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Cancer patients are being denied drugs, even with doctor prescriptions and good insurance

jaeger19 said:
I agree.. and its important not to shame people suffering from cancer because they decide not to seek treatment.
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Agreed. Or when they seek doctor assisted suicide...which is essentially the same, in fast forward.
 
OlNate said:
That's one of those easy to say things...just like me saying "I'd suffer any negative aspects of treatment if it meant one more day with my son"....easy to say from a reasonably healthy place, I don't think any of us can really say what we'd do when faced with the reality of our own death - not in some abstract, "someday" way, but knowing that you're going to die, how you're going to die, and roughly when.

Which is why I think it's important to make the patient the number one decision maker when it comes to treatment, one way or the other. I find this highly problematic.
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True, I may change my mind when/if faced with that decision, but knowing what I know now, I don't think so...I've seen too many suffer needlessly with chemo and radiation, only to end up dying anyway...the extra time is not worth it if it's spent in misery...I am not afraid to die, it's what happens before death that is so scary...
 
jaeger19 said:
Good question. The issue is 1. How much rationing.. 2. Who gets rationed.

So back to the OP.

This women's experience is an outlier. In other words..its probably pretty rare that she, with good insurance, was denied these cancer drugs when she needed them. That's why we find her experience outlandish. Because its not commonplace with good insurance.

She fell into one insurance program that required her to use a CVS pharmacy and had a PBM manager that denied her. In all likelihood... if she had any other insurance in the area.. this would never have happened to her.

Which of course.. is one of the reasons that healthcare costs so much more in the US.

To get the savings across the system like other countries.. .. EVERYONE.. would have to be under the same PBM management that denied her. In other words.. anyone in her position would get denied as well. And it would not matter if she had a different insurance.. (presumably she would have the same government insurance).
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And those of us on Medicare do have the same government insurance. I wonder if Medicare patients have the same sort of issues? I've been on Medicare for several years, and never had a problem, but that's just me.
 
Elvira said:
True, I may change my mind when/if faced with that decision, but knowing what I know now, I don't think so...I've seen too many suffer needlessly with chemo and radiation, only to end up dying anyway...the extra time is not worth it if it's spent in misery...I am not afraid to die, it's what happens before death that is so scary...
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My biggest fear, when it comes to death, is for those who I leave behind. Of course, my son is 6, so I'm open to the possibility that my thoughts on this may change. :)
 
jaeger19 said:
Universal healthcare does not remove insurance companies from the loop. Canada has private insurance companies.. in fact..in Canada..it would be a private insurance company covering this ladies cancer drugs.
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They need to be. They serve no purpose but to pillage trillions of dollars that could be spent on actual health care. Paying the insurance companies to pay our health care bills while they syphon off trillions is beyond stupid. Instead of paying all these middlemen why can't we just pay for the health care directly. When I pay my phone bill I don't look for someone to charge me 20 dollars on top of what I owe to pay the bill for me. I get 100 dollar bill and instead of paying it I give someone else 120 dollars to pay it for me. Does it get any more stupid than this.
 
Dittohead not! said:
And those of us on Medicare do have the same government insurance. I wonder if Medicare patients have the same sort of issues? I've been on Medicare for several years, and never had a problem, but that's just me.
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Not really. At least not as of yet. There are lots of things that have been happening to medicare to reduce costs. Things that are affecting medicare patients.. (things like bundled payments etc).. but the medical industry quite frankly is not telling patients why certain processes are happening. An example is that folks that would have gone to rehab before these changes..now are sent home or sent to assisted living..and never reach their full functional potential. Its an unintended consequence of some of the changes to medicare in an effort to reduce costs. .

There are also changes to medicare and medication formularies, and to the handling of durable medical equipment that are impacting patients but you would only know it if you are a provider.

There will be a big change coming in October when medicare rolls out a completely knew way that Skilled Nursing Facilities get paid. I fear that the impact will be devastating to patients. We will see.

When it comes specifically to cancer drugs....I saw a comparison study between the British system.. NHS.. and the US medicare. And it showed that Medicare was generally much more free with Cancer drug payment than the NHS. Medicare has been very lenient with payment, basically paying "medical necessary".. which even includes drugs not even approved by the FDA (for patients with experimental drugs in clinical trials etc).
 
PIPEWRENCH said:
They need to be. They serve no purpose but to pillage trillions of dollars that could be spent on actual health care. Paying the insurance companies to pay our health care bills while they syphon off trillions is beyond stupid. Instead of paying all these middlemen why can't we just pay for the health care directly. When I pay my phone bill I don't look for someone to charge me 20 dollars on top of what I owe to pay the bill for me. I get 100 dollar bill and instead of paying it I give someone else 120 dollars to pay it for me. Does it get any more stupid than this.
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Well.. you can say they need to be... but it ain;t going to happen. Especially in this country where administering public plans.. equates to about 60% of private insurance company revenue.

By the way.. yes when you pay your phone bill yes.. you are being charged for the administrative cost to produce that bill and keep your account. You just don't know it .

There is an administrative cost to billing patients, handling provider relationships.. etc etc. And that cost is going to get paid for. Whether you see it as a line item or not.
 
jaeger19 said:
Good question. The issue is 1. How much rationing.. 2. Who gets rationed.

So back to the OP.

This women's experience is an outlier. In other words..its probably pretty rare that she, with good insurance, was denied these cancer drugs when she needed them. That's why we find her experience outlandish. Because its not commonplace with good insurance.
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Sorry but our son has run into the same roadblocks and we pay the equivalent of a house payment for his insurance.
He was born with five major heart defects and will eventually need a heart transplant.
It is a daily and sometimes twice daily battle with his insurance.
When he is in the cardiac ICU (twice this year so far) we wind up on the phone for hours every single day he's in there.
It is the textbook embodiment of what you guys used to try calling "DEATH PANELS" only it's NOT the so called evil government, it's the insurance companies.
You just don't know the facts, sorry.
And I've been listening to people like you spin this for better than twenty years.

Daryl 232.webp
 
PIPEWRENCH said:
They need to be. They serve no purpose but to pillage trillions of dollars that could be spent on actual health care. Paying the insurance companies to pay our health care bills while they syphon off trillions is beyond stupid. Instead of paying all these middlemen why can't we just pay for the health care directly. When I pay my phone bill I don't look for someone to charge me 20 dollars on top of what I owe to pay the bill for me. I get 100 dollar bill and instead of paying it I give someone else 120 dollars to pay it for me. Does it get any more stupid than this.
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Insurance companies in Canada function under regulations which are remarkably different than ours.
 
jaeger19 said:
Well.. you can say they need to be... but it ain;t going to happen. Especially in this country where administering public plans.. equates to about 60% of private insurance company revenue.

By the way.. yes when you pay your phone bill yes.. you are being charged for the administrative cost to produce that bill and keep your account. You just don't know it .

There is an administrative cost to billing patients, handling provider relationships.. etc etc. And that cost is going to get paid for. Whether you see it as a line item or not.
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Wrong. The insurance companies are not needed. If I go to my doctor and pay the bill the only difference is the money wasted making CEO's of insurance companied billionaires is cut from the process. They provide nothing but unnecessary cost. Single payer should be we pay taxes to the government the government pays for the health care. Not trillions of dollars needed for insurance companies, their billionaire CEOs, millions of employees, all the advertising, the buildings, the paperwork, and all the stock holders. All that money is used to provide health care not make people rich. They can all go find work doing something productive and needed.
 
Checkerboard Strangler said:
Insurance companies in Canada function under regulations which are remarkably different than ours.
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Regulations would work except our government is bought and paid for by the rich and powerful people are exploiting our health care. That is primary reason Obamacare failed is the millions of people making millions and billions off of our health care tell our leaders what to do not "We the People." Otherwise everyone in this country would have the same health care as the privileged government workers.
 
Checkerboard Strangler said:
Sorry but our son has run into the same roadblocks and we pay the equivalent of a house payment for his insurance.
He was born with five major heart defects and will eventually need a heart transplant.
It is a daily and sometimes twice daily battle with his insurance.
When he is in the cardiac ICU (twice this year so far) we wind up on the phone for hours every single day he's in there.
It is the textbook embodiment of what you guys used to try calling "DEATH PANELS" only it's NOT the so called evil government, it's the insurance companies.
You just don't know the facts, sorry.
And I've been listening to people like you spin this for better than twenty years.

View attachment 67261449
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Pooh. First.. I am not spinning anything. I know the facts..and I say the facts.

Yep..its happening for your insurance. and why? To reduce their healthcare costs.

It happens in the VA.. a government insurance as well.. to reduce healthcare costs.

It happens with Medicaid.. a government insurance as well.. to reduce healthcare costs.

And it happens with other countries single payer... and why? Again to reduce healthcare costs.

There is no free lunch here. The fact is that patients like your son.. account for the vast majority of healthcare costs. 5% of patients account for about 50% of healthcare spending. If you want to reduce costs.. one of those ways is management of those 5%..

Doesn't matter if its the "big bad insurance companies".. or big bad government... if you want to reduce costs..you have to do cost management. And controlling the costs of outliers.. is one way in which its done.

By the way.. stop with the death panels crap. I have multiple times stated that the right wing complaining about death panels was pure bunk..that there was no such thing in Obamacare... oh wait.. I know that because I HAVE READ THE AFFORDABLE CARE ACT.

That being said, I hope that you son recovers and they find an acceptable donor heart and he lives a long and happy life. BUT.. be a little careful of what you wish for when it comes to insurance.. its very possible you will end up with worse situation.. if the goal of the healthcare system is to reduce healthcare costs.
 
jaeger19 said:
Pooh. First.. I am not spinning anything. I know the facts..and I say the facts.

Yep..its happening for your insurance. and why? To reduce their healthcare costs.

It happens in the VA.. a government insurance as well.. to reduce healthcare costs.

It happens with Medicaid.. a government insurance as well.. to reduce healthcare costs.

And it happens with other countries single payer... and why? Again to reduce healthcare costs.

There is no free lunch here. The fact is that patients like your son.. account for the vast majority of healthcare costs. 5% of patients account for about 50% of healthcare spending. If you want to reduce costs.. one of those ways is management of those 5%..

Doesn't matter if its the "big bad insurance companies".. or big bad government... if you want to reduce costs..you have to do cost management. And controlling the costs of outliers.. is one way in which its done.

By the way.. stop with the death panels crap. I have multiple times stated that the right wing complaining about death panels was pure bunk..that there was no such thing in Obamacare... oh wait.. I know that because I HAVE READ THE AFFORDABLE CARE ACT.

That being said, I hope that you son recovers and they find an acceptable donor heart and he lives a long and happy life. BUT.. be a little careful of what you wish for when it comes to insurance.. its very possible you will end up with worse situation.. if the goal of the healthcare system is to reduce healthcare costs.
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It is not reducing costs at all, in fact it is increasing them.
Because he was unable to afford two medications that he needed, he wound up in the cardiac ICU for a month and a half over the New Year, for a total of 186 thousand dollars. It was avoidable.

UCLA Hospital Bill2.webp

His cardiologist at UCLA agrees that it was avoidable.
Would you like his phone number so that you can talk to him yourself?

In the end, all you're doing is justifying the Republican Healthcare Plan.

90
 
PIPEWRENCH said:
Wrong. The insurance companies are not needed. If I go to my doctor and pay the bill the only difference is the money wasted making CEO's of insurance companied billionaires is cut from the process. They provide nothing but unnecessary cost. Single payer should be we pay taxes to the government the government pays for the health care. Not trillions of dollars needed for insurance companies, their billionaire CEOs, millions of employees, all the advertising, the buildings, the paperwork, and all the stock holders. All that money is used to provide health care not make people rich. They can all go find work doing something productive and needed.
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Sorry..but you are wrong. If you go to your doctor and pay the bill? Sure. IF that bill isn't thousands of dollars. (unless you are rich), If you are like most people..you can't pay for it out of pocket..and therefore you need insurance...

First..single payer in most countries... STILL HAS INSURANCE COMPANIES. so they are still going to be there.

Second.. there is still going to be administrative costs. So.. like in America.. Medicare.. and Medicaid... ARE STILL ADMINISTERED BY PRIVATE INSURANCE COMPANIES.

In fact..public plans make up about 60% of private insurance revenue.

Its just the facts man.
 
Checkerboard Strangler said:
It is not reducing costs at all, in fact it is increasing them.
Because he was unable to afford two medications that he needed, he wound up in the cardiac ICU for a month and a half over the New Year, for a total of 186 thousand dollars. It was avoidable.

View attachment 67261457

His cardiologist at UCLA agrees that it was avoidable.
Would you like his phone number so that you can talk to him yourself?

In the end, all you're doing is justifying the Republican Healthcare Plan.

90
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Yep… but it was done with the thought of reducing healthcare costs... In all likelihood.. the folks in charge of the medications.. denied the medications.. because it made their bottom line look better... even though it ended up costing more because he went to the ER.

The same thing happens in the VA.. the same thing happens a LOT with Medicaid. Medicaid would not pay for my patient to get therapy after a meniscal repair. So instead of preventing the contracture for 1500 dollars.. (if it would have cost that)…
I
It ended up costing thousands more for a manipulation under anesthetic and a special ROM brace that applied continuous low load stretch. Totally avoidable.

All done by a government program...and all done with the purpose of saving healthcare costs.

I can give you multiple examples of this happening to VA patients as well.

Not to mention private insurances.

And yes.. I wouldn't mind if you give me the name of the cardiologist at UCLA. Feel free.. though I doubt he wants you to post his number on an internet forum. But I will tell you what. How about YOU talk to him about this issue. See what he thinks about say dealing with government insurance like Medicaid... or VA.. if he deals with it. And maybe he has some experience working in other countries like I do... so maybe he can get you to listen to facts...

by the way.. the republicans don't have a healthcare plan.
 
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