Humira in one month supply only.

http://www.edmontonsun.com/news/columnists/kerry_diotte/2009/08/13/10445326-sun.html

I wonder why bureaucrats can be so inflexible?

A regular reader wrote to say he's being treated for Crohn's disease and the Edmonton-to-Arizona snowbird can only get a month-long supply of a vital drug from Blue Cross, called Humira, that could put his disease into remission.

"My choices would be to fly back from Arizona to Edmonton every month this winter or go to an American specialist to have him prescribe the drug," said Alex Harboway.

Either way could be very costly. After months of dealing with Blue Cross and Alberta Health, Harboway has caught a bit of a break. His other insurance company, Sun Life, will pay 80% of the cost of the drug for a 100-day supply. The cost of the drug here is about $1,700 a month. He'll pay the rest out of pocket.

"I've never jumped through hoops like this in my life," he said. There's no question it's a valuable drug. Indeed, Harboway has been told it's similar to the one that has helped Oiler Fernado Pisani to recover from ulcerative colitis, a very serious disease related to Crohn's.

First of all, dood's got three insurance companies that will cover this one way or another!

The American specialist would cost this financially impoverished snowbird that flies back and forth between Canada and the US $350. With the deal that he's worked out he's already paying just about that much on his monthly deductible for the drug. A plane ticket to Canada is going to cost about that much as well.

One reason an insurance company might not want you walking away with a one year supply of $20,000 worth of drugs is that you very well might have to discontinue the drug before your one year supply is up. This happens all the time with Humira---there are all sorts of reason why this might happen. And once you've bought it, you'll have $20 grand of expensive protein sitting in your fridge right next to the leftover potato salad.

Recently a woman offered to sell me a one month supply of Humira (she had discontinued it) for a few hundred dollars cheaper than what it retails for. She would have pocketed this money, of course, at the expense of her insurance company who paid for the drug. I didn't take her up on her offer since whatever I pay her doesn't count towards my out of pocket max, and secondly, I don't trust anyone but me to keep this drug properly refrigerated.

Imagine Insurance CEOs did get those million dollar compensation packages....

H. Edward Hanway, chair/CEO, Cigna Corp., $30.16 million compensation: 11 million insured. If he worked for free then each insured would pay $3 per year less in premiums on a policy that costs about $10,000 or more per year.

If their $1.7 billion operating expenses were reimbursed to the insured, they'd save less than $200 per year.

Savings we can believe in!

Providers make more mistakes than my insurance co.

One of the things that I worried about when I got sick was that my insurance company was going to rip me off somehow.

Year To Date:

1. I have been balance billed by a provider which I unwittingly paid and never received a refund, billing service will not return calls so that I can get refunded.

2. Been misreported as delinquent by a provider to a credit collections agency which billing service agreed was a mistake after I suffered through a month of nasty collections calls. "We changed billing services and this is happening to a lot of our patients. Soooooorry" I changed docs immediately with that.

3. A dentist told me my insurance company would pay for some dental work which was necessary. You can guess the rest and skip to #4 or keep reading.

He got the work half way done, refused to do more work until I paid the insurance company's portion telling me the insurance company had denied the claim three weeks ago and wasn't going to do any more work until I paid the ins co. portion. So I paid. Turns our the insurance co. never denied or paid the claim because dentist never did file the x-ray. Claim was just sitting in insurance limbo. Even after I stood there and insisted they do so he wouldn't file that xray (he's PPO not indemnity) so I had to get a copy of everything and file it myself. Surprise, what I filed was denied, based on the fact that the documentation, that x ray as a matter of fact, didn't support the need. I looked into the condition a little more and I'm pretty sure they are right and the dentist was offering me something more on the cosmetic side than on the "necessary" side. Lesson learned: Should have gotten a second opinion on that much work, should have gotten the work pre approved. Pediatricians don't make more money by recommending tonsillectomies, but dentists do make more money recommending $$$dental work.

4. Pick up three prescriptions at pharmacy. Clerk gives me only two prescriptions in three bags and we both sign off on it.

Here's what happened: One bag was empty but marked "fridge"with a prescription label stapled to it, the second bag had the refrigerated prescription but otherwise no label, the third bag stapled shut had two different bottles in it and two different prescription labels stapled to it. Turns out it was a single prescription in two different bottles. I didn't realize the mistake until I got home. Went back to the store and the clerk gave me lots of flak. Had to come back a third time with all the bags to explain it, and there was not room for a third bottle in the overstuffed bag. She rolls her eyes and told me "it was possible" before giving me the prescription. Thank goodness it was something lame and not painkillers or I never would have been believed.

I only see the mistakes that cost me. I have no way of knowing about the mistakes that have been to my benefit that the provider eats, but I assume that the mistakes must go both ways.

Profiting off sick people

Random blog comment:

I'm just glad I don't have to suffer your system. Sweeping reform seems in order. I cannot for the life of me understand why anyone would accept a system where insurers can profit off sick people.

Sick people represent actuarial losses, not profits.

Crohn's and Thickened Blood

Two years preceding my Crohn's diagnosis I had muscle spasms, numbness and tingling in my hands, feet, arms, and legs and for the first time I also developed sharp pains in my calves. Neurologist did the mega workup and nothing turned up in the blood work.

Thromboembolic disease is a significant cause of morbidity and mortality in inflammatory bowel disease (IBD). A hypercoagulable state exists in IBD which may involve many components of hemostasis and is closely linked to disease pathogenesis.

It's time for me to go back and revisit all that blood work at next GI appt since the symptoms are back. Need to scrape together the deductible first. (Thanks to the dentist that did $2700 worth of unnecessary dental work not covered by my insurance and now I know about this thing called PREAPPROVAL)But I'm curious: If they could establish that I have thickened blood what could be done? Blood thinners with an ulcerated bowel?

Why don't insurance companies give more donations to politicians?

Here is the top 100 donors to Congress. You see the AMA, dentists, pharmaceutical companies. You see everyone that's going to make out like a bandit when reform passes. I see a single insurance company represented. If the big evil health insurance companies are so rich, why haven't they been the biggest donors?

House Speaker Nancy Pelosi ridiculed criticism by Republican Senate Leader Mitch McConnell of Democrats’ health-care plans, saying he’s echoing an insurance industry which makes “exorbitant profits” at the expense of Americans’ well being.

Why aren't they turning those exorbitant profits into massive donations like the other businesses do? The industry that's made the smallest donations is being singled out as the root of all health care woes.

Sacrifice, my butt.

KevenMD blogging about patient sacrifice required to reign in costs in abstract terms...

What if the pricey blue pill is actually better than the cheaper red one? What if it’s better but just a little bit? What happens when a yellow pill comes along, costing twice as much as the blue? What happens if there’s a new procedure that cures the ailment, but at an even bigger cost?

You healthy folks have the luxury of discussing this abstractly, but let's cut to the chase. Will I or won't I have to give up my no-side-effects Humira ($1600/month) and end up on Prednisone* ($16/month) instead? I've got a great GI that has kept me off that mess so far. What if in the long run prednisone and ostomies for prove to be cheaper than Humira for All? And if I make this sacrifice, what for? So someone else can get $30 off their next well baby visit?

Just sayin'

Nasty steroid side effects: high blood pressure, headache and muscle weakness. Prednisone also can cause puffiness of the face (moon face), growth of facial hair, thinning and easy bruising of the skin, impaired wound healing, glaucoma, cataracts, ulcers in the stomach and duodenum, worsening of diabetes, irregular menses, rounding of the upper back ("buffalo hump"), obesity, retardation of growth in children, convulsions, and psychiatric disturbances. The psychiatric disturbances include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior.