HMO's just don't care anymore..... About This Page:

[mcc0313]

My girls have insurance through Child Health Plus....I pay a small amount of money towards their insurance every month...I never had any problems all these years, I found that all their doctors were covered, their medication and even the dental was not bad...

This past year they have cut so much that it makes you want to give up eating in order to just put your kids on decent medical coverage...

First they cut out all the good dentists...so it took me like five visits just to find one that (a) spoke english that I could understand and (b) actually had a clean office....

Then yesterday I go to pick up DD's medication (they both have asthma and have been on daily meds for years...)

Pharmacist tells me the insurance won't cover it...they want a pre-authorization from the doctor and then they will review and get back to me...

So I stand there and look at the pharmasist intern who I really do not like becuase he always has this I don't really care this is just a way to make money attitude and aske for the senior pharmasist that I know...

Seems that the insurance does nto want to pay for the expensive meds so they want to put her on soemthing else that might now work but they are willing to give it a try...

Before this medication DD was in 24 hr oxygen tents and IV drips for a week at a time everytime she got hit with an attack...

Since this new mixture of drugs (they are both on different combinations- trial and error until they find the right mix) they have not had to be admitted to the hosptial in (knock on wood) over 2 years...

And now the insurance company "whose logo is committment to your children's health" wants to take her off this medication and play Russian Roulette with her health...

But I still am down to one pill...doctor says he will do his best to get her authorization to keep her on her meds as they are...he has samples (5 mil over 4) but he said she was ready to go up in dose anyway...he will give me those to last me...

I asked the pharmasist about how much a 10 day perscription would be just so that I can have her pills until this whole insurance thing goes through...about $57.00...

I think medical benefits should be for every child I really do... I know you need to think about profit and all that stuff but I can not see how money should even be an obstacle when our government can spend millions of dollars fixing every other person's country and there are kids here in this country who cannot get decent medical attention...

[jimmymac]

I totally agree. Health care in this country is a national disgrace. I wish it was higher on the national priority list or that any of the presidential candidates would pay more than lip service to it

[snoozin]

Wow, Megan; that stinks! I would contact the insurance company directly and go toe to toe with them now. And make sure you take names and times you called, so there's no question down the line when you (hopefully don't!) have to do this again.

[Disney_Scarlett]

Originally Posted by jimmymac

I totally agree. Health care in this country is a national disgrace. I wish it was higher on the national priority list or that any of the presidential candidates would pay more than lip service to it

and

[Colexis Mom]

[tndisneyfam]

Our doctor's group doesn't even take our form of Blue Cross Ins. anymore. But our hospital does. So it's cheaper to take the kids to the ER. But I wouldn't do that unless it's an emergency. I agree the whole system is disgraceful!

[BelmontBelle]

[lexiemom]

This subject was just on Oprah yesterday. I believe that EVERYONE...baby, child, adult has a right to the best health care they can get. I am sorry that this is something you need to worry about. that everything gets worked out and that your girls get the meds they need.

[DisneyFanAnn]

Originally Posted by jimmymac

I totally agree. Health care in this country is a national disgrace. I wish it was higher on the national priority list or that any of the presidential candidates would pay more than lip service to it

[graygables]

After our HMO went to over $1,000/month for our family, we had to drop it and go with a less expensive plan. Less expensive, however, means crappy coverage, no vision, no dental. We have a $5600 PER PERSON deductible and they do not cover routine exams or prescriptions AT ALL. And we only have to pay $300/mo for the privilege.

My now 19yo and I both had CT scans of our heads. She has military coverage and our OOP was $26. I did not have coverage and mine was $1800. The people who can least afford it pay the most. Unbelievable.

[mcc0313]

Just spoke to the doctor today...he told me to come in tomorrow and we can talk about what he can do...until then the pharmacy was gracious enough to give me a 5 day supply for $30...guess that is a discount of .70 a pill...lol

It just really eats at me and I know this is going to happen again when I have to refill her other perscriptions...

I checked my medical (I have one through my job that is not bad once I add the kids on) and even through them the co-pay will be $50 for just the pills but it is better then $174 a bottle...

One of the other meds she is on they have a different form that is hceaper and that they will cover (she was on it before) but I hate the side affects but I guess at least they will pay for that...(It works but it just gets her so hyper and her heart rate goes so fast) but it is the same stuff that they give her at the hospital...(It is nice to know that they use the cheaper forms there too...lol)

What I don't understand is that when she goes into the hospital I can only imagine what the bill must look like but the insurance would rather pay that then the $174 a month for a drug that is keeping her out of the hospital...

I just don't get it...but at least she will have her five day supply until the doctor can try to work something out with the plan...(he said there is a way to try and fight it)...

Thanks for the pixies....

[magic mickey]

I can really feel your pain. Ever since my DH had a stroke, my kids have been on state health insurance. I have horror stories about some of the places that we were forced to visit. One time my DS had a horrible toothache and I had to bring him to some dirty looking place in the city where you had to line up early in the morning and if you were lucky enough to make it onto the waiting list you got to see a dentist. We waited 3 hours and only because the tooth hurt so bad. We finally just got up and left and I called their old dentist and he took him right in and only charged me a small fee. My kids lost their insurance once for a whole year because I made $20 more than my normal pay and they said I was making to much money. It took me that long to fight through 3 hearings and get it reinstated.

It really is time that this country does something about the sorry state of health insurance.

All I can say is keep fighting for your childs right to the best medicine for them. Good luck!

[RobinKay6573]

I hope things work out for you. I went without health insurance for 7 years. Yes 7 years. All 7 of those years I worked at horse breeding farms (very dangerous work). When a foal knocked me into a hay manger and dislocated my shoulder I had to pop it back in myself. OMG talk about pain. I did go to the free clinic and they said there wasn't much they could do and sent me to the ER. I couldn't afford that so I just lived with it. It healed (thankfully).

There is NO REASON people in the United States should be living without health coverage.

for you and your family.

[Jookiba]

I share your pain. It enrages me to know that while we are the richest country there are millions of us (and the three of us in my household) that have no medical coverage.

My son is an asthmatic and every day is constant prayer that he doesn't have an asthma attack.

I have had to stop all medications except the pain ones I take for my hip-and even then I had to switch to something that doesn't work as well because cash price (each month) for the one Rx alone was $225. I'm supposed to be on hormones but my premarin each month costs $95 so until I either get the job I've interviewed for or find another one with good benefits I'm resorted to living in a state of a constant hot flash.

I can't stand insurance companies that dictate what, when, and how much medication we are to take. The majority of employees of said insurance companies aren't even medical professionals making LIFE-ALTERING decisions!!

We need someone in the oval office that will FIX this problem but sadly I think it'll only get worse until eventually the whole country can't afford medical insurance and then hospitals will be overflowed to the T. <sigh>

Depressing statistics.

[revral]

Not only is the state of our health insurance a national disgrace and the cost of drugs outrageously ridiculous but what absolutely kills me is that the insurance companies are being allowed to practice medicine.