Text 10736, 163 rader
Skriven 2013-10-15 10:31:12 av Janis Kracht (1:261/38)
  Kommentar till text 10730 av Roy Witt (1:387/22)
Ärende: APODs
=============
Hi Roy,


> I'm not employed...you're paying for my healthcare though. When I worked
> as a roadside tech here in Texas, I had no insurance except for Medicare.

Yep, happens.

>>> A drug I take now is billed at over $20,000/per unit. That's on an
>>> average

>> Darn that's insane...

> Insane as in Obama Scare...

Heh.. he didn't the price for that drug, neither did he set the price for this
drug my neuro wants me to start.. that's just BigPhama.. I could on about that
but it's not worth the discussion <g>.

>> I only use medicare for Hospital/Docs-in-hospital.. not for drugs or
>> doctor visits in the doc's offices.  That will probably change in the
>> future, well, it will change in the future, but not right now.

> You have to be on Medicare to use it, else you either pay out of pocket or
> an insurance company pays it for you. This isn't supposed to happen,
> (asking a female her age), but are you 65 yet?

Nope.  Since I have a 'dred disease' that's not ever going to go away, and
because I worked most of my life the gov't gives me some $$.

>> Sure, 'they' said I don't have Relapsing/Remitting MS and my doc
>> disagrees with them.

> Unless Aetna calls for a 2nd opinion by one of their network docs, then
> your doctors opinion rules.

Heh.. not in this case.  It will take that other doc's 2nd opinion, and then
Aetna may still reject it.  Then I'll appeal their decision if I really care to
go on this drug, but it's so new.. I may just tell my doc. forget it
:)

>> I'm one of those people who have had MS for years, and it's just a
>> nuisance.

> Well, MS is known to get worse with age.

Not necessarily.  Mine hasn't changed in how it affects me in over 20 years.. I
just walk a little slower than some people some days, really.  That's what
relapsing/remitting means.. it just comes and goes.  For me, it mostly "goes"
away.  There are different types of MS, some people have a very horrid version
and they're dead in a couple years.  Some people have a type that is really
rough on them and they're in wheelchairs, possibly blind, and that's a mean one
that gets chronically slowly worse.  Most people though, have it like I do..
it's just a PIA. <vbg>.  Now some day when I'm in my 80's I may progress to a
nastier version, but MS is damn weird.. it affects everyone differently.. and
by the time I'm in my 80's well... I might give in and get a cane then Lol.

> Look at MJ Fox and see the
> results of MS with aging.

MJ Fox doesn't have MS.. he's got Parkinson's.  Very different disease ... My
uncle had that one.. poor guy.  He suffered in a similar way to MJ Fox before
he died.  These days they have better meds though for that one.

>> .  I have an apt. set up for a second opinion, but it's pretty
>> obvious Aetna doesn't want to pay the high fee for this new drug that
>> recently hit the market.

> ^^^^^^^^^^^^^^^^^^^^^^^
> Ahhh, there's the reason.

Everything with MS is very new except for the standard "CRAB" drugs as they
call them.  The CRAB drugs (Copaxone,Rebif,Avonex,Betaseron) are even nastier
drugs for what they do to you side-effect-wise (injections every day, constant
flu symtoms, nasty looking injection sites), so I never agreed to take them.  
The "new" drugs are very very new, and while they'll cause a lot of
infections they've only killed a few people (seriously <g>) Anyway, that's why
I am in no rush <g>.  These are kind of like cancer drugs that affect your
immune response, hence all the infections.

>> Yep, doc in the network.. My neuro is setting this up the 2nd
>> opionion.

> Cool. If the 2nd agrees with your doc, then it shouldn't be such a
> problem.

I know how Aetna thinks haha.. they'll reject it just because they will hope
that I won't push it..

>>>> Truthfully, I don't care about this one, but it makes me laugh at
>>>> Aetna's med. practices.

>>> They're just going by what the Unaffordable Healthcare Act has done to
>>> the medical practice. Many doctors refusing to take new patients due
>>> to the Obama-scare plan, many more are taking cash only.

>> Nope, not ours.

> Then you have a good doc who's working for your best interests. Same as
> mine does.

Yep, he's a good guy.  He knows how Aetna is..

>>> My doctor continues my
>>> coverage because it is Medicare and not Obama-scare.  Both my doctor
>>> and my RN sister know what's coming, they're not very happy about it
>>> because of the high costs of premiums and the worse health care that
>>> will be coming with those premiums.

>> Nah, Roy.. this is how Aetna has always been,

> I had Aetna in California and it was never like that. My employer changed
> carriers because their plan was too expensive, while Blue Cross' insurance
> plan proved to be better and cost less.

We had BC/BS for years when we had our own company, they were great.  Back
_then_  they were extremely expensive.. I'm talking like 20-30 years ago.
Trouble was once you have any 'dred disease' the insurance companies charge you
up the ass. That's when we started working for another company to get insurance
through them.

>> Our plan really stinks to high heaven.. It's a very small company
>> and you don't get big benefits at place like that. You really have to
>> consider it more catastrophe insurance.

> My youngest daughter was hit by a car when she was 3yo. That hit twisted
> her left femur and broke the bone. She spent a month on a hospital bed in
> traction and Aetna paid every dime of it, while I was in the process of
> suing the driver for negligence. She walked with a noticible limp as the
> bone was healing and trying to catch up with the right leg. She still
> limped slightly at 23yo.

I'm sure everyone has an insurance horror tale for every good one.. it's the
nature of the beast <g>.

Our plan is so bad, that for a procedure that you can get for a couple hundred
dollars in Europe, I have to pay something like $1500.00 here in the US (that's
my cost after insurance pays).  MRI exams are ridiculously over priced in this
country.  I had to get one though to prove that I still have R/R MS though.

>> For us when it comes down to it, it won't be much different than what
>> we're paying now, but the coverage will be MUCH better, and copays
>> won't exist.

> That's what Obama says, but it isn't true.

That's what the program we will select will do when the time comes.

>>> How much did your premium skyrocket under Obama-scare?

>> It's will be about the same cost as we're paying now.. not much more.
>> It's the benefits that will increase.. dramatically.

> 8^( That isn't what's being reported by those who have signed up.

Depends on what plan you sign up for, Roy.  The one we're looking at isn't
cheap, but it's a much better plan for us compared to what we have now.

Take care,
Janis

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