- Location
- Here
...They either didn't actually fulfill her medical prescription or KEPT the rest of her medications.
We've got one days worth, I'm going to be busy.
We've got one days worth, I'm going to be busy.
Pocket System
- Thread starter theaceoffire
- Start date
- Crossover Fantasy
And then they find out about the literal insurance thugs who enforce shadow blacklists and completely own and operate the medical board with the power to revoke their license to practice medicine if they are found undercharging.
And those are the good ones. ... Said good ones have actually confided that there is literally courses, not just a class here and there in the course, but literal courses on how to arrange, file, fill, and gouge as many patients in a given time period for maximum charge(ing) AND which pharmaceuticals pay the most for randomly prescribing their medicines. And that those courses have become mandatory for gaining their licenses.
Wtf u serius 5grand fir fucking hospital visit?
What hapend to obama care if it did help any thing? Allso why da fuck do US state allow it if its cause more people to go brocke and lose there jobs thus losing taxrevenu?
Allso ofice arent they leagaly/contractualy obligated to keep the payments coming till stated exerationdate? And should look in to geting a nev enshurence company
What hapend to obama care if it did help any thing? Allso why da fuck do US state allow it if its cause more people to go brocke and lose there jobs thus losing taxrevenu?
Allso ofice arent they leagaly/contractualy obligated to keep the payments coming till stated exerationdate? And should look in to geting a nev enshurence company
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Err... The $5,000 USD is the co-pay after the insurance paid the rest. Depending on the percentage, meaning that the visit was likely something closer to $35,000. Likely more than. The average ER outpatient visit typically starts at $15,000; and only goes up from there depending on what procedure/resources were used during the visit. In patient typically starts closer to $25,000... how close to that minimum value typically depends on Region, State, and/or County one lives in, and the hospital is placed within the boundaries thereof.
{Edit}'Murica! We've made an industry out of charging the patient for their own health care. {sarcasm}Yet, for some reason other countries keep calling us heathen capitalist pigs... {/sarcasm}
{Edit2}Err... if this post is to close to being political just let me know, and I'll delete it.
{Edit}'Murica! We've made an industry out of charging the patient for their own health care. {sarcasm}Yet, for some reason other countries keep calling us heathen capitalist pigs... {/sarcasm}
{Edit2}Err... if this post is to close to being political just let me know, and I'll delete it.
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Jesus 5grand is like 3 months pay if i dont spend on anything wtf?
I need to go in to ear specalist after a copel of months to get it cleard from waxe to hear any thing i only pay like 50 dollars for that wtf amerika?
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Medical prescription confusion
- Location
- Here
So now we have three different groups of medications to keep track of: Mine part a, mine part b, and my wife's part c.
My insurance requires all refills for ongoing medications to be redeemed from CVS for 90 day periods.
Due to confusion, my medications have got off cycle.
This means that my refill times for 90 day periods is offset... Meds a b and c all get refilled on different dates. None of them can be refilled earlier, and skipping them until they line up is not acceptable as they are required medications.
I don't think it's ever actually possible to ever pick up all my meds on the same day ever again. I've talked to CVS and my doctor, but there's a robot involved in the middle when they try to talk to my insurance... All the humans are fairly understanding and willing to help me, but none of their systems will allow it to occur because they think that I might be trying to steal extra medication or something.
Not even the fun meds, just the stuff you need to live.
Believe me or not, this is actually a step up in my quality of life! Hopefully things will settle down and I can actually get all this stuff edited and put back online at a more reasonable update schedule.
My insurance requires all refills for ongoing medications to be redeemed from CVS for 90 day periods.
Due to confusion, my medications have got off cycle.
This means that my refill times for 90 day periods is offset... Meds a b and c all get refilled on different dates. None of them can be refilled earlier, and skipping them until they line up is not acceptable as they are required medications.
I don't think it's ever actually possible to ever pick up all my meds on the same day ever again. I've talked to CVS and my doctor, but there's a robot involved in the middle when they try to talk to my insurance... All the humans are fairly understanding and willing to help me, but none of their systems will allow it to occur because they think that I might be trying to steal extra medication or something.
Not even the fun meds, just the stuff you need to live.
Believe me or not, this is actually a step up in my quality of life! Hopefully things will settle down and I can actually get all this stuff edited and put back online at a more reasonable update schedule.
- Location
- United States
With CVS being a corporate chain this probably can't work, but it's worth tossing out.
When filling a 90 day prescription, CVS could be 'short' the amount you need and so can only fill part of it. As part of their record keeping they have to report the exact number they gave you and when you will run out of the medication.
When that shorted amount ends the insurance would have to approve the new 90 day refill at that time so everything would be lined up.
When filling a 90 day prescription, CVS could be 'short' the amount you need and so can only fill part of it. As part of their record keeping they have to report the exact number they gave you and when you will run out of the medication.
When that shorted amount ends the insurance would have to approve the new 90 day refill at that time so everything would be lined up.
- Location
- England
I've had similar things happen, if not so drastic. Over here in NHS land you ask for a new set of pills once a month and there is a fair degree of lassitude about exactly when you ask for them and can pick them up. So you can get your pills ever 25 days or something instead of 28 and slowly pick up extra until you have enough to get them all on the same date. Also, some pills come with 30 days worth of doses, some with 28. So eventually you're an entire month ahead in some pills and just get to skip them once.
- Location
- Canada
I'm in Canada, not the States, but - speaking as a pharmacy technician - this is actually normal. It's incredibly hard to get all your pills at the same time and keep it that way given strengths change, drugs change, etc. I mean the pharmacy can do it, but often the drug plans don't like it because then they are having to pay a dispensing fee more frequently. Depending on the cost of your meds and just how far off things are, you might be able to pay cash to get just enough of whichever ones are necessary to get them lined up again, but really just learning to live with them not being refilled at the same time is probably the easier course since it is actually pretty normal.
- Location
- United States
In the US you have a few days wiggle room on when to pick them up, but the dose schedule is fixed. If the prescription is for 90 days you can pick it up on day 85 of the previous one, but the computer tracking everything still knows when that refill was actually needed and in turn when the next one is needed.
So if the meds were out of sync by just a few days that would work but if it's at least 2 weeks apart then it will still require seperate trips.
Had a separate thought if there is no way to fiddle with the dates and may depend on if you are required to use CVS or not.
After covid most pharmacies will deliver med refills. From a quick google search CVS charges a delivery fee but I know Walgreens is free and I think most Walmarts are free as well. That way even if they are separate days you at least aren't forced to make separate trips.
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Yep, they are fighting us on this.
- Location
- Here
Insurance is arguing that her inability to walk and Hypertension and everything else that kept her hospitalized doesn't matter, because she was admitted due to fears of her eye having rental scarring/detachment. That since the eye was less critical than feared, the rest of the issues don't matter and they shouldn't have to pay for anything.
Hopefully things can work out.
Hopefully things can work out.
- Location
- Mt. Holly, North Carolina
I wish I knew a way to help, but US health insurance is a loop of "deny everything that costs money, until the courts get involved". Hell, depending on local limits you can have it before a judge in small claims rather than spending money on a lawyer.
Also, those incredibly crazy prices only exist because of insurance. Look it up sometime. It's quite disturbing.
Stephenopolos
Going through stargate withdrawl
- Location
- illinois
A few things, depending on how your particular billing dept. coded things, if the insurance requires authorization for inpatient stays, and who your wife's insurance is:
They're likely running into a few issues here, if authorization is involved, when they requested authorization for an inpatient admission they specified it was for the eye diagnosis and did not include anything relating to other conditions.
When they coded for the inpatient stay they indicated on their coding that your wife's *other* conditions were not present on admission CMS federal government guidelines indicate that things that qualify as hospital-acquired conditions are not covered by Medicare when the facility indicates that the condition was not present at the time of admission.
Insurance companies will milk that last little bit for all it's worth, and a patient appeal can only go so far; one of the doctors who signed off on keeping your mum hospitalized will likely have to spend some time doing their appeal process. Indicate to the hospital at every opportunity that you want them to fight the decisions because they are overworked on that front and will happily choose to not fight a denial of care if the patient lets them get away with that.
Finally, when it's time for a bill, ask for an itemization. this sometimes shaves a lot of fluff magically off the bill.
and if you can swing it, some insurance companies now have a "patient advocate" team someone they pay to be on your side with lining up all the ducks in a row and getting paperwork explained and filled out on time and before deadlines. if your wife's insurance has one of these teams ask for them to assign one of them to her case, they're literally being paid to help you game their system as far as they're allowed to go.
oh and one more federal guideline, they're required by law to let you file a fast appeal (same day) for continued treatment as soon as you're notified that coverage of care is no longer considered reasonable or medically necessary when that denial would end on the same day.
They're likely running into a few issues here, if authorization is involved, when they requested authorization for an inpatient admission they specified it was for the eye diagnosis and did not include anything relating to other conditions.
When they coded for the inpatient stay they indicated on their coding that your wife's *other* conditions were not present on admission CMS federal government guidelines indicate that things that qualify as hospital-acquired conditions are not covered by Medicare when the facility indicates that the condition was not present at the time of admission.
Insurance companies will milk that last little bit for all it's worth, and a patient appeal can only go so far; one of the doctors who signed off on keeping your mum hospitalized will likely have to spend some time doing their appeal process. Indicate to the hospital at every opportunity that you want them to fight the decisions because they are overworked on that front and will happily choose to not fight a denial of care if the patient lets them get away with that.
Finally, when it's time for a bill, ask for an itemization. this sometimes shaves a lot of fluff magically off the bill.
and if you can swing it, some insurance companies now have a "patient advocate" team someone they pay to be on your side with lining up all the ducks in a row and getting paperwork explained and filled out on time and before deadlines. if your wife's insurance has one of these teams ask for them to assign one of them to her case, they're literally being paid to help you game their system as far as they're allowed to go.
oh and one more federal guideline, they're required by law to let you file a fast appeal (same day) for continued treatment as soon as you're notified that coverage of care is no longer considered reasonable or medically necessary when that denial would end on the same day.
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- Location
- Germany
No offense, but I really would not consider moving to the USA from germany, even with the grumbling of parts of the local population about the economy and migrants from africa and middle east.
Halfway decent general social security does wonders for your mental state, even if your means aren't little. Since that can still change but the social system will also help you then to not hit a probable rock bottom. And it can be seen as parts of charity when the taxes are appropriatly adjusted and considered since the rich can feel good about themself propping up social emergency cases and saving lifes
.
Halfway decent general social security does wonders for your mental state, even if your means aren't little. Since that can still change but the social system will also help you then to not hit a probable rock bottom. And it can be seen as parts of charity when the taxes are appropriatly adjusted and considered since the rich can feel good about themself propping up social emergency cases and saving lifes
.
Great news!
- Location
- Here
Things are moving along! The hospital is arguing with my insurance, ALL the home care professionals refused to help her until she can get an appointment to acquire a primary care doctor (Managed to schedule an opening in December) but hopefully will talk to us again after THAT is handled, and when she HAS a primary care doctor hopefully he/she can adjust the dosage to 90 days from CVS so my insurance doesn't jack up the price.
In general, things are looking up! Happy turkey holiday, everyone!
In general, things are looking up! Happy turkey holiday, everyone!
Glad to hear things are improving for you, Have a Happy Turkey Holiday
Merry Christmas Everyone!
- Location
- Here
Hope you all have a happy holiday!
My personal stuff should be wrapping up, or at least stabilizing soon, and I hope to have all the various medications straightened out and prescribed in such a way that my insurance will cover it without adding extra fees soon!
Story should continue in January, I've been distracted for so long that I need to double check a few things before continuing to ensure I don't follow the wrong John in the wrong direction. Next Realm should also be neat, it's a place where Faith is fueled by the young while adults blur away until blandness and eventual passing. REALLY affects how the energy interacts with reality, neat stuff!
My personal stuff should be wrapping up, or at least stabilizing soon, and I hope to have all the various medications straightened out and prescribed in such a way that my insurance will cover it without adding extra fees soon!
Story should continue in January, I've been distracted for so long that I need to double check a few things before continuing to ensure I don't follow the wrong John in the wrong direction. Next Realm should also be neat, it's a place where Faith is fueled by the young while adults blur away until blandness and eventual passing. REALLY affects how the energy interacts with reality, neat stuff!
- Location
- Here
Too unstable. I mean, YEAH it was an option that John saw, but it's marked as Flintstone levels of 'Reality is Jell-O'. That's a place where condiments and garbage can make lasers and giant warrior mechs.
Other System users may travel there in the future, but John has a phobia of going to places that are too fluid to easily exist at the moment.
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