Sadness and ire over health care problems

chic

chic

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U.S.
My mom's friend is 83 and has had some serious health issues for the past few years. She's been hospitalized and in rehab many times. This week her health insurance dropped her. Now she has no health coverage and is worried sick, no pun intended.

My mom who will be 85 in a couple of days, had a health issue and went to her doctor for it. Her doctor called a prescription into the pharmacy and mom went to pick it up but was told the prescription had not been called in. She called the doctor and was told again the prescription had been called in. She walked back to the pharmacy, again no prescription. This drill went on 5 times until one of the pharmacists told my mom her health insurance refused to pay for the prescription because it was too expensive. Mom was furious, she caught a cold from walking back and forth to the pharmacy because our weather has been so cold this spring. When she had her follow up appt at the doctors she told them the situation and they prescribed something less expensive for her, so she's doing better but she suffered unnecessarily for two weeks and caught a cold on top of it.

Has this been happening to anyone else? I'm wondering if something larger is going on in the health care industry that I am unaware of?
 

Butterfly said:
I didn't think that, under Obamacare, an insurance company could drop you if you got sick, as long as you are paying the premiums. Doesn't your mom's friend have medicare, at least?
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She must. She is 83. I don't know what kind of health insurance she has. Her husband was a successful sales representative and she retired with a lot of wealth, but has had terrible health issues since her husband died a few years ago. She lives with a married daughter now. Maybe she will be able to help her mom? IDK. It just makes me sad for her.
 

chic said:
My mom's friend is 83 and has had some serious health issues for the past few years. She's been hospitalized and in rehab many times. This week her health insurance dropped her. Now she has no health coverage and is worried sick, no pun intended.

My mom who will be 85 in a couple of days, had a health issue and went to her doctor for it. Her doctor called a prescription into the pharmacy and mom went to pick it up but was told the prescription had not been called in. She called the doctor and was told again the prescription had been called in. She walked back to the pharmacy, again no prescription. This drill went on 5 times until one of the pharmacists told my mom her health insurance refused to pay for the prescription because it was too expensive. Mom was furious, she caught a cold from walking back and forth to the pharmacy because our weather has been so cold this spring. When she had her follow up appt at the doctors she told them the situation and they prescribed something less expensive for her, so she's doing better but she suffered unnecessarily for two weeks and caught a cold on top of it.

Has this been happening to anyone else? I'm wondering if something larger is going on in the health care industry that I am unaware of?
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Oh the solution is so simple. Get the prescription from your doctor and take the actual prescription to the pharmacy. Forget about faxing or whatever.
 
Camper6 said:
Oh the solution is so simple. Get the prescription from your doctor and take the actual prescription to the pharmacy. Forget about faxing or whatever.
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The problem was that her health insurance would not cover her prescription so the pharmacy would not fill it. No one told her this.
 
The 83 year old lady may have been dropped from her Medicare supplement for some reason. The Medicare supplement plans cannot simply drop you because you're "too sick". Without the supplement plan, she would be responsible for approximately a 20% co-pay up to a certain amount. Medicare Part A is at no cost to the subscriber. Medicare Part B costs around $130/month. Most folks have that simply taken out of their Social Security so there is no worry about it getting paid. OTOH, the supplement plans are either paid from your Social Security proceeds or you are billed direct. The folks who have them billed direct... remember, we are getting old and forgetful... may forget to pay the premiums. If that happens, the supplement plan could well drop her. Hopefully, if she receives assistance from a younger family member she can get things worked out and receive the care she needs.

As far as the unfilled prescription due to cost, the pharmacy was at fault for not making contact with the patient. The pharmacy we use has called our home when a prescription is getting close to expiration, when there has been a change in benefits, etc. All the pharmacist would have had to do was make a phone call and ask the patient if she would allow them to call the doctor and see if he would okay a generic, less expensive medication.

There is nothing more confusing than Medicare... parts, plans, benefits, etc. Just as we get to the point our ability to process a medical care plan that makes about as much sense to us as listening to someone give an hour long speech in a language we've never heard before is suspect due to our age........... We use a person whose only business is working with seniors ferreting through the Medicare process. She charges us $100/year for each of us. Well worth it when we look at the coverages she has found for us and the dollars we've saved compared to other folks we know.
 
chic said:
Yes, but Medicare does not cover everything obviously.
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That depends on what Part D plan you choose. There are levels... IF you pick a cheaper one, it doesn't cover as much and most time you must get the generic version unless you want to pay more for the brand name.

I would think that someone 83 years old would have Medicare... Medicare does not drop people when they get sick.. Part A is free... Part B is deducted from your Social Security benefit every month

You must pay for your Medicare supplement on your own.. The Supplement covers the Part A deductible plus what out patient expenses Medicare part B does not cover. They also cannot drop you if you get sick.. BUT.. if you don't pay the premium... yes. you will be dropped.

Now.. one thing about Medicare paying for Rehab.. Medicare will generally only pay for 100 days unless there is a new medical need.. Perhaps that is what happened to your mom's friend. She may have used up all her Medicare days in rehab and now must pay for it herself. That doesn't mean she was dropped for Medicare.. If she develops another skilled care need, Medicare will again pay... but only up to that 100 day limit.
 
Butterfly said:
Some doctors here insist on faxing scrips directly to a pharmacy. I dunno -- maybe they are afraid people will alter prescriptions or something??
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My doctor will do either... Most times he sends the order electronically... not actually faxing... but via the internet.. and I have never had a problem of the prescription not being received by my pharmacy.
 
nvtribefan said:
Why on earth would they not fill it? She could pay for it herself.
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My pharmacy sort of does this. If the doctor sends it in, and it's not covered by insurance, they will not get it ready ahead of time. You have to call in or show up and tell them you will pay. They will try to contact you though, and they *will* fill it once you give the OK. Maybe the person they talked to at the pharmacy did not explain that very well, or was new and didn't understand. Just a thought...
 
One of my doctor's offices is most insistent on sending in the prescription themselves. I had to almost throw a hissy fit to get the prescriptions in hand. The reason I like a printed prescription is that I "shop" around for best prices. Walmart has some on the 90-days-for-$10 plan, which is cheaper than my prescription plan, others are cheaper using my prescription plan. I'm cheap/frugal/thrifty and I don't mind saving a few dollars here and there.
 
nvtribefan said:
Why on earth would they not fill it? She could pay for it herself.
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They wouldn't fill it because they ( her health insurance) said it was too expensive. It was $87.00. Mom takes 7 prescriptions but only co-pays about $20.00 for a ninety day supply for all of them. She could not really afford to pay for this medication on her own. $87.00 for one prescription would be too much for her to spend.
 
jujube said:
One of my doctor's offices is most insistent on sending in the prescription themselves. I had to almost throw a hissy fit to get the prescriptions in hand. The reason I like a printed prescription is that I "shop" around for best prices. Walmart has some on the 90-days-for-$10 plan, which is cheaper than my prescription plan, others are cheaper using my prescription plan. I'm cheap/frugal/thrifty and I don't mind saving a few dollars here and there.
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With the way prescription prices vary, you make a very good point. I have Part D and don't use many prescriptions but at someone on here's recommendation I have the GoodRX app. It does comparison shopping in your area with their discount; it is shocking at the variation in pricing.
 
Lolly said:
My doctor will do either... Most times he sends the order electronically... not actually faxing... but via the internet.. and I have never had a problem of the prescription not being received by my pharmacy.
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The pharmacy was just telling my mom that her prescription had not been sent in when really it had. Finally one of the pharmacists fessed up and told mom her insurer would not cover the cost of the medication because it was too expensive and her doctor would have to prescribe a cheaper alternative, which she did and my mom got her meds. But someone at the pharmacy really should have told her the truth. I don't know why they didn't.
 
jujube said:
One of my doctor's offices is most insistent on sending in the prescription themselves. I had to almost throw a hissy fit to get the prescriptions in hand. The reason I like a printed prescription is that I "shop" around for best prices. Walmart has some on the 90-days-for-$10 plan, which is cheaper than my prescription plan, others are cheaper using my prescription plan. I'm cheap/frugal/thrifty and I don't mind saving a few dollars here and there.
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That sounds very smart to me. :)
 
chic said:
The pharmacy was just telling my mom that her prescription had not been sent in when really it had. Finally one of the pharmacists fessed up and told mom her insurer would not cover the cost of the medication because it was too expensive and her doctor would have to prescribe a cheaper alternative, which she did and my mom got her meds. But someone at the pharmacy really should have told her the truth. I don't know why they didn't.
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Stupid and inconsiderate thing for the pharmacy to do. I would find another pharmacy.
 

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