bad press, so if you can contact 7 on your side or some other consumer advocate, that would get their attention.
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:27 PM
Response to Reply #53
58. I told Mom to contact the news media there. Figure that'll change their damn tune
...thanks!
Printer Friendly | Permalink |  | Top
 
supernova Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:21 PM
Response to Original message
57. Patient Assistance links
Edited on Tue Jun-23-09 01:22 PM by supernova
Most of the Big Pharma companies have patient assistance programs, where they give patients who signed up their meds at very low or no cost, depending on economic need. Though this has all been very hush hush for years, Big Pharma doesn't like it getting out that they do this. Too fucking bad.


GSK

http://us.gsk.com/html/healthcare/healthcare-coupons.html

My guess is that your parents qualify for the Medicare Part D one, but see what you think.

I couldn't find a page about the PA program for OrthoBiotech, the makers of Procrit, but I'm sure if you call and ask for the patient assistance program, they will get you to the right person. If you get a run around, talk to your parents' docs. All MDs offices should be familiar with these programs, especially those dealing with elderly patients.


Ortho Biotech Products, L.P.
800 Ridgeview Drive
Horsham, PA
19044
USA
1-888-227-5624

I'm really sorry your parents are having to go through this. It's humiliating and immoral to place profits above human health.

Let me know how it goes.

:hug:
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 03:29 PM
Response to Reply #57
70. Tx. She declined the medicare drug rx program when they changed it
that's how she ended up w/ private drug coverage. Then GM dropped her ins so she ended up w/ Kaiser.

Sheesh. :-\
Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:41 PM
Response to Original message
60. What do you all envision national health care will look like?
Do you think you'll automatically get the most expensive drugs manufactured? That it'll be flawless? That 80-year-olds will get any organ transplant they need? I'm finding it amazing that you all think Kaiser is such crap, and that national health care will somehow be nirvana. Kaiser is, in fact, probably a model for how any large managed-care plan will operate. They pioneered preventive care, they cover all illnesses, and they don't kick you out of their plans if you suddenly come down with a catastrophic disease. No one goes bankrupt when they get sick within the Kaiser system. As I mention in a post above, my mom got intra-ocular injections every two months for years -- and those injections cost a thousand dollars per injection. She needed it, and they did it, no questions asked.

Printer Friendly | Permalink |  | Top
 
supernova Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:48 PM
Response to Reply #60
61. Boy are you on the wrong thread
Edited on Tue Jun-23-09 01:49 PM by supernova
This isn't the thread to complain about the limitations of national health care.

Even if what you say has some merit, KP handled this very badly. Unprofessional and sleazy, getting two older people all jacked up with anxiety. But, in the case of Procrit, there is no alternative. Right now, it is a unique product.
Printer Friendly | Permalink |  | Top
 
Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:52 PM
Response to Reply #61
63. Look around SN
every thread about healthcare.
Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 01:55 PM
Response to Reply #61
64. I'm familiar with national health care in UK and Holland
so I know how they actually ends up functioning. These plans do great for the vast majority of the population. But every so often, of course, there's a slip-up. To think that it would be any different in the US is being completely unrealistic. Yes, there'll be slip-ups, just as there are at Kaiser or in any large hospital. I was simply trying to explain why a health plan might conclude that Advair is not the only way to treat this patient. Expensive combo drugs are not always necessary when two different generic drugs could do the same thing.

As for the OP, I got the impression that only one of the elderly parents was on Kaiser -- the other was on another plan. What went wrong there?
Printer Friendly | Permalink |  | Top
 
alstephenson Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 02:00 PM
Response to Reply #60
65. I'm glad you've had good experiences with Kaiser, but...
that doesn't negate the problems others have had.
Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 02:03 PM
Response to Reply #65
66. No, of course it doesn't
Edited on Tue Jun-23-09 02:06 PM by mainer
But there seems to be a total lack of perspective here. There ARE happy Kaiser patients. And our family has a lot of them. With multiple illnesses -- and no bankruptcies. And even some referrals to high-priced California specialists that were outside the Kaiser system.

Meanwhile, I can give you many, many examples of patients who were denied treatment by Blue Cross because of that "pre-existing illness" clause. It's people with private (or no) insurance that end up bankrupt, not Kaiser patients.

p.s.: I'm now in a non-Kaiser state and have to buy my own health insurance. It costs a fortune, and that's with a $5,000 deductible. So yes, I know what it's like outside the Kaiser system, and it costs a hell of a lot more.
Printer Friendly | Permalink |  | Top
 
Ms. Toad Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 02:05 PM
Response to Original message
67. You need to go through their appeal process.
Sucks. It's a pain. But a lot of times it works - especially if you get your doctor on board. (Yes - I am covered by Kaiser - and yes, I have won appeals from their decisions, generally in the first round. I haven't found them to be any better or worse than any other, which is saying a lot since I had Kaiser in the 70s and quit because it was so bad. I'm back because I have no choice, but haven't found them to be any harder than any other company to deal with.)

I am not justifying the deny first and make them beg process - it absolutely should not be that way - but if it is what you are stuck with (or your parents are stuck with) you're betting with your life if you don't learn to play their game.
Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 02:28 PM
Response to Original message
69. Would Blue Cross have paid for the Advair?
The question just needs to be asked. I'm on Blue Cross, with a high deductible, so none of my meds EVER gets paid by my insurance company. I buy them all out of pocket. My mom's on Medicare, and she pays thousands of dollars a year for her meds -- even with the discount. The OP is outraged that Kaiser isn't covering 100% of the cost of the Advair.

Does any insurance plan do that? Or would this elderly parent first have to reach some immense deductible? And would the premiums for those insurance plans be any cheaper than the Kaiser premiums?
Printer Friendly | Permalink |  | Top
 
Horse with no Name Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 03:31 PM
Response to Reply #69
71. I have BCBS and I get Advair 3-months supply for $60 n/t
Printer Friendly | Permalink |  | Top
 
Triana Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 03:32 PM
Response to Reply #69
72. The OP is NOT outraged that Kaiser isn't covering 100% of Advair. YOU SHOW ME
where I wrote that!

I did NOT.

Kaiser covered SOME of the cost of Advair and then unceremoniously and suddenly announced that they wouldn't anymore.

Whether they covered all or part of it - even a small part of it is irrelevant when you're 80-something years old on a fixed income that is WAY below the poverty line.

Jeeze. Get a CLUE!

Printer Friendly | Permalink |  | Top
 
mainer Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jun-23-09 03:46 PM
Response to Reply #72
73. It's how I read it. But now clear it's not how you intended it.
Edited on Tue Jun-23-09 03:47 PM by mainer
"In my Mom's case, Kaiser Permenante called her doctor and told them they would no longer pay for her $600+ Advair."

(Kaiser pharmacy generally pays for the entire cost of a covered drug, minus a small fee. )

It sounds like she should just leave Kaiser and go on BC/BS.
Printer Friendly | Permalink |  | Top
 
DU AdBot (1000+ posts) Click to send private message to this author Click to view 
this author's profile Click to add 
this author to your buddy list Click to add 
this author to your Ignore list Tue Sep 21st 2021, 08:35 PM
Response to Original message
Advertisements [?]
 Top

Home » Discuss » Archives » General Discussion (1/22-2007 thru 12/14/2010) Donate to DU

Powered by DCForum+ Version 1.1 Copyright 1997-2002 DCScripts.com
Software has been extensively modified by the DU administrators


Important Notices: By participating on this discussion board, visitors agree to abide by the rules outlined on our Rules page. Messages posted on the Democratic Underground Discussion Forums are the opinions of the individuals who post them, and do not necessarily represent the opinions of Democratic Underground, LLC.

Home  |  Discussion Forums  |  Journals |  Store  |  Donate

About DU  |  Contact Us  |  Privacy Policy

Got a message for Democratic Underground? Click here to send us a message.

© 2001 - 2011 Democratic Underground, LLC