One employee's family recently found this out the hard way. The wife, a former County worker, needs Dexilant for acid reflux. Her husband, a diabetic who still works for the County, needs Januvia to keep his blood sugar under control. But their pharmacist is unable to fill their prescriptions. It keeps coming back as declined.
The wife, I'll call her Carol, called Executive brown today to complain. he was too busy to speak to her, and handed off the ball to a woman named Cathy. I presume that's Cathy Allen. The conversation went nowhere.
Upset, Carol told me she "could get stomach cancer" without that medication. But the person she is really concerned about is her husband.
"They're killing him," she charged.
"His blood sugar is going through the roof and now they're playing with his health. Diabetes is not something to mess with."
"An employee of twenty years and this is how you thank him?" she asked. She concluded that the Brown administration is "playing with people's lives."
Carol thinks this problem could go away if a doctor prepared a letter claiming that the prescriptions are "medically necessary." I thought that was the whole point of a prescription. But I wrote to the administration, asking someone to explain what option employees have when confronted by this problem. My email went to Brown, Allen and Director of Administration Luis Campos.
Not one of them has bothered to respond.
98 comments:
Reading this is making me reconsider my application with Northampton county corrections. This is crazy
A protocol often used by pharmacy benefit managers is to make you prove you failed on TWO less-expensive drug therapies before they will authorize the big-ticket one. That said, with my plan, thirty generic Cozaar tabs today were under tour bucks. The clerk told me to be grateful because some people had to pay fifty or sixty dollars for the same thing. Hmmm.
Dexilant is a generic, so what is happening with that denial makes no sense.
But look how much money Brown is saving the taxpayers.
Where is council?
It is overdue they change the HRC so we can vote this Clown out of office before someone dies
You voted for change. You got it. Stop whining.
Real world health coverage.
Reflux and type II diabetes are lifestyle disorders that can be managed with diet and exercise. Having either one is a choice, and taking meds to maintain an unhealthy existence is moronic. It's a bit like providing free booze for alcoholics.
something, other than the obvious, doesn't sound right about this
baloney @5:31 my children suffer from both ...my sons condition can't be changed with diet or anything else ...it leads to other problems with the stomach etc..regardless that should be covered period!
The taxpayers shouldn't be expected to pick up the tab to treat disorders that are a result of choosing to live like a goat. The cost of obesity in this country is streaking toward the trillion dollars a year mark. Give them six months worth of meds and then they're on their own.
Typical conservative behavior. Handouts are bad unless their MY handouts.
Bernie, I saw this coming last fall because it affects me as well. In the Cap Blue book there are three exceptions to the formulary. If a currently prescribed drug is also available OTC, it is no longer covered regardless of the dose; no proton pump inhibitors are covered at all-not even with a doctor's letter, and no testosterone drugs are covered. But birth control drugs and ED drugs are now both covered... go figure. HR has copies of the formulary on the counter.
Happens all the time in the private sector. It sucks. But it's common.
not about to argue with anyone who doesn't have md behind there name ...I will say this my grandson who has cerebral palsy must take meds for acid reflux he is six and not overweight or fed a poor diet ... there are not blanket reasons people have illness ..when you are paying a hefty price for healthcare your scripts should be covered period!
it appears that the first requirement to become employed by the county is that you must be able to whine louder than the average citizen.
all the average citizens do is whine ...county workers have jobs and pay for their healthcare unlike some who get a free ride ..they have every right to whine !
Does anyone really think Mr. Brown or Allen cares??? They don't give a dam about the workforce. Their actions have shown that time after time.
Dexilant is not a generic drug. It is a very expensive brand-name drug of the proton pump inhibitor family. There are many cheaper alternatives such as omeprazole or protonix available on the market. Also Januvia is an adjunct to diabetes type two. It is not first line for treatment. Metformin a cheaper alternative is first line for treatment and Januvia has many other treatment alternatives that are much cheaper. Such as a sulfonylurea. This story is balony!
Conservative logic 101 - pregnancy through rape = gift from God.... Intervening is a sin...
Life threatening illness - mistake that requires man made intervention... Screw god
REALLY? What incentive is there to stay and even work there anymore?
@ 5:31...WRONG...My brother who works out and is 8% body fat has Diabetes. Most of the time it is genetic that you have this.
Keep up the good work Mr. Brown. It is heartwarming to see the thinning of the herd and the associated savings.
The County can now do exactly what private businesses have done which is the same job with less costs. The tax payers appreciate your efforts.
Can we now move on to privatizing the county old folks home? It seems to be a terrible waste of money putting yet another financial drain on our citizens. Privation seems to be the most fiscally responsible thing to do.
Wishing you even more success in the future.
"Reflux and type II diabetes are lifestyle disorders"
You know nothing abiout these people and are in no position toc claim that their illnesses are their own doing. As it happens, the fellow with Type 2 goes to a gym every day and has it because it is hereditary in his family.
If the county can deny coverage for medication based n its disdain for someone's lifestyle, it might as well deny all coverage. What a piece of shit you are.
This is precisely ythe kind of insensitive
"Does anyone really think Mr. Brown or Allen cares??? They don't give a dam about the workforce. Their actions have shown that time after time."
If they did, at least one of therm would have responded to my email. They don't.
alot of doctors must post here. Or, people who talk out of their ass.
I posted links to the NIH and ADA that say you are wrong. I know, I know... tough choice, who to believe the most renowned experts in the field or a blogger.....
"Dexilant is not a generic drug. I"
It is not only a generic, but the company that makes it has been sued by the patent holder. You are full of shit. Just turn over your car or get ready for jail.
Dexilant is a brand name drug, made by Takeda. Takeda successfully won a lawsuit on its patent a couple years ago - and the patent won't expire until about 2020. There is no generic currently available for Dexilant. The "generic name" is Dexlansoprazole, which is also known is its "chemical name." That doesn't mean the generic is available now, though. It is not. Takeda won a lawsuit a few years ago against a generic competitor - they have their patent intact.
That said, both Januvia and Dexilant are very expensive, and it is not unusual for pharmacy benefits to require prior authorization before allowing these medicines. It's a process the patient and their doctor must go through. I don't know what the specifics of these county employee's coverage is, but something tells me they need to call their insurance and ask how to go about getting approval for these medicines.
I'd be curious to know what happens! You cannot financially manage a pharmacy benefit plan without some restrictions in place. This is VERY normal in the private work sector.
shouldn't the real question be for decent citizens of this country, why are we all paying more for this healthcare when these companies are posting record profits every year?
"it appears that the first requirement to become employed by the county is that you must be able to whine louder than the average citizen."
Given the insensitive treatment they are receiving from the Brown administration, which is endangering their lives and health, they have every right to complain. They contribute 4-5% of their salary for health care.
Some of these comments need to be copied and circulated before the next election so voters know who the assholes are. Anyone supporting Brown needs to go.
so if all these experts here are right, how do they explain a skinny low bmi index person having type 2 diabetes? that would never be possible then would it?
A quick check on Google indicates Dexilant is covered by Pennsylvania Medicaid, but Junuvia is listed there as 'non-preferred,' whatever that means.
Hopefully, there IS an equivalent drug to Junuvia that will be covered. Your healthcare benefit is changing rapidly, that much is certain.
On the national level, we now learn many who took government subsidies under Obamacare, will soon be paying some of that back through their tax returns. This will be fun to watch.
Fred Windish
Here's an example of how a pharmacy benefit plan in North Carolina approves Dexilant. It's not reimbursed as a "first line" drug - in other words, in this plan, you cannot get coverage for Dexilant unless you meet certain criteria or fail other (cheaper) meds.
http://www.shpnc.org/library/pdf/pharmacy/dexilant.pdf
This same type of process occurs all the time with a very wide variety of medicines. Huge areas of marketing within pharmaceutical companies exist solely to deal with managed care companies who impose these restrictions. It is a major component of the American health care system, in that our insurance plans somewhat dictate what type of medicine we can receive - at least, receive discounted.
I would recommend these employees work with their pharmacist, doctor and insurance company to see what they need to do to get what's known as "prior approval" for these meds.
I'm surprised their past county prescription plan did not require prior approvals - they really did have Cadillac plans!!! It is VERY unusual to find a medical plan that will fully or almost fully cover absolutely anything the doctor prescribes - this is mainly due to major competition within certain classes of drugs, where one drug (like Dexilant) has a minor advantage over existing and generically available medication. (Omeprazole and others are available over the counter, without an RX, and the only real difference with Dexilant is that it is time release.) Prior approvals are a PAIN IN THE BUTT, but they are standard of care for most health plan recipients.
Monkey Momma, I understand that changes in the formulary being used for NorCo workers and other plan participants mean that some drugs formerly available are no longer authorized. You have provided an example of how that drug can be made available under a plan elsewhere.
Here is my problem. When a change like this is made, it needs to be explained to workers. When they have concerns, those concerns should be addressed. They don't need to be told that their illness is the result of poor lifestyle choices. They need a game plan for getting access to medication that in the past has made them better. The administration has been totally unresponsive to these concerns. It is a terrible way to treat what brown calls the county's most valuable asset.
and nobody cares what you think tricia.
Good point, Bernie!
Would be better for employers to publish a listing of what medications are NOT covered as they were before. Then, in the second column, list comparable alternatives to each that ARE covered, and how to go about getting them.
In today's world, workers are purchasers of insurance. Sounds like Northampton County consumers could use better customer service.
Fred Windish
Bingo. If a change like this is made, the options need to be explained.
"When a change like this is made, it needs to be explained to workers."
I would agree - that would be the polite and ethical thing to do. That doesn't always happen, though.
"Carol" and her husband need to talk directly with the insurance company and determine what the process is for covering these drugs. AND, they need to immediately notify their doctor of these availability issues so that they can receive alternative medicines that are more readily covered.
I sincerely doubt that Brown himself went through a list of medicines and made line by line decisions - that is usually the role of the pharmacy benefits plan, and it can be a real beast to sort out.
In the specific case of the Januvia denial, a call to the doctor is priority number 1. The patient can work with the doctor to determine if another medicine is available, and the doctor works with the insurance to prove need. Leaving the diabetes untreated is not the way to go. That would be my main concern here. If his blood sugar is "going through the roof," then he needs to get into the doc's office TODAY. It's urgent. The patient's doctor should be well versed in handling pharmacy denials. If he/she is NOT, then it's time for a new doctor.
I am presently 79 years old and a Northampton County Retiree. When I first started with the County I was told we would not make a lot of money but we will take care of you and your family with good health benefits. This wasn't just fact fifty years ago. This was fact through THomas Hahn County Commissioner,Richie Raidline county Comm. Martin Bechtel County Commissioner, Don Corriere Count Comm. Jim Hemstreet County Comm. and then when we elected a County executive and all of them told us the same thing. We worked for little more than minimum wage so we could have our health benefits. When I started for the County in 1955 I was 19 years old and I was making A little more than $1.15 an hour. Even when I retired I was only making 75 cents above minimum wage. Take a look at what the employees are making now. Seventy five percent of our employees are making very little over minimum wage. The reason was that we we were always told we would have good health benefits and the county would take care of us as employees and later on in life as retirees. All we ask is the County keep their promise.
"Would be better for employers to publish a listing of what medications are NOT covered as they were before. Then, in the second column, list comparable alternatives to each that ARE covered, and how to go about getting them."
Yes, Mr. Windish, I agree that would be the best course of action for an employer who changes pharmacy plans. However, it's not the employer who decides which drugs are covered, which are not covered, and which require a prior auth. It's part of the pharmacy benefits, administered by a 3rd party. And those pharmacy benefits can change all the time. I actually would counsel patients to work directly with the health insurance, doctor and pharmacy to get coverage - at this point, the contract NorCo signed is in place, and now Executive Brown has absolutely no control of the process.
It would be very enlightening to see if Brown himself has the same coverage as employees. Did he also downgrade to this more economical plan? Or is this just for his minions?
At my office, we had informational meetings offered to explain our new insurance when we switched carriers. People could meet one on one with an agent - they gave them a list of their current meds and conditions, and the agent let them know how the new plan affected them. The employer never knew any of the details of this meeting. Brown should have offered such a meeting. Did he?
There were overview meetings in the County at the end of last year, but there were so many changes being made it would hard to follow them all. There were no one-o-ones. Really, there should have been individual reviews so tht a game plan could be in lace for each worker. That's what an outfit does that values its employee.
hey bernie...someone should let cathy allen know it doesn't cost anything for the nicotine patch at the county....maybe she should try it instead of smoking out back on county time....
9:28 breaks my heart.
"All we ask is the County keep their promise."
I understand where he's coming from. But there are so many Americans who getting similarly screwed. They're being laid off, they're being downsized, their benefits are shrinking.
Promises mean NOTHING unless it's in writing. A promise is not a contract. This is what people are learning the hard way. And even then, bankruptcy and other legal maneuvers can make written contracts go up in flames.
The other thing to consider is that a county cannot afford to provide 100% coverage for all prescriptions to all employees. That would be insane. Given the cost of medicine these days, that is unsustainable. Taxpayers cannot be expected to foot the bill on Cadillac plans that pay for anything no matter what the reasonable alternatives are.
I really feel for 9:28. If he still has insurance, even with restrictions, then he's doing OK. But I know so many people offered similar promises in the private sector who are getting royally screwed now. Oh, you were promised a pension if you worked until age 49? Sorry - we're laying you off at age 47. Believe me, it's happening everywhere. It's a terrible indictment of America in general, and certainly not limited to NorCo.
This is why our health insurance should be universal, and not dependent upon the whims of employers.
"I sincerely doubt that Brown himself went through a list of medicines and made line by line decisions - that is usually the role of the pharmacy benefits plan, and it can be a real beast to sort out. "
This is probably the result of "improvements" suggested by cost control consultant C#, which told one county worker, "Nobody subpoenaed you to work here."
"I understand where he's coming from. But there are so many Americans who getting similarly screwed. They're being laid off, they're being downsized, their benefits are shrinking. "
The difference is that I believe the public sector should serve as an example to the private sector. How can the government insist that employers be fair to their employees in the private sector when the government treats its own employees poorly?
That has been my argument all along. The government needs to set an example that the private sector can emulate. Instead, everyone is going for the lowest common denominator. The net result is shitty service in both public and private sector.
"hey bernie...someone should let cathy allen know it doesn't cost anything for the nicotine patch at the county....maybe she should try it instead of smoking out back on county time.."
Based on the comments of one insensitive asshole, the argument could be made that the patch should be denied bc it is the result of a poor lifestyle choice. But I do not believe that we have the right to condemn others.
In response to Mildred at 8:14-
Fuck You! Your taxes at the county level were raised for the fisrt time in nearly a decade (under Republican John Brown and under a Republican controlled council).......but keep acting like you are being taxed to death at the county level! Very few jobs at the county level can be compared to jobs in the private sector i.e. corrections officers, juvenile justice employees, sheriffs office, children & youth just to name a few. How many people have had shit or piss thrown on them in the private sector? How many people are faced with the risk of exposure to HIV, TB, Hep or numerous other diseases on a daily basis? Lets put people's lives at risk just so Mildred's taxes dont go up a few dollars a month for the first time in a decade.......and just remember your savior John Brown was the one to raise your taxes!
9:54, your right on! unlike my school taxes which go up EVERY YEAR without fail.
The difference between the drugs used for Type II diabetes and GIRD, and a nicotine patch should be obvious. The first two are meant to help a patient MAINTAIN their obese lifestyle and the patch is used to help a person END a smoking lifestyle. It makes more sense for the county to pay for smoking cessation programs, which will save the county health care costs in the long run, than to pay for "designer" drugs that enable an obese person to continue his/her unhealthy lifestyle. Allen should set an example for the administration by entering a smoking cessation program rather than spend her "valuable" time taking drags on coffin nails on the loading dock or employees entrance.
9:28 You should be demanding more from your private employer not bashing gov't employees. Your argument that private sector employees are getting screwed so public sector employees should get screwed as well is both juvenile and off base. Here's a novel idea, maybe private sector workers should stand up for themselves and fight for workers rights instead of hiding in the shadows and taking whatever shit is thrown in their direction!
im sorry the above comment was aimed at 9:42 Monkey Momma
The argument is also illigical. Just because some people get treayed like shit is no justification for treating all like shit.
might I suggest that one of the benefits awarded to the poor employees of the county be a bed in gracemess upon retirement. That way the county and it's citizens can wipe their asses for their entire life
8:46,,
double their contributions
Next up - Brown/Allen responsible for nationwide measles breakout.
The fact is they are insensitive to employee concerns.
12:04, why don't you double your meds?
I think Brown is responsible for diverticulitis and strep throat. He's also responsible for the Seahawks choosing to pass from the 1 on third down. The guy's bad news all around.
He is bad news and the callous attitude displayed by people like you will be remembered at election time. Let's see how many GOP COUNCIL candidates support this madness, when they know they will answer to the voters.
1:18 i know one thing that John Brown is responsible for, RAISING YOUR TAXES! I hope you enjoy it:) And dont give me that bullshit about Stoffa or council because your HERO sat idle with his VETO in his pocket.
Hey, genius- it was BROWN who sat idle with a veto of the tax increase in his back pocket.
Bernie, the same type of issues with formularies, non-preferred medications, "step treatment", and prior authorizations exists for just about EVERY health plan offered by EVERY private and public employer. I think we all can agree that it's not fiscally responsible for any employer (private or public) to pay $200/month for one drug, when there is a $20/month drug that will do the same thing. Obviously, the devil is in the details of how to accomplish this goal, but it's certainly not the clear cut issue of "not caring" that you try to present.
I get it...you have an axe to grind with the current Norco Government, and I agree with many of the issues you raise. However, each time you ascribe some type of evil intent to routine aspects of employee health care that are much more attributable to the insurer than the employer (such as the couple days in the beginning of the year when there was a coverage "blip") you weaken your credibility in the areas where you do have a point.
Brown will not be re-elected. And his bitching, whining, background noise opposition (who had their asses handed to them in 2013) will have little to do with it. He raised taxes and will be purged by his own party. The tax raisers on council are as good as gone, also. R's tend to take out their own trash. Ds hold on to their mistakes for life and name parks and things after them.
This entire discussion is depressing and a prime example of why America needs Nation healthcare., The Insurance companies are like bookies between you and your doctor. The days of cheap healthcare provided by your employer have gone the way of 30 year careers with the same employer.
It really is time for America to pull its head out of it ass and join the 21st century. National healthcare is the only sane answer.
Anon 3:10 "...National Healthcare is the only answer".
National healthcare would simply replace bean counters at Insurance Companies with bean counters in the Government. You're crazy if you trust any of them.
You're right when you say that healthcare should be between you and your doctor, but nationalized healthcare is actually a huge step away from that.
The best solution is actually market based healthcare, with real financial incentives for people to make good decisions. Anytime you go too far to fully insure everything, it leads to waste since there's no incentive to save money. Why should I try the $20 drug when I can have the $200 one at no extra financial cost to me?
This is a difficult topic, and one that doesn't lend itself to simple solutions. The answer is finding the right balance. I think we all agree that if the $200 drug legitimately is the only one that works for someone, it should be covered. However, I think we also all agree that, if a $20 drug works just as well, there's no reason insurance should have to pay for the higher priced drug. Unfortunately, there's so many shades of gray between these two black and white extremes that aren't as obvious of a decision.
Requiring prior authorizations for some medicine isn't "treating people like shit." My point was simply that this type of prescription drug insurance restriction is very common place in the real world.
I don't understand some commenter's assumption that money grows on trees. The County, like any real world business, must control expenses. There is no dragon sitting on gold under the county courthouse.
As an expense for businesses small and large, health insurance has grown exponentially in the past few decades It is a truly runaway expense. Any prudent organization, public or private, would be wise to impose limitations on prescription drug benefits. It makes no sense to say the sky is the limit in terms of a business's exposure to drug costs. Taxpayers shouldn't accept that burden. Businesses don't accept that burden for the simple reason that they CAN'T. On the whole, businesses are working hard for their revenue, and there's only a finite amount of money to cover all expenses, including healthcare.
That said, these types of major changes to employees' plans should have been much more clearly communicated. Employees should have already had a plan for managing their existing medicines within the confines of the new plan. Someone dropped a ball big time here.
Requiring prior authorization is not treating people like shit, but the failure to communicate sure is. You mentioned one-ones where you work, but there was none of that. And the employees were already stressed by other reductions. Brown could not be bothered to discuss it with "Carol" yesterday, and not one member of his staff answered an email asking for guidance. That is treating people like shit.
I voted for Brown. He is a disgrace and should resign.
Hank_Hill
And the Northampton County Republican Party is silent on Brown's rampage through the Courthouse. Can someone in the Party reign this guy in?? Otherwise, the Republicans will never hold a seat in the County again. The Dems are licking their chops by taking notes and formulating campaign issues.This is bullshit what this guy is doing. Signed... New Generation County Republican!
John Brown's desire to cut all the county's benefits to the bone is common for short-sighted leaders and benefits administrators who are not strong enough to do and provide the analysis that show the ramifications of that poor decision.
Prescriptions are preventative for the most part. Those who are battling diseases that are long term and life threatening if not maintained are long past the berating of "you should have done this or that differently in your life". That helps no one.
What is important is to provide these medications to your employees and their plan members to keep them from spiraling farther into the disease and/or death.
Taking medication for high blood pressure for years is much cheaper than bypass surgery or heart transplant.
Taking medication for ulcers is much cheaper than stomach cancer treatment.
Taking diabetes medication for type I or II is much cheaper than dialysis or kidney transplant or pancreatic cancer.
Missing the long-term prognosis for your employees who are on treatment drugs is negligent. The county is self-funded for their benefits. Meaning that up to the amount of their stop-loss insurance (usually $350,000 - $500,000 per occurrence)the county pays for the full medical cost for every plan member. If you have a $250,000 medical bill, you pay your part/percentage and the county pays the remainder - not the insurance carrier.
Prescriptions are cheaper than the treatments for diseases that are not treated with prescriptions.
As I stated, this is common in business. Benefits can be confusing. Transparency is a must. Education of all your plan members is absolute. Doing neither of that is negligence.
A savvy and tenacious Benefits Manager is a financial must for a large self-funded groups. Neither which NorCo has.
On a side note I did contact John Brown and Cathy Allen and offered my services to the county while they were going through their renewal. Their silence told me that they didn't want to see the future and just wanted to slash without rhyme or consideration.
A Tenacious Benefits Manager
Where is council? E-mailing Barron's staff trying to find dirt so they can get their candidate elected. They COULD CARE LESS about the employees. John Brown and crew could also CARE LESS about the employees. We are beneath them, peons, money suckers, who need to be glad we have jobs. Those who did not leave are actively looking for other work.
McClure, Werner, Kraft, Parsons and Ferraro deserve some credit for asking Brown to reconsider his health care changes. I respect Phillips as a man of conviction, even though he is not with the worker on this issue. Geissinger is in my opinion willing to listen. He, Vaughn and Benol had bad first years, but I believe Geissinger will get better.
Lose weight with a group that exercises almost daily.County should allow rehab at YMCA during working hours perhaps.This Type 11 is dangerous and costs are going up . Diet and a work out can help and make a world of difference.First is education of why it exist. A 55 year old female with a high BMI is at risk of not completing a career and her weight and problems can compound her relationship with her spouse. GET EDUCATED about this . I have had family member in the past like this and it can be hell.
The gentleman I mention with Type II is of slender build and works out every day. His lifestyle is not the problem, as someone insensitively and inaccurately suggested. It's his genes.
So we are supposed to do all of the preventative medicine crap to keep the insurance company happy, but not be able to access the drugs we need if there is a condition. If you read the formulary, these drugs are on it, but those cost cutting bastards at C3 feel the county will save a shitload of money if they don't have to pay for it. I am positive they looked at the meds people were/are taking and chose the ones that were the most popular to cut. this is ludicrous.
Diabetes a lifestyle choice? sorry, your ignorance is stunning!Diabetes is a hereditary disease, not caused by eating a poor diet! And, not everyone is able to work out strenously to lose weight!
As a Norco employee for over 20 years, I am being discriminated against by selectivity and capriciousness. I could get all the birth-control pills I want, but God forbid I should need a drug to help me manage an insidious disease like diabetes!
All those involved in making these ridiculous choices should remember that you might get ill some day. What goes around comes around.
Perhaps if my salary was more in line with the private sector, I could afford 3000 bucks a year for a drug on top of my $8000 a year plus 4.5 percent for health care! But lo, I am not one of the special ones who got a raise this year. I make less than median salary.
Anybody from the county staff die today?
Tired of hearing people say, "Real World this and real world that". The real world people is that you have a county executive that wants to give friends contracts for $715,000, increasing salary of his Bangor buddy that has no experience, hire an HR person from out of state who is clearly not qualified (don't understand why council didn't see this) and there is a lot more. Brown is taking care of his own at employees' expense. I think council should ask for a list of employees who have benefits and wonder if the heads who put this into effect have this coverage. I'm going without something medically needed because I don't have the money for the out of pocket expense. Trying to save up. Should have gone into private sector long ago. Pay would have been higher, but being dedicated to job, I stayed. So, next time someone says anything about the real world, we are all too familiar with it thanks to Mr. Brown, go to some council meetings and see the real world first hand or some committee meetings and look who is on some boards of this county. Then you'll know the real world too.
This is the kind of disgusting shit that Mezzacappa posts.
@8:47, hopefully not, but the night is young and I haven't taken my medicine yet. Every night when I take my breast cancer medicine, I hope I don't have a reaction because I don't have money to be seen at a hospital!
It's a real shame what NorCo has become.
8:47.....you are jobless, carless, got turned down by the county because you are unemployable, are 50 plus years old and depend on your mother, are a complete embarrassment to your family, and you lost that shack you call a home on Ridge Street.......face it you are failure who wants to bring people down with you. Just think, every morning I wake up knowing my car is nicer than yours, my house is a whole lot nicer than yours, and I'm way happier than you......I'll sleep well tonight knowing I don't have to worry about a sheriff knocking on my door. Nite-nite sweetie:)
anon 4:17, I sort of agree.
Your last paragraph is well written and reasoned. Sadly the parts before that betray basic tea party doctrine that is not something that I can rationalize like some others. .
The idea that the government rather than insurance companies would be worse in healthcare is debatable at best. Insurance companies are for profit and live for profit, not care of their policy holders. Switching companies is like picking between twiddle Dee and twiddle Dum as to prices. I have also had many more battles over coverage with Insurance bean counters than any bureaucrat. You mention the free market. I agree that the free market principle works in many situations. I agree that the rule of the marketplace is fine in buying a home or a car. If you can afford the Mercedes, God Bless you, I will make do with my Chevy. If you can build a mansion and I can only afford a twin, so be it.
Healthcare should not be at the mercy of the marketplace. If you need a certain medication for your health, you need it. If you claim that you can get a better deal in the "marketplace" for the drug that is misleading. There really is price fixing by drug companies who get what they want. Also not many people are comparing costs on their heart attack care.
This notion of free marketplace rules for healthcare is fine for cosmetic surgery, or some other elective surgeries you may want to price shop but that is about it. Also will you get the operation at Dr. Bart's cheaper hip replacement city?
Let us have a reasoned and complete understanding of the unique place healthcare has in all our lives and not put it in the same category as shopping for a new winter coat.
Thank You
Interestingly, the C3 consultant told Gracedale employees that they reviewed all of the medications that the county employees were currently taking- and that they were all covered on the new formulary. Yet another lie. And keep in mind- if your RX is not covered, your cost does not count towards your out of pocket max because it is considered non- covered. So for that generic proton pump inhibitor for bleeding ulcers, the rx cost is $140/month non covered that doesn't count towards the 6600 max and also can't be applied to the gap insurance because it isn't a coinsurance expense,.....although council was told the employee wouldn't have to pay more than 2500 out of pocket. Another lie.
@ 9:36 - It IS the county/employor who decided what is and isn't covered in this instance. The county is self insured. The Capital BC rep told us that the COUNTY specifically excluded proton pump inhibitors from the plan and the COUNTY decided to go with a closed formulary which specifically excluded many of the drugs in question- including post mastectomy drugs and post thyroid cancer drugs which are necessary to successful recovery. Contrary to the information provided at the employee meetings where employees were told all of the current drugs employees currently take are covered- they clearly are not.
Anon 5:04 - First of all, thanks for a fairly reasonable discussion - it's kind of rare in this type of forum.
My last paragraph, however, wasn't simply tacked on to "tea party rhetoric", it built logically from it. I prefer a private insurer making these decisions over a government being judge and jury. With all due respect, you're drinking the liberal "Kool-Aid" if you believe that the government cares about you any more or less than a private insurer.
Believe it or not, just about all private health insurers will do their absolute best look out for the well-being of their members. This isn't for altruistic reasons, but is done for a very simple reason - keeping people healthy saves them money in the long term. The natural result when maintenance medications aren't taken and preventative visits aren't completed isn't normally "simply" death - it's doctor's visits, ER visits, hospitalization, and expensive procedures. The private health insurers know this, and there programs are tailored accordingly.
Government health care would be ruled by the same logic, but do you really trust the government to do this better than a private company? Our bloated government, weighed down by politics and red-tape, and isn't nearly as responsive as a private company.
Reimbursement on brand name drugs is sometimes available! I found this out on my own. No, the Drs forget to tell you. Being forced into early retirement due to a health problem, I knew the cost of drugs was going to kill me, so I went to the computer. Low and behold I have found that many brand name drug companies offer some very decent rebates. I always fill my drugs at the 90 day supply and I just received 2 checks last week, one for 145.00 and the other 80.00. So it's worth your time!
Thanks Elaine
anon 9:44, what world do you live on? When my husband was dying of cancer we played games with the insurance company "customer service" reps who jerked us around and around. pre-approve, then say a different pre-approve then say was this checked in the past, etc,etc.
There is zero reason for insurance companies to be efficient. They and the healthcare companies work out the deals. That is why if you see them paying $200 for a test that you would be charged $2000 for you, it is bogus. They print huge markups just to make the deal look sweet and screw the uninsured.
Preventative care was not even on their radar screen before the ACA. Why do you think so many specialists popped up and primary care doc's went away. Our Dr. told us the system is rigged to go for the big operations and specialists since there is no money going between the guys for inexpensive preventative care. The hospitals don't want that and the insurance boys play along.
You accuse someone else of drinking Kool-Aid. Step away form the Hannity!
4:54 you are 100% correct as long as insurance is for profit you can forget about fair treatment. Govenment might be better if we could get our elected officials to also do what is right. Our country is run by the rich, for the rich corporations.
Bless you anon 4:54 for telling it like it is in the "real world"!
Anon 4:54...I live in a world where everything is not so simple as it apparently is in yours. In my world, not every private company is evil and heartless - every company is composed of PEOPLE who decide how their company is run. Yes, there's lousy companies out there, but there's more than a few out there that do the right thing for all the right reasons.
I haven't even addressed the above in my posts, however, since I know it's far too easy to blow off this argument in today's populist environment. So I've instead pointed out the fact that insurance companies save money by providing good preventative care to members. This still isn't good enough for you and others - since in your minds the evil insurance companies just want to kill everyone so they don't have to pay bills.
Your third paragraph makes no sense. The ACA has had no effect on preventative medicine, and you actually cite the proof yourself. If the ACA was making preventative medicine more popular, the exact primary care physicians you mention as currently being forced out would have a booming business, as they are the ones who handle those type of things. The ACA is just bad legislation. The political process of horse-trading that was needed to pass it took a liberal piece of legislation that made some sense if you agreed with the philosophy behind it, and replaced it with a hashed together patchwork of changes designed to get votes that make NO sense to ANYONE with any knowledge as a cohesive proposal. Even its designers and informed supporters will very quickly admit that when asked.
Obviously, you feel you had a bad experience with an insurance company, and you have my sympathy for your loss. I'm obviously not going to change your mind on the subject. However, I'd simply ask you to consider who has the "extreme" opinion here - is it me or you?
I am a 12 yr NORCO employee. I have Barrett's Esophagus, which is a condition brought on by years of acid reflux. My doctor advised by acid reflux is genetic, as BOTH of my parents have it. I don't eat unhealthy, I don't drink very often at all, I don't eat spicy foods, etc. I work out 5-7 days/week and have NEVER been obese in my life. I participate in NORCO health and wellness Pilates, C25K, Yoga, yearly health screenings, etc. You name it, I do it.
Back to the Barretts. I was diagnosed early 2014. My father had Barretts, which was undiagnosed until it was already cancer and had his esophagus removed in 2003. Mine is in the beginning stages. I am on Dexilant (for the rest of my life), to keep me from having my condition turn to Esophageal cancer. I am not a Swine, a GOAT or gluttonous. I am NOT obese. I do NOT LIVE a lazy, unhealthy life. My medicine keeps me from getting sick and is no longer covered. NO ONE IS "GIVING AN ALCOHOLIC BOOZE"... SO MANY OF THE COMMENTS HERE ARE PURE IGNORANCE AND THERE IS A SPECIAL PLACE IN HELL FOR YOU PEOPLE.
anon 10:33, you Mr. Hannity, you.
Anon 10:33
The ACA will hopefully swing the pendulum back to primary care. For over two decades prior to ACA, the healthcare industry comprised of large hospitals and health insurance companies made enormous expensive surgeries.
You make such a simple case that if life were so sweet and 1800's simple, would in fact be right. In todays modern world it is wrong. In your analysis, Banks would never do things that would lose money but short term profit and huge executive salaries have erased that motive.
Unfortunately you are seeped in Fox Americana folklore and unaware of the modern system of capitalism that bears little resemblance to the simple blacksmith system your handlers use as examples. Todays "capitalism" bears little resemblance to mom and pop bakeries. Just a big game involving government and big players moving money around making big dollars and kicking the can of the destruction they are creating down the road. Much like the run up to the collapse of 2008. If you make millions in income today, why worry about tomorrow. It is not your family that will suffer. Sadly, you folks have lost the ability to think beyond the simple icing on the cake and see what is in the batter of the modern cake.
It is easy to see you are too far gone to have a rational discussion with.
Anon 4:56...it's truly scary that you feel I'm "too far gone" to have a rational discussion with. I'm the one who all along has been saying that there's good companies and bad companies, while others slam every company ever created as "evil". My "simple" case logically points out the fact that it is in the best interest of insurance companies ethically and financially to work in the best interest of their members the vast majority of the time, but that's not good enough. In your mind, I'm the extremist who must be under the influence of (insert one...Fox News, Tea Party, Hannity), and your extreme view is perfectly appropriate and "mainstream".
I'll ignore all that for now and just ask one simple question about your last statement. The ACA that you apparently love was passed five years ago, and has been fully in place for at least two years. At what point do we stop talking about what it "hopefully will do" and look at what it has done? There's a long discussion there that's beyond the scope of this blog (a couple positives, a lot of negatives, IMO), but it certainly hasn't had the effect on primary care that you are looking for, and it never will.
"but it certainly hasn't had the effect on primary care that you are looking for, and it never will."
You really are dense. A law that as you stated just took effect isn't going to change everything immediately. The ACA is actually very tame. A Republican plan from the Heritage Foundation proposed back in the early 90's.At least it is a start to fixing a dysfunctional system .
The only solution to healthcare costs is "cost control". That is something the "marketplace" should take care of, it has not. In all the years of "free market" medicine, costs continued to rise year after year at double digit inflation. Your argument is continue with more of the same.
Healthcare does not conform to the "norms" of the marketplace. It is something that is far too important to everyone to let in the hands of the healthcare bookies or "Insurance companies" to manage. One great way to control costs is to eliminate the middlemen the health Insurance companies. If it was their job to "control costs" because of their "business models", thy have done a poor job for the past thirty years. Since they are the only game in town they have never cared and continued to rig the system and suck up huge salaries. You are big into the theory of why it should work but come up short on the reality of it not having worked.
You Sir are the extremist with the soft voice but no substance. You are fooling no one.
anon 5:26, Amen!
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