Another Medical Billing RANT!

[WanderingGoatie]

So have you noticed drugs that have huge discounts ONLY if you are younger than 65? Medicare and Part C do not provide similar cost reductions?

I have serious reactions to statin drugs and was on Livalo at ~$45/month. The drug was moved to lower classification so now closer to $200/month. Spoke to both Medicare (freaking useless contractors, I know more about the requirements) and Part C provider. Both told me I am required to take generic statins. I explained they will cause significant harm, my cardiologist also spoke to them. Answer: tough .

Few years ago, I was on Repatha injection program for statins, minimal cost worked great. Stopped program but offered shot at $10K/shot. This not a typo. Its now available at several hundred/shot I hear.

Symbicort has a $25 coupon ONLY if you are less than 65. Then it becomes around $130/prescription. So if you have asthma you are screwed royally.

I often wondered why this isn't age discrimination and start a Class Action sgainst drug companies?

So if you are post 65, good luck on prescription costs! Buy the large bulk double pack of Vaseline from Costco, you are going to need it.

If you're Medicare and did arformoterol and busesonide in a nebulizer it would bill under Medicare part B leaving only 20% that your secondary insurance might cover. Might be a lower OOP option for you.

 

[Muddyboots]

If you're Medicare and did arformoterol and busesonide in a nebulizer it would bill under Medicare part B leaving only 20% that your secondary insurance might cover. Might be a lower OOP option for you.

First, Thank you for suggestion! We have done this recently but this is also part of the billing screwup as well! The Symbicort is needed for additional treatment. The problem isn't just asthma but also relates to lung condition from "other" medical problems. Albuterol is in play as well. Its pure that financial pharmaceutical opportunities for under 65 are not available to over 65.

 

[Mike Matteson]

So get text bill for wife's visit, way off the mark. Look up EOB and wthello is going on. Did not charge Medicare and of course secondary insurance won't pay until Medicare is charged.

Call billing, agent is completely non communicative. Had to numerous times ask are you there?. Agent comes back what were we discussing? Clearly doing something else. Finally admits this is all wrong. No duh! Cannot tell us why the billing is screwed up but hinted new software.

I go back on line and EOB clearly states bill not submitted to Medicare.

Are you having similar medical billing problems? Nobody gives a about doing their job any more. Our data is there, just input it correctly! Not asking for the world, just do your freaking job!

Is that too much to ask?

Yep! Operator error. Garbage in, Garbage out. It's the computer fault. Saw that right off.

 

[Muddyboots]

Yep! Operator error. Garbage in, Garbage out. It's the computer fault. Saw that right off.

But yet this seems to be accepted. Can you imagine how much improper billing $$$ has been obtained from elderly who are not computer or medical program savvy without recourse? I can tell you at 73 and laying the hammer down when their billing dept gets stupid is interesting the realization oh crap he know what he is talking about. why? The elderly should be the one group that gets the most assistance and it is not by long shot.

Unless you have a government health care driven program. Want this crap fixed? Put government on same program. No more SS or Medicare issues poof!

 

[xsn10s]

So have you noticed drugs that have huge discounts ONLY if you are younger than 65? Medicare and Part C do not provide similar cost reductions?

I have serious reactions to statin drugs and was on Livalo at ~$45/month. The drug was moved to lower classification so now closer to $200/month. Spoke to both Medicare (freaking useless contractors, I know more about the requirements) and Part C provider. Both told me I am required to take generic statins. I explained they will cause significant harm, my cardiologist also spoke to them. Answer: tough .

Few years ago, I was on Repatha injection program for statins, minimal cost worked great. Stopped program but offered shot at $10K/shot. This not a typo. Its now available at several hundred/shot I hear.

Symbicort has a $25 coupon ONLY if you are less than 65. Then it becomes around $130/prescription. So if you have asthma you are screwed royally.

I often wondered why this isn't age discrimination and start a Class Action sgainst drug companies?

So if you are post 65, good luck on prescription costs! Buy the large bulk double pack of Vaseline from Costco, you are going to need it.

Asfar as medicare part D I suggest get on mymedicare.gov and shop the plans,..... every year. I didn't do this until recently. And widen the pharmacies that you'd go to and check the "suggested" prices and overall costs including the premiums. The venders can make a huge difference on the cost of a certain drug. I've seen the cost vary over a $1k per drug per vendor per month. At one time I had three different pharmacies that I was going to to get the lessor price. Then some visitors messed up my records........ don't even ask.

 

[birddog 68]

A couple weeks before switching jobs I had a MRI on my shoulder. 2 months later I received a bill that my insurance at time of mri didn't respond and I was on the hook. I called the insurance company and they were going to take care of it. 3 months later I received a letter from a collection company! Another call and asking to speak with manager and it was resolved. How many people would have just paid?

I wonder how many people never look at their bills & just pay the amount owed ? Could the companies have figured out, it is quite profitable for them ?

 

[Mike Matteson]

But yet this seems to be accepted. Can you imagine how much improper billing $$$ has been obtained from elderly who are not computer or medical program savvy without recourse? I can tell you at 73 and laying the hammer down when their billing dept gets stupid is interesting the realization oh crap he know what he is talking about. why? The elderly should be the one group that gets the most assistance and it is not by long shot.

Unless you have a government health care driven program. Want this crap fixed? Put government on same program. No more SS or Medicare issues poof!

I will go a long with that.

 

[Muddyboots]

I shop but the drug classifications lay out the minimal pricing. What's is GoodRX has beaten our insured pricing at times. Its when you need specialty drugs when they have you by the gonads.

 

[xsn10s]

I shop but the drug classifications lay out the minimal pricing. What's is GoodRX has beaten our insured pricing at times. Its when you need specialty drugs when they have you by the gonads.

One med cost $1300 for a 3 month supply. Anther vendor wanted $1k for a month supply. I got it down to $386 for a three month supply. And then I found in by chance for $20 for a three month supply. Frustrating.

 

[Muddyboots]

How the heck is this not price gouging? I just don't understand how there is this enormous disparity for same drug. Bet you our illustrious representatives do not face this at all. Not to mention staff doing legwork on our freaking nickel.

 

[Mike Matteson]

Man We's Are On A Roll Now!

 

[xsn10s]

How the heck is this not price gouging? I just don't understand how there is this enormous disparity for same drug. Bet you our illustrious representatives do not face this at all. Not to mention staff doing legwork on our freaking nickel.

It's very strange. One of the reasons is vendor supply. I've had medications not be available and have to search for it. It came down to nationwide shortages. Then I found a supply locally and quickly secured it. It can be a difficult situation since my Mom takes 217 pills a week. It used to be 23X.

 

[HARPERC]

 

[dustbag]

Ain't that true