Healthcare question
08-16-2016 | 08:06 AM
#1
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From: Captain, SS Orca
Healthcare question
One of my kids has a prescription that they take every day. Been on it for a couple of years. It has been covered by United and costs $20 a month. Went to get it filled last month and pharmacist says United is no longer covering this medicine. New cost - $850.00. So this prescription just went from $240 per year to over $10,000!
United basically says they believe that another medication is better. Thing is, our doctor had previously tried that medicine with very poor results, bad side effects, etc. We have written an appeal to UHC. They responded telling us to go pound sand. Basically, that they know what's better for my kid than her doctor and parents.
Anybody have any experience with this? Are there any avenues of relief I can explore with either the company or DALPA?
Thanks
United basically says they believe that another medication is better. Thing is, our doctor had previously tried that medicine with very poor results, bad side effects, etc. We have written an appeal to UHC. They responded telling us to go pound sand. Basically, that they know what's better for my kid than her doctor and parents.
Anybody have any experience with this? Are there any avenues of relief I can explore with either the company or DALPA?
Thanks
08-16-2016 | 08:18 AM
#2
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From: I'm here, i'm there, i'm everywhere...
Yes, that's been happening with several other medications. You see, Delta chooses which prescription drugs they want to cover and which they don't want to cover if you choose one of the non-contractual health plans. You can always try an appeal but you're likely to be told to go pound more sand.
This is why i'm always surprised that your PWA has so little in it when it comes to health insurance plans. Most ramp agents at other airlines have more protections when it comes to their health insurance than Delta pilots.
This is why i'm always surprised that your PWA has so little in it when it comes to health insurance plans. Most ramp agents at other airlines have more protections when it comes to their health insurance than Delta pilots.
08-16-2016 | 08:48 AM
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One of my kids has a prescription that they take every day. Been on it for a couple of years. It has been covered by United and costs $20 a month. Went to get it filled last month and pharmacist says United is no longer covering this medicine. New cost - $850.00. So this prescription just went from $240 per year to over $10,000!
United basically says they believe that another medication is better. Thing is, our doctor had previously tried that medicine with very poor results, bad side effects, etc. We have written an appeal to UHC. They responded telling us to go pound sand. Basically, that they know what's better for my kid than her doctor and parents.
Anybody have any experience with this? Are there any avenues of relief I can explore with either the company or DALPA?
Thanks
United basically says they believe that another medication is better. Thing is, our doctor had previously tried that medicine with very poor results, bad side effects, etc. We have written an appeal to UHC. They responded telling us to go pound sand. Basically, that they know what's better for my kid than her doctor and parents.
Anybody have any experience with this? Are there any avenues of relief I can explore with either the company or DALPA?
Thanks
08-17-2016 | 05:57 AM
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One thing to consider, just in case things don't go your way. What does YOUR research on the alternate medication tell you? What about other doctors, what do they say? How many patients have had adverse reactions, in numbers? Two, or twenty? Some doctors are well rewarded by pushing expensive medications, and it can influence their opinions. Would he pay 10K per year from his pocket for this prescription?
08-18-2016 | 05:04 AM
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From: Captain, SS Orca
One thing to consider, just in case things don't go your way. What does YOUR research on the alternate medication tell you? What about other doctors, what do they say? How many patients have had adverse reactions, in numbers? Two, or twenty? Some doctors are well rewarded by pushing expensive medications, and it can influence their opinions. Would he pay 10K per year from his pocket for this prescription?
Maybe I didn't explain it well, but the alternate med, the one UHC wants us to use, is the one our pediatrician originally prescribed. We tried it, with poor results. The way I understand it, is if you are in this situation, you must try the med that UHC recommends for a certain amount of time, if it doesn't work, then you can appeal your case. We have already tried the one they want and I won't put my daughter through that again. We explained this to UHC in our appeal. They don't care.
08-18-2016 | 05:06 AM
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From: Captain, SS Orca
08-18-2016 | 05:13 AM
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Maybe I didn't explain it well, but the alternate med, the one UHC wants us to use, is the one our pediatrician originally prescribed. We tried it, with poor results. The way I understand it, is if you are in this situation, you must try the med that UHC recommends for a certain amount of time, if it doesn't work, then you can appeal your case. We have already tried the one they want and I won't put my daughter through that again. We explained this to UHC in our appeal. They don't care.
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