One of my favorite health insurance prescription scams; Scenario A: Your plan is approved for 2 pills a day and you're prescribed 2 pills. “Great you’re covered!” Scenario B: Your plan is approved for 2 pills a day and you’re prescribed 3 pills a day. “Fuck you, we’re not paying for shit. Go fuck yourself.”
About the same for me. It’s p nice. My one regular prescription costs 1/3 of what it was on my previous shitty insurance I got on my own thru Anthem.
not saying it’s not annoying but there is usually a justifiable reason why it’s it’s not. I review those cases all the time. Usually it’s because there is a more cost effective way to achieve that dose or it exceeds the fda max dose
Correct me if I’m wrong, but my understanding is reimbursement isn’t contingent on the dosage of medication and the denial is predicated on the number/count medication administered daily. Regardless, the plan should cover what it says it will cover. It’s horse trading 101.
correct, most strengths of medications are the same price. For example they want you to take 90 mg and you were on 30. But they make a 90mg. They don’t want to pay 3x as much unless it’s medically justified. Basically you can’t swallow the 90mg, you are take three times a day this need the 30mg etc. Could also be that they view three times a day as exceeding the fda max dose. Like if you the doctor wanted you take 120 mg of simvastatin so 40mg TId, twice a day is fine but three times a day will reject because it’s over the FDA max dose. I promise you it’s most likely covering exactly what is in the contract. with that being said some can be overridden by a pharmacist at the pharmacy or a prior approval will get it covered. Again it’s shitty but they aren’t just making up the dose limits typically. There is some reason why.
seems like I struck a nerve and that wasn’t my intention. So I’ll attempt to explain. The first reaction by many was “why are people upset at what the insurance companies are going to start doing. That is what they always do in our system”my only point was saying “oh well that’s our shifty system “ shows how programmed we are to accept out shitty system. I didn’t once say you liked the system or that you were advocating for the system. Our system is fucked up and the insurance companies can’t wait to fuck us and no one with any power cares.
Only in Biden's America are we rationing monoclonal antibodies and blaming the states rather than the NIH. To be clear, the state's recommendation is based on guidelines from the National Institutes of Health. A Vanderbilt expert told me this is the right choice to do the most good in a bad situation. Trump was blamed for PPE, Vent, and Ecmo rationing. How is this any different?
What I’m saying is, based on my earlier scenario, they should still cover the first 2 pills if the prescription is increased to 3 pills. “We were going to cover 2, but you got 3, so now we’re covering 0.” If they’re using the “exceeds FDA max dose” threshold argument, they should cover up to the FDA max dose.Instead, they absolve themselves from any obligation to reimburse the patient for any of the medication even the dosage that’s below the FDA limit. It’s bullshit.
because we had stockpiles and a big head start for one group and the other is an experimental intervention. what’s your next brain buster?
*unvaccinated people. Thankfully, Nashville started publishing data from the recent deaths. A lot of 300lb+ diabetics are not vaccinated, it's sad.
that’s not entirely how it works but I completely understand your frustration. Paying for unnecessary (not saying your example is) number of medication increases healthcare cost for all. I also understand they are also trying to save themselves money first and foremost
100% and please don’t take any of that frustration to be directed at you, I’m just ranting. And you’re exactly right about trying to save themselves money, which is part of the “broken-ness” of the system. The fastest route for Healthcare providers to increase profits is to cut expenses i.e. deprive patients care. In my experience isn’t never about increasing revenue and almost exclusively about cutting expenses. “If we just water down the soup we can make an extra nickel a day!”
if you ever have issues let me know I work for a major health insurance company. I can usually see what I takes to get things approved. I don’t particularly like our health care systems but it pays the bills
“The right choice to do the most good in a bad situation.” Debatable! I posit that the willingly unvaxxed dying because of their own choices is the best thing for the country and the species. How about that, Vanderbilt expert?
Ended up taking a PCR today. Been coughing since Saturday (isolated since then), so better be safe. No fever at all, which is good, so hoping it’s just a cold. Been fully vaxxed since May.
When were you potentially exposed? It’s best to wait five days, anything earlier than that and you stand a chance of getting a false negative.
Have no idea if the claims of this being scheduled to air and being pulled are true. I do know it does need to be aired.
The unvaccinated continuing to fuck over the rest of us. Spoiler: Limiting of Monoclonal Antibodies U.S. Limits Covid Antibody Treatments For All States As Shortage Fears Rise Jemima McEvoy TOPLINE After moving to limit supplies for a handful of states earlier this month, the Biden administration is further tightening its grip on states’ access to monoclonal antibodies following a dramatic surge in demand for the life-saving treatments in states with high coronavirus cases and low vaccination rates—despite the president just last week vowing to ramp up distribution of the drugs. KEY FACTS The Department of Health and Human Services is starting to allocate treatments to states based on case levels and usage of the treatments according to a policy introduced Monday, a senior HHS official told Forbes. This marks a shift from the agency’s distribution strategy over the past few months which allowed states to freely order supplies, and reverts back to how the HHS distributed the drugs between November 2020 and February 2021, before they were widely available. The change, which is all but certain to reduce supply in some hard-hit states in the Southeast, comes after the HHS earlier this month warned a group of seven states relying heavily on the treatments that they would need to cut back on their orders. HHS officials stressed at the time that they had not shifted back to an allocation process, but have since changed course, though the senior official emphasized to Forbes that these changes are intended to be “temporary.” Regeneron and Eli Lilly both announced this week they have come to new purchasing agreements with the federal government, which has secured 1.4 million doses and 388,000 million doses from the drugmakers, respectively. TANGENT The Biden administration is publishing weekly breakdowns of the distribution of its 150,000 monoclonal antibody doses on its website, with this week’s report revealing Florida, Texas, Mississippi, Tennessee and Alabama as the states given the most treatments. WHAT TO WATCH FOR How this will impact states relying heavily on these treatments. Doctors and state leaders in places battling some of the worst Covid-19 outbreaks have already started expressing concern, including Kentucky Gov. Andy Beshear, who on Tuesday warned residents against “placing faith” in monoclonal antibody treatments instead of the vaccine as they “might not be there for you.” This came after physicians with the Medical Association of the State of Alabama released a statement on Monday saying they are “very concerned” that the federal government is limiting supply at a time when it should be helping “provide more of this treatment … not less.” https://www.forbes.com/sites/jemima...tates-as-shortage-fears-rise/?sh=728374c22406
This is not the case with Delta. Time from exposure to positive has like a median of 3.5 days. My kid (unvaccinated) tested positive by PCR after less than 48 hours.
Both mine and my boy’s PCR test came back negative. It is what I expected but was just being safe as can be.
Exactly. I would not be taking advice from a guy who works at a hospital or medical office who isn’t a doctor lol
I flew down to FL a few weeks ago for our Boise State game and just drove up to Louisville last Friday. I’m not worried about outside spread, but did wear a mask inside stores/hotels. At this point, it should be based on your risk tolerance and if you or your family are at a risk.
Outside stuff seems mostly ok. Don't remember seeing any stories of huge outbreaks at outdoor sporting events