Here are all the articles I've written about Prescriptions. Enjoy!

August 17th, 2016

“What’s Up, Doc?” Blog Series Part 11: All Better… But OUCH, This BILL!!

Oodles of gratitude for taking this virtual trip to the doctor with us!  Here’s even more in the series “What’s Up, Doc?”  Catch up with parts one, two, three, four, five, six, seven, eightnine, and ten.

And now, our last in the series… “All Better… But Ouch, THIS BILL!!”

  1. Your doctor is IN-network right?    The doctor’s office MUST submit the bill (aka “the claim”) directly to your insurance company.
  2. The IN-network doctor CAN ask you for the office visit co-pay at the time of the visit.    But, for medical services done during the visit…
  3. The IN-network doctor canNOT charge you until after the insurance company applies the IN-network discounts (the negotiated rate).
  4. When you get a bill from the doctor’s office, be sure that the IN-network discounts have been applied.   How do you know?
  5. … because you got an Explanation of Benefits (EOB) from the insurance company!   Check the EOB against the provider’s bill, and THAT’s how you know you’re getting the right discounts.
  6. If the doctor is OUT-of-network you’ll be submitting your own claims to your insurance company – and the doctor can charge you whatever she likes, there are no discounts.
  7. If you have an HMO, you must ONLY see a doc in your HMO group.  There are NO benefits in an HMO if you go to an out-of-network doctor.

Talk to me!  Was this helpful?  What was your fave piece of info?  Suggestions and thoughts are welcome.  And as always, reach out to us for any of your insurance needs.…

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March 25th, 2016

PART FIVE: The Insurance Mom’s Guide to Better Living Through (Cheaper) Chemistry

Here’s PART FIVE in our series we call . . .

“The Insurance Mom’s Guide to Better Living

Through (Cheaper) Chemistry”

 

If you’re just joining us, check out the hyperlinks to PART ONE, PART TWO, PART THREE, and PART FOUR.  Pretty smart, huh?

 

Here’s the final part to our series;  it’s part tip / part FYI.  President Obama is finally suggesting that drug companies have to justify their ridiculously high prices.

 

But Mom, why does this matter to me?  Well, sweetie, it matters to ALL of us!

 

In PART ONE, we mentioned an article from Consumer Reports about drug costs in other countries.  The article asserts that USA residents pay significantly more for Rx than most other countries.  The Insurance Mom suggests you compare & contrast at The Canadian Drugstore and Pharmacy Checker.  We included the comparison chart from the article here:

 

drugschart

 

Who knows how this will all work out, but the focus could be shifting.  Here’s an article from the LA Times which goes more into depth.

 

To wrap it up . . . 

PART ONE: EDUCATE YOURSELF!

PART TWO : FIGHT FOR YOUR RIGHTS TO AFFORDABLE MEDS!

PART THREE: WORK THE PHARMACY!

PART FOUR: WORK THE INTERNET!

 

Above all, be the master of YOUR money.…

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February 26th, 2016

PART ONE: The Insurance Mom’s Guide to Better Living Through (Cheaper) Chemistry

Here’s PART ONE in our series we call . . .

“The Insurance Mom’s Guide to Better Living

Through (Cheaper) Chemistry”

The Insurance Mom

PART ONE: EDUCATE YOURSELF!   

 

The Affordable Care Act has created a LOT of confusion for everyone – especially the doctor’s offices!    Learn how your plan works before you go to your appointment!   If you have problems getting affordable prescriptions, ask your doctor for alternative options.

 

Learn your tiers!  The formularies are the lists of drugs your insurance company covers.   If your drug IS in the formulary, it will be categorized into one of four tiers – generic and brand name.   Generic drugs are cheaper.   If the cost of a brand name drug makes you sick, call your doctor and ask for samples.  OR ask if they will prescribe a generic!…

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February 19th, 2016

Intro: The Insurance Mom’s Guide to Better Living Through (Cheaper) Chemistry!

Hi Insurance Mom Family,

 

OK, let’s talk prescriptions.  But Mom… they’re so expensive!  I know, sweetie.  The Insurance Mom hears you.

 

Yet another (un)intended consequence of the Affordable Care Act… formulary shrinkage.    The formularies are the lists of drugs your insurance company covers – generic and brand name.   Most people just pay up at the pharmacy and don’t know they can actually shop around for better prices.   Just because you have health insurance doesn’t mean you’re getting the best price!

 

To help you along the way, we’ve written a blog series we call …

“The Insurance Mom’s Guide to Better Living

Through (Cheaper) Chemistry.”

high-cost-prescription-medications-health-care-concept-money-flowing-open-pill-white-background-34658791

 

This FIVE part series walks you through money saving tips & tricks from the moment the doctor writes the script to the moment you pick it up at the pharmacy.  Keep tuning back for the next five Fridays to learn to speak Rx.

 

As an intro, click the hyperlinks for these great articles from the website, GoodRX and another one from Consumer Reports.

 

In the meanwhile, talk to me!  What are your insurance concerns for the coming year?…

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July 13th, 2015

Good news for people with pricey $$ prescriptions!

Good news… perhaps!   If you have health insurance through Covered California (the CA exchange/marketplace), new limits have been set on how much you’ll pay for those expensive monthly “specialty” drugs.  Starting January 1st, 2016, you’ll see some upgrades in your prescription benefits.

Covered California ruled that Silver, Gold, and Platinum plans will have a cap of $250 a month per specialty drug.    Bronze plans are a little different– there is a yearly $500 drug deductible, and then a $500 monthly cap for each specialty drugs.

What does it mean?   If you are one of those people who gets hit hard with expensive specialty drug costs, you might be see some savings starting 1/1/16.

But this new ruling could drive up the cost of health insurance… it’s the nature of the beast.   We’ll see.

Covered California did say the biggest problem boils down to the ridiculous and overwhelming costs set by the drug companies.   “You can fault the drug companies,” says a smart Covered California official.

Nicole Kasabian Evans with the California Association of Health Plans said the bill could be misleading, noting that patients pay higher shares of specialty drugs because they often are very expensive.

She said, “Bills like this give a false sense that drug costs are going to be reduced, when in reality costs are just shifted from your out-of-pocket costs to premiums.”

Health insurers also contend that out-of-pocket costs already are capped under the Affordable Care Act. They say a better way to address high prescription drug costs would be to have drugmakers be more transparent about how prices are set (“KXJZ News,” Capital Public Radio, 2/18).

The Insurance Mom agrees!  What do you think?  Did YOU have big prescription costs this year?…

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June 4th, 2015

Good news for the ladies!!

Hurray!

On 5/11/15, the Department of Health and Human Services (ObamaCare)  told insurance companies they HAVE to give ladies access to  ALL federally approved methods of birth control.  NO EXCEPTIONS!

Women’s groups have been reporting that IUD’s, Plan B, the patch, and the ring have been refused by many insurance companies.  According to the White House, this is breaking the law.

Another positive step in the enforcement of some good bits of the Affordable Care Act.

http://www.ibamag.com/news/white-house-cracks-down-on-insurers-flouting-birth-control-requirements-22455.aspx

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May 12th, 2015

YOU’RE A COMPARISON SHOPPER FOR OTHER THINGS, THEN WHY NOT FOR MEDICAL STUFF?

You’re a smart shopper.  You do your research.  You clip coupons.  You read Yelp reviews, compare online ratings and costs.    So why is it when it comes to your health, you don’t do the same?

The Insurance Mom is here to help you be your own best advocate.  In this new world of Affordable-Care-Act-madness  here are some handy do-it-yourself tips to get the biggest bang for your health plan buck and save you money in the long run.    Just because you have health insurance doesn’t mean you’re automatically getting the best deals.

When you have the ability to plan before diagnostic tests, procedures, and doctor visits:

Check out this nifty website from Health Care Blue Book.  It will compare and contrast costs for doctor visits, procedures, hospitals and other facilities, as well as the Fair Price for a medical services from different locations.    A friend found that two hospitals near him were charging very different amounts for the EXACT SAME diagnostic tests.  One was $1,400, the other was $6,400!!! Very smart shopping! When you can, plan!

https://healthcarebluebook.com/page_Default.aspx

When your prescriptions get too spendy, we have three suggestions:

GoodRx to compares costs of different meds at different pharmacies in your area.  Didn’t think there would be a difference, did you?  Give it a try and you’ll see costs vary from one pharmacy to another.    Make an informed choice about how and where you shop.

www.goodrx.com

There’s a free discount card available with just a simple click!  Go to Water Tree Health’s website for great discounts on pharmaceuticals, diabetic supplies, even some pet supplies!

http://www.watertreehealth.com/our-products/

I get a lot of questions on this one.  For certain medications, you can shop outside of the country and see a big discount.   Pharmacy Checker is a good example of how to compare drug prices …

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March 19th, 2015

Why we love John Oliver OR How to get a free lunch!

The Insurance Mom is a big fan of “Last Week Tonight” with John Oliver.   I thoroughly enjoyed his expose (which aired on 2/8/15) about the relationship between doctors and pharmaceutical companies.

The gist is this . . . it has been a long-time practice of pharmaceutical companies buying doctors lavish lunches, providing divine holidays, inviting them to be a brand ambassador, speaking at events, and paying the docs handsome sums.   It’s one thing to hand out free samples.  But some of these practices are bordering on bribery, false advertising and in the process, perhaps skewing the doctor’s medical practices towards the companies’ products.   John Oliver wondered why it is that some medical offices advertise a free lunch in their job postings.   Is it possibly because Big Pharma is footing the bill?!

Aren’t you curious about what your doctor is up to?   Here’s the website where you can see what kind of benefits your doctors may be receiving from Big Pharma.  Go to https://openpaymentsdata.cms.gov/ to find out more.…

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October 21st, 2014

Good News for All You Ladies in CA!

Ladies!

Were you excited to hear that the new federal law, The Affordable Care Act (ObamaCare,) would make it so your health insurance would cover your birth control, but then were disappointed to find out that your specific brand was the exception to that rule?

Well, the State of California has passed SB 1053 that improves the access women have to THE FULL RANGE of contraceptive methods!

The ACA lacked clarity and that led to the health insurance companies interpreting it in a different way than the law intended.  Some plans covered the full range of contraceptive methods, some had co-pays for rings and patches, and some didn’t cover IUD’s.  The federal law had wording that wasn’t specific enough regarding female care.  Confusion reigned.

The goal of SB 1053 is to make it so YOU and your doctor are making the best choice for your health, and SB 1053 is helping make that happen in California.

SB 1053 was passed on September 25th.   Find out more at cfhc.org or healthlaw.org.…

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March 10th, 2014

Is your medication worth $84,000? You tell me . . .

I just read an article about new drug treatments for Hepatitis C.  Hep C is the #1 cause of liver transplants in America.  Serious problem, right?  Drug companies have come up with a serious answer . . . but to the tune of $1,000 per pill, making one course of treatment with this new drug cost $84,000!!!

What does that mean?  It means that if drugs cost this much, it drives up the cost for health insurance for EVERYONE!  Yes, you too, person without Hep C.  Health insurance rates will go up for everyone because of the cost of drugs like these.  And insurance companies may tell people to try the older, less effective drugs first to try to save money when they really need the new stuff.  Not fair on either end, is it?

And that’s not all.  This article also says that this is just the beginning of pricey drugs.  We’re going to see huge spikes in cost for treatments for MS, cancer, and more in the coming years causing health insurance premiums to skyrocket.  Ouch!!!

Is it worth it?  Heck no!  Who’s to blame?  Not who you would think.

I want to know…  why aren’t the pharmaceutical companies being regulated too?  Of course, these drugs do cost money to research and produce, but why this much?  It seems to me that all of the weight of health care reform is falling on the shoulders of the insurance companies where the focus should be broadened to include pharmaceutical companies, hospitals, labs and doctors.

Tell me, friends, what do you think?…

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