As others have said, contact you insurance company and start climbing the management ladder.

I went through a similar issue with Tricare (Retired mil) we’re they denied me eye drops that were prescribed. When I asked them why, they said because it’s a “maintenance” medication (I still don’t understand that). My retort was, so is my cholesterol medication, are you gonna stop that too? I had my eye drops by the end of the day.

Tricare is now Humana Tricare which really hasn't changed much except I get to talk to very nice people from Virginia and not DC or Philly.

Insurance companies defy all logic at times . Most of the time in fact .A few years back my wife had back surgery . A few months later we got an envelope full of bills amounting to about $60,000 . Long story short we ended up in a third party review that sided with us and thank God for that .
It was a convoluted mess . .

quote:

Originally posted by ZSMICHAEL:
As you discovered it pays to shop around. The discrepancy in pricing is typical. The hospital will say they are covering their overhead.

This is key, Hospitals have plans with carriers they negotiate, use of equipment, facilities, the $150 Aspirin etc... If you are admitted it's different situation since you can't leave to go to a MRI center.

Always check price, and check coverage before any medical procedure, shop medications at different pharmacies, not all Doctors will consider the cost of the service when prescribing, they are concerned with what they want done for your care.

It's your responsibility to manage your HC and monitor the costs, and know your insurance rules, having insurance isn't a blanket get whatever you want for free program.

Most of the time when you see billing issues its the supplier improperly coding the item(s) or the patient not checking to see if where or who they are seeing is covered by the plan their employer bought.

Remember not all employers are looking for max coverage plans, the costs are significant per employee.

Call the toll free number before getting services done, and the facility to be sure they are contracted with your plan...

quote:

Originally posted by HRK:

shop medications at different pharmacies, not all Doctors will consider the cost of the service when prescribing

My primary care doc's office seems to be totally oblivious to cost differences. They just want to send the Rx to "my pharmacy" -- I have that in quotes, because "my pharmacy" is usually the one that I choose after shopping prices, which can vary all over the map. This is why I insist on a hard copy of the Rx, rather than letting the doc's office send it to a pharmacy.

They don't like to do it (give me a printed copy). I told them that I would do it their way IF they were willing to take the time to go price-shopping for me, and factor in travel time and convenience. They looked at me as if I had three heads and I was speaking green Martian language.

quote:

Originally posted by StorminNormin:
I find it frustrating how insurance companies seem to be the ones running things and will override what a doctor recommended.

Because the insurance companies do run the healthcare racket system. They make sure everyone is well-fed as they get the lion's share.

quote:

Originally posted by Rey HRH:

quote:

Originally posted by StorminNormin:
I find it frustrating how insurance companies seem to be the ones running things and will override what a doctor recommended.

Because the insurance companies do run the healthcare racket system. They make sure everyone is well-fed as they get the lion's share.

The way a doctor described it to me is that a hospitalist will write the protocol for treating each condition for their hospital or medical network. That protocol must be followed precisely or the doctor gets in trouble and may be fired. Next, any insurance company involved adds rules to that protocol about what lab tests are allowed and which drugs may be used. Once that protocol (checklist?) is derived, the doctor simply follows the protocol and does what it says to do.

Doctors in many cases seem like mechanics looking up a vehicle, issue, and then going down the checklist trying various parts to see if any make the issue better.

^^^^^^^^^^^^^
Hospitalists are employees. Administration may try and impose guidelines but it is up to the individual physician as to how to proceed.

quote:

Originally posted by RogB:
I take the generic version of bystolic (nebivlol), 10mg less than $10 without good rx.

Same, I'm on a 5mg dose of generic bystolic (nebivolol), and it's about $3 for a 90-day supply at my local Fred Meyer (Kroger-owned).

quote:

Originally posted by bryan11:

The way a doctor described it to me is that a hospitalist will write the protocol for treating each condition for their hospital or medical network. That protocol must be followed precisely or the doctor gets in trouble and may be fired. Next, any insurance company involved adds rules to that protocol about what lab tests are allowed and which drugs may be used. Once that protocol (checklist?) is derived, the doctor simply follows the protocol and does what it says to do.

Doctors in many cases seem like mechanics looking up a vehicle, issue, and then going down the checklist trying various parts to see if any make the issue better.

It's even more simpler than that when it gets to the insurance side as far as "protocols" go. It really is all about the money and the insurance company wants to maximize the profit for everyone involved. Not many doctors have the time to actually understand the racket run by the insurance companies.

I was going to post one of several videos of a doctor who did go into understanding the health insurance industry. I had them saved. I don't see anyone of them now. There are still plenty of youtube hits using "the truth about health insurance" but none of them are his. He took the time because he became a consultant pushing for a one payer system but, I suspect, he didn't realize that the same insurance companies he was dissing would still want to be a part of a one payer system the same way they're in Medicare now.