United has been accused of doing this for a while... They are probably better at doing it than most of the other commercial insurers too. They have started utilizing AI to deny your care ever more effectively.
New healthcare thread...
- Thread starter TIDE-HSV
- Start date
Remember UNH is likely part of a group of companies lobbying for a permanent tax cut from Republicans. And they are likely going to get it...
apparently my visit to the CVS Minute Clinic was not covered by my insurance. The "office visit" and flu test ended up costing $140 with insurance.
Apparently there are 'doc in the boxes' popping up now that bill as 'urgent care' (or similar) meaning they tag your insurance as an ER visit. One opened near me and I've had a couple of friends go in for quick flu shots, etc. only to get billed later for upwards of $1K.
I wish I knew what the answer is.
The extraction of money from insurance plans with all manner of schemes, and the dumping of those extracted funds on the patient for them to pay, is something I see every single day. It is a disaster.
It should be criminal.
I'm sure there are ways we can fix the system we have (the money is clearly there), it's just so convoluted I've no idea where to begin...
Well after having a very frank discussion with my boss, he said the company will cover the difference after my copay.
My wife was in tears this morning because we just can't get our insurance to approve the Rx her doctor wants her to try for her severe acid reflux. All over the counter medicine fails to work, she has tried them all over the years. Insurance wants her to try those same over the counter meds instead of approving the Rx.
I asked the pharmacist how much it would be without insurance and even with a discount card it is $145 for a 30 day supply. We can't afford a new $145 monthly bill. So, she's back to just having to deal with the constant, all day, pain and soreness because of greedy billionaires who control the system. Insurance companies should not be allowed to make medical decisions which is essentially what they have done to my wife. They should not be allowed to say no to a doctor's request. This is the medicine they say she needs; it should be out of the insurance's hands. If they don't like covering the customer's costs, then maybe they should exit the insurance business.
The "system" doesn't need to be fixed, it needs to be blown apart. The medical insurance industry has way too much power and control. That control should be in the hands of the doctors.
Really sorry to hear that, @CrimsonNagus - truly feel for your wife.
That Insurers are allowed to override doctors is criminal, imo.
That Insurers are allowed to override doctors is criminal, imo.
I have acid reflux as well and have been taking prescription strength omaprezole for about 10 years. It works pretty good and costs me a $10/month copay. $145 sounds incredibly high. It must be either an experimental drug or a new one still under patent. If it were me I would be more angry at the drug company. The insurance company shares in the blame but that amount of money for acid reflux treatment is crazy.
Yeah, that is what I take as well. I had to get approved to take. My doctor had to write a letter to the insurance stating this was "medically necessary."
Yeah, my insurance is good when it comes to paying for generics (most of which are dirt-cheap anyway.) When my doctor wants to try a name-brand drug with no generic alternative, it's a solemn guarantee that BC/BS won't pay it, end of story. It's a never-ending battle between the medical industry/pharmaceutical industry and the insurance companies who are routinely getting soaked by high prices for meds and/or treatments. Last time I was hospitalized, I actually paid attention this time to the itemization report which showed what everything cost. Just the cost for a bag of saline nearly knocked me off my feet. With both sides continually trying to screw each other, it feels like a war of attrition, but the real victims in all this continues to be us.
For all I know that is what it would cost us as well if the insurance would cover it. The $145 was without insurance and some discount card the pharmacist said they used. The doctor has tried 3 times but, I don't know if they have written a letter.
Call the doctor and ask for the written letter. It is what I did. They (insurance) approved mine but only for (3) 90 day supplies per year because apparently math is hard.
I’ve been taking the OTC version everyday for years.
I just double the dose to take the same RX strength.
I had killer ulcers back in 2020 and lost like 50 lbs in 9-10 Months and was down to about 120lbs at 5’10
I just finally had enough and said to myself I’m gonna take this stuff everyday no matter whether you are supposed to or not.
Not giving specific medical advice... but yes, OTC omeprazole is a 20mg tablet and that is the original prescription strength. It works fine for most people who don't need much more expensive branded proton pump inhibitors like Nexium, Prilosec, and Protonix.
Please discuss with your physician before making a change though.
42 tablets cost 12$ at Costco just now.
Please discuss with your physician before making a change though.
42 tablets cost 12$ at Costco just now.
My wife was due to have a colonoscopy a couple years ago - a procedure that was supposed to be covered on my insurance if it was for preventative care.
She was having some stomach troubles, and her Doc recommended a colonscopy.
We ended up getting slammed with the cost of the procedure due to the difference in how it was coded.
The clinic said they couldn't change the coding because it would leave them open to being charged with fraud.
I hate our healthcare system.
That's a bunch of crap. Things get coded incorrectly all the time. If one coding error would truly open them up to fraud charges, it's probably because they already have a history of coding shenanigans.
This. 
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