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Danged Medicare B.S. nonsense.

Old_Me

Old_Me

Ronin
just 1 day ago, i got a refill of my meds, via the mail order service thru my health care insurance.

ok, today, i get a bill for that medication

like WTH...?? it was always covered by my insurance as 0 co-pay

so i called my health insurance, yes, someone answered on a saturday

i also called the mail order pharmacy, yes, someone answered the phone on a saturday there as well

it wasn't my health insurance, but Medicare, that moved my meds to a Tier 3, meaning it has a higher co-pay, which now, i have to pay.

what a bunch of BS.

so now on Monday, i have to call this "advocate" with-in the insurance company, to see if i qualify for them to cover either some, or all of the co-pay.

oh if i decide to go to a local pharmacy?

that med will be $25.00 higher than the mail order pricing..

this is why we are given choices of where to get our meds,. i get some via the local pharmacy, all (still) no co-pays

and some via mail order.

sheesh...retirement ain't no fun.


for those of you on SS, i hope you don't get a "surprise" letter telling you that one of your meds has changed Tiers.
 
I feel for you. My meds are covered by Tricare for Life and i get them at the local Air Force Base. Every time i go there it's a problem with something but i can't complain about the price. I'm a diabetic and require insulin. If i had to pay for that i would be in the poor house. Hopefully they can figure something out for you
 
Just another reason I don't have insurance! The only bad thing on not having insurance is some medical places will not let you have appointments with them. I guess so they can stick it to the companies and make more money! That's bs also. I laugh at "affordable healthcare"! For who? It's horrible for the honest people that companies change policy and you get informed the hard way and they don't care!
 
Been through the red tape with insurance companies many, many times. My Wife's last extensive stay in the ICU. The insurance company wanted almost $400,000 dollars. I blew a gasket. Even got the threatening calls from a collection agency. Round and round many calls and letters later come to find out THEY made a coding error. No apologies no nothing.
 
my meds are with VA or tricare express scripts ( gagle fluck)
my wife has all of hers with tricare for life express scripts our co pay for hers climbed this year, but still waaaaayyyy less than out in town. only bad thing is tempe az sits on them for days then DHL flucks around for a week then post office finally delivers, these are drugs that are tracked by sig at every stop.. every 3 months we go through the same old WE dont have them ...tracker then boom they arrive .. once they went to niagra falls from tempe then back to texas...WHY
who is congress is getting kick backs fro DHL?? they suckkkkkk
i switched to VA 100% a few years back to save lots O dollars for my stuff. or i would selling plasma to cover the copays

one silver lining is my wife(100% disabled with SSI, brain disease) has medicare primary and tricare for life as secondary. so if she goes in hospital or any in patient care..its zero co pay..tricare; by law has to pay everything medicare does not..thank goodness
 
wolfpack076 said:
Been through the red tape with insurance companies many, many times. My Wife's last extensive stay in the ICU. The insurance company wanted almost $400,000 dollars. I blew a gasket. Even got the threatening calls from a collection agency. Round and round many calls and letters later come to find out THEY made a coding error. No apologies no nothing.
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and that's what's got me bugged too...no mention whatsoever from anyone that the med changed Tiers, just the "hello you owe us money letter" today...

and that reason for the letter?

the credit card info they needed? well that old credit card was part of a fraud alert, and i got a new one, but never updated that information. otherwise, the real surprise, would have been to see a charge on that card, next month.

in order to have the mail order pharmacy, you need to have a credit card, so that yes, they can charge us for the meds, when our insurance doesn't pay.
 
nmedge said:
I feel for you. My meds are covered by Tricare for Life and i get them at the local Air Force Base. Every time i go there it's a problem with something but i can't complain about the price. I'm a diabetic and require insulin. If i had to pay for that i would be in the poor house. Hopefully they can figure something out for you
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powerboatr said:
my meds are with VA or tricare express scripts ( gagle fluck)
my wife has all of hers with tricare for life express scripts our co pay for hers climbed this year, but still waaaaayyyy less than out in town. only bad thing is tempe az sits on them for days then DHL flucks around for a week then post office finally delivers, these are drugs that are tracked by sig at every stop.. every 3 months we go through the same old WE dont have them ...tracker then boom they arrive .. once they went to niagra falls from tempe then back to texas...WHY
who is congress is getting kick backs fro DHL?? they suckkkkkk
i switched to VA 100% a few years back to save lots O dollars for my stuff. or i would selling plasma to cover the copays

one silver lining is my wife(100% disabled with SSI, brain disease) has medicare primary and tricare for life as secondary. so if she goes in hospital or any in patient care..its zero co pay..tricare; by law has to pay everything medicare does not..thank goodness
Click to expand...
to say you vets are lucky, can be a double edge sword at times. you did your service, you should get 100% free everything medical, i always said that, maybe not here, but to all the vets i came to know here where i live, and met up with at the barbershop, bait shop, gun stores, etc.

yes, DHL also covers my mail order meds.

funny too, i worked for a contractor, pulling the DHL trailer. then they "left" the states, only to return and supposedly were only supposed to deliver from airport to customer, then back to airport, in other words international freight only, no door to door deliveries.

i guess there were some changes made in the past few years regarding that.
 
nmedge said:
I feel for you. My meds are covered by Tricare for Life and i get them at the local Air Force Base. Every time i go there it's a problem with something but i can't complain about the price. I'm a diabetic and require insulin. If i had to pay for that i would be in the poor house. Hopefully they can figure something out for you
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well the "advocate" is part of the BC/BS family. they help (from what i was told today), people of lower income such as us on SS, to pay the co-pays. now whether that is a percentage, or all the co-pay, i will not know until i call Monday, which is terrific in of itself, as i have the "gas company" coming over ...."sometime" that day, and they already blew an appointment, 2 months ago...!!!!!

TEXASforLIFE said:
Just another reason I don't have insurance! The only bad thing on not having insurance is some medical places will not let you have appointments with them. I guess so they can stick it to the companies and make more money! That's bs also. I laugh at "affordable healthcare"! For who? It's horrible for the honest people that companies change policy and you get informed the hard way and they don't care!
Click to expand...
if you are young, you may not need health insurance, but as you said, many doctors do not accept you as well. hospitals cannot refuse you for anything, if it is an emergency

healthcareinsider.com

What Will Happen if I Go to the Hospital Without Insurance?

If you end up at the hospital without health insurance, doctors are required to treat you no matter what until you've been confirmed as stable.
healthcareinsider.com healthcareinsider.com
 
i left out an all important thought
those of us that worked 50 plus years , paid medicare TAX and or served or both..we should not get gouged for higher co pays. meds are actually cheap.
before congress raided the ss and medicare funds , we ...would be fine,
i write my congress critter often and they should be on same plans as medicare and same premiums for co pays or supplements....not the cushy crap they get now. why are they allowed to use walter reed ?? if they are not veterans, suck it up and go out in town.

i feel very lucky or fortunate that our copays are under control for now, but next year congress could screw us again
i would rather have my wife healthy and no drugs if i could change it. traumatic brain injuries are just no joke.
soap box down
sorry
 
nmedge said:
I feel for you. My meds are covered by Tricare for Life and i get them at the local Air Force Base. Every time i go there it's a problem with something but i can't complain about the price. I'm a diabetic and require insulin. If i had to pay for that i would be in the poor house. Hopefully they can figure something out for you
Click to expand...
My dad has TriCare and I am jealous of his insurance...I am on private health insurance. I pay $1500/month for insulin and supplies for me. There is no way anyone earning less than $100k/year could afford to be a diabetic on private health insurance these days...
 
I get my insulin, Novolin 70/30, from Walmart. It costs $25 a vial, and Anthem won't cover a penny. Yet when I was taking Humalog my co-pay was about $150 a month and Anthem was paying over $500. The problem now is the meds I take to treat diabetes and heart issues will put me in the donut hole which is a gap in coverage for prescription drugs in Medicare Part D. So once that happens I go from paying $47 a month for farxiga to paying about $140, and I'll be in the donut hole by June or July. When that happens my co-pays with sky rocket. Such is life.
 
I'm ok with my copays until I hit the donut hole, then several of my meds get pretty high, in the $300-400 range. I just did our taxes and our medical amount was pretty high considering we have insurance. It didn't help we both had several big dental visits, one colonoscopy, and two eyeglasses and exam. Not enough to itemize on Federal, but Arizona is helpful with medical expenses. Now if we could get government from subsidizing students, ev's, green energy Ukraine and China, taxation might not be so onerous.
 
and to all of you others that most certainly are paying more than what i got hit with, every 90 days now, i know that my costs are lower than yours, but still as retired, or disabled, or Vets, we earned our SS, and pensions, LEAVE US THE "F" ALONE.

i can actually "see" why many retired people HAVE TO go back to work.........and that's just downright WRONG.....

we earned our retirements..!!

also, i am not saying "sock it to" the working stiffs, to charge them more than us.

there are millions of people working in single family homes with at least 1 child, that maybe don't even qualify for medical insurance thru thier employer, they should suffer too.??

i think not.

all those pharmaceutical companies get federal subsidies, grants, and other monies to develop, test and mass produce the drugs, not to mention they are all on the stock exchange earning MORE money.

and the alphabet soup board members (CEO, CFO, etc,etc) get HUGE salaries, Leer Jets, homes in 27 other countries, and Swiss bank accounts.....

i don't have the answer, to all of this, i highly doubt anyone actually does, but for Medicare to "play around" with the forulatory Tiers should be forbidden, as not everyone is an Elon Musk, Warren Buffett, Bill Gates, nor the most recent Mega Millions winner.
 
Wirenut said:
So far, I have been lucky since medicare considers it a lifesaving drug and right now my secondary picks up the rest after deductible.
But that didn't stop big pharm from raising it $3000.
My monthly cost for this one drug is $30283, this is definitely price gouging.
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Ho-Lee-Christ....!!!!!!

is it any wonder some people just skip some meds?

maybe even cut down on the dosage?

and that's EXACTLY what i will be doing starting today,,,i am supposed to take 2 pills, twice a day...

i will now take only 2 pills for the day......

i will be seeing that doctor sometime in March, however, there is no substitute for the meds i am on, as they are already generic, and the name brand..??

isn't even on the formlatory list..>!!!!!
 
youngolddude said:
I'm ok with my copays until I hit the donut hole, then several of my meds get pretty high, in the $300-400 range. I just did our taxes and our medical amount was pretty high considering we have insurance. It didn't help we both had several big dental visits, one colonoscopy, and two eyeglasses and exam. Not enough to itemize on Federal, but Arizona is helpful with medical expenses. Now if we could get government from subsidizing students, ev's, green energy Ukraine and China, taxation might not be so onerous.
Click to expand...
i did to
i had over 5200 in medical last year, but not enough to beat the standard deduction. i about crapped when added up the MY out of pocket medical..
 
i just checked the co-pays on all my other meds, (9 in total each day i take), and thankfully it is only the one that Medicare messed with.

thankfully, the Mrs is safe from the tyranny of price changes from Medicare........for now at least......

anyone know if this is a yearly thing that Medicare moves Tiers/co-pays on meds, like on the first of the new year, or do they do it more than once per year....??????

i haven't had this issue ever before..
 
Last year I took out some retirement funds to pay for new furnace, air co, fireplace, chimney and roof work also had some outstanding co-pays for out of network specialists.
Medicare took notice to the “increase” in my annual income. They doubled my premium, now paying B & D costs, at least for a year. Essentially I’m now paying Medicare/Aid for someone else that never contributed a dime to SS.

Does the sandbagged taxpayer need to consider using the old “in 13 days I’ll be in this country a whole two weeks“ excuse to get free medical care?
 
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