Pharmacists were previously prohibited from telling customers on some insurance plans about the lowest price for a prescription drug. A new bill changes all that.
There is one drug I take that my pharmacist cannot sell me unless it is the brand name when the generic is 75% cheaper....
When Dr.'s write prescriptions, they choose whether it is okay to substitute with a generic form...or strictly AS WRITTEN. Besides being cheaper, there is a difference in how the drugs work between brand names and generic versions. Pharmacists cannot override a prescription written by a physician. To be able to use the cheaper generic drug...speak to your doctor.
On that note, there are many Health Insurance companies that tell their members they must change to the generic version - because it is cheaper...not because it is better for you. At that point, your Physician can do nothing to change their minds. This practice has been going on well before the PPACA.
My doc has written me scrips that the pharmacy (trough my insurance) refuses to fill-they will only fill certain types of a specific drug. They call the doc and tell them its a no-go.
Cynical, but it sure seems to be the case. The shenanigans with prescription drugs are one of the most obvious things that drive costs up in this country and politicians seems unwilling to do anything about it (thankfully, present case excepted).
I've been preaching this for years now. I paid a $20 co-pay every 30 days for a maintenance medication. They wouldn't allow me to purchase 90 days worth...only 30 days. When I was between insurance carriers, I told the pharmacist I was going to pay cash for 30 days...the cost was less than $7! This was well before the PPACA went into effect.
I also paid cash for my Dr.'s visit during this time waiting for my new insurance cards. This visit included blood work. When I compared the cash visit to an insurance visit I was shocked $165 cash including blood workup - $250 + $90 for the blood workup through Insurance. When I spoke to the Dr. about it, he explained that Insurance visits requires more paperwork and a delay in payment...depending on which insurance company, some delays were significant. Most insurance companies have what they call 'reasonable and customary' charges for each visit or procedure...we patients end up paying the difference along with our monthly insurance premiums.
When I spoke to the Dr. about it, he explained that Insurance visits requires more paperwork and a delay in payment...depending on which insurance company, some delays were significant.
A reasonable explanation, in that it takes more labor and time to process than cash. Like it or not that does cost money.
Now an inordinate amount of time for delay is BS. With our electronic capabilities today there is no reason for such delays. They are just using the time value of money to make more money and that isn't right or reasonable.
Now an inordinate amount of time for delay is BS. With our electronic capabilities today there is no reason for such delays. They are just using the time value of money to make more money and that isn't right or reasonable.
The larger Insurance companies have millions of claims to process. Some claims go through as approved...and some are stalled for approval for whatever reason - a check mark in the wrong box by that extra person required to file forms. Those claims must be approved before the electronic payments can be made. Next, some insurance companies pay on a quarterly basis...so my visit - while approved - could take 90 days to be electronically transferred into the Dr.'s bank account.
Have you ever had a Dr. drop a health insurance plan that you had? Normally they do this either because the reasonable and customary charges drop significantly, or the Dr. isn't being paid in a timely fashion. Your Dr. must make a deal with the Health Insurance companies...those deals are constantly being negotiated.
Yes, Health Insurance Companies are in the business to make money...and they do make quite a bit!
I'm not a Doctor, nor did i stay at a Holiday In Express last night so i have no idea what their contracts read like with insurance companies but here is my point.
Once that claim for service is made, the value of that service is no longer theirs. Sure they can delay the approval process, establish procedural/contractual delays or simple just hold that money longer than they need to. I mean what are we going to do about it? But make no mistake, once that claim is made, assuming it is a valid claim, that money is no longer theirs. It belongs to whoever made the claim.
I will never defend insurance companies. They tend to be very efficient at collecting premiums and not so efficient in paying claims. You would have to be living under a rock to not notice or experience that reality these days.
I will never defend insurance companies. They tend to be very efficient at collecting premiums and not so efficient in paying claims. You would have to be living under a rock to not notice or experience that reality these days.
I am certainly not defending insurance companies! I do, however, have an inside tract - I used to sell health insurance.
I agree that payment should be made to providers as soon as possible...but realistically, when dealing with millions of claims...how does anyone do so efficiently? Dr's and Insurance companies have contracts...how Dr's are paid is in those contracts. Now, Dr's can, and do, drop insurance companies for many reasons.... I don't believe that we - as patients/insureds - have much say at all in the matter.
As electronic technologies progress, it should be taking less time not more. Right? Do you think it's taking less time now?
That said, I hear what you're saying but this is a huge a pet peave of mine. Companies holding owed money longer than required to make more money, on money that isn't theirs.
I'm not in the insurance business but i have ZERO doubt that it happens all the time just like it does in my business. It's bottom feeding, plain and simple and there is nothing right about it.
Companies 'hold' monies all the time...they all have their reasons.
Not all of us. Some of us take great pride in paying ASAP after we are paid. Yeah, we could make a few extra bucks by holding the money longer but to us it's a golden rule kinda thing.
No reason trumps that. At least not any good and fair reason.
Not all of us. Some of us take great pride in paying ASAP after we are paid. Yeah, we could make a few extra bucks by holding the money longer but to us it's a golden rule kinda thing.
KUDOS to your company! I am certain that your customers/clients appreciate prompt payments...and they spread the word.
Apologies for being off subject - I had ordered a custom item from a large retailer. 30 days later, that item still hadn't arrived and after many phone calls I learned that it was never ordered. I went to the retailer to get a refund and was told I would have to pay a 're-stocking' fee! They not only had my money for a month - and failed to order the item - they wanted to charge me to put it back!! There wasn't a person in that place that didn't hear exactly what I said!! I wasn't nice at all...and NO, they didn't get to charge me that 'fee'.
S E E D E D C O N T E N T
It's about damn time!
There is one drug I take that my pharmacist cannot sell me unless it is the brand name when the generic is 75% cheaper....
He was frustrated over that.
This is VERY good news!
When Dr.'s write prescriptions, they choose whether it is okay to substitute with a generic form...or strictly AS WRITTEN. Besides being cheaper, there is a difference in how the drugs work between brand names and generic versions. Pharmacists cannot override a prescription written by a physician. To be able to use the cheaper generic drug...speak to your doctor.
On that note, there are many Health Insurance companies that tell their members they must change to the generic version - because it is cheaper...not because it is better for you. At that point, your Physician can do nothing to change their minds. This practice has been going on well before the PPACA.
My doc has written me scrips that the pharmacy (trough my insurance) refuses to fill-they will only fill certain types of a specific drug. They call the doc and tell them its a no-go.
You can thank your Health Insurance Company for that one. Many insurers are making the prescription drug list smaller and smaller....
A step in the right direction. Now what we need is a reduction in the price of drugs. Ooppsss big contributors to politicians.
Cynical, but it sure seems to be the case. The shenanigans with prescription drugs are one of the most obvious things that drive costs up in this country and politicians seems unwilling to do anything about it (thankfully, present case excepted).
I've been preaching this for years now. I paid a $20 co-pay every 30 days for a maintenance medication. They wouldn't allow me to purchase 90 days worth...only 30 days. When I was between insurance carriers, I told the pharmacist I was going to pay cash for 30 days...the cost was less than $7! This was well before the PPACA went into effect.
I also paid cash for my Dr.'s visit during this time waiting for my new insurance cards. This visit included blood work. When I compared the cash visit to an insurance visit I was shocked $165 cash including blood workup - $250 + $90 for the blood workup through Insurance. When I spoke to the Dr. about it, he explained that Insurance visits requires more paperwork and a delay in payment...depending on which insurance company, some delays were significant. Most insurance companies have what they call 'reasonable and customary' charges for each visit or procedure...we patients end up paying the difference along with our monthly insurance premiums.
A reasonable explanation, in that it takes more labor and time to process than cash. Like it or not that does cost money.
Now an inordinate amount of time for delay is BS. With our electronic capabilities today there is no reason for such delays. They are just using the time value of money to make more money and that isn't right or reasonable.
The larger Insurance companies have millions of claims to process. Some claims go through as approved...and some are stalled for approval for whatever reason - a check mark in the wrong box by that extra person required to file forms. Those claims must be approved before the electronic payments can be made. Next, some insurance companies pay on a quarterly basis...so my visit - while approved - could take 90 days to be electronically transferred into the Dr.'s bank account.
Have you ever had a Dr. drop a health insurance plan that you had? Normally they do this either because the reasonable and customary charges drop significantly, or the Dr. isn't being paid in a timely fashion. Your Dr. must make a deal with the Health Insurance companies...those deals are constantly being negotiated.
Yes, Health Insurance Companies are in the business to make money...and they do make quite a bit!
Yes and if they make a few extra pennies on each of those by holding them a bit longer after they've been paid, they can make millions more.
No one is against them making money (not me at least) but holding payments longer than they need to is not right. It's not their money to hold.
According to the agreement between the Physician and Insurance Company - it is.
I'm not a Doctor, nor did i stay at a Holiday In Express last night so i have no idea what their contracts read like with insurance companies but here is my point.
Once that claim for service is made, the value of that service is no longer theirs. Sure they can delay the approval process, establish procedural/contractual delays or simple just hold that money longer than they need to. I mean what are we going to do about it? But make no mistake, once that claim is made, assuming it is a valid claim, that money is no longer theirs. It belongs to whoever made the claim.
I will never defend insurance companies. They tend to be very efficient at collecting premiums and not so efficient in paying claims. You would have to be living under a rock to not notice or experience that reality these days.
I am certainly not defending insurance companies! I do, however, have an inside tract - I used to sell health insurance.
I agree that payment should be made to providers as soon as possible...but realistically, when dealing with millions of claims...how does anyone do so efficiently? Dr's and Insurance companies have contracts...how Dr's are paid is in those contracts. Now, Dr's can, and do, drop insurance companies for many reasons.... I don't believe that we - as patients/insureds - have much say at all in the matter.
As electronic technologies progress, it should be taking less time not more. Right? Do you think it's taking less time now?
That said, I hear what you're saying but this is a huge a pet peave of mine. Companies holding owed money longer than required to make more money, on money that isn't theirs.
I'm not in the insurance business but i have ZERO doubt that it happens all the time just like it does in my business. It's bottom feeding, plain and simple and there is nothing right about it.
I would agree that it should be taking less time...whether it is or not, I couldn't say.
Companies 'hold' monies all the time...they all have their reasons. Those reasons certainly don't include any of us and our well being.
Not all of us. Some of us take great pride in paying ASAP after we are paid. Yeah, we could make a few extra bucks by holding the money longer but to us it's a golden rule kinda thing.
No reason trumps that. At least not any good and fair reason.
KUDOS to your company! I am certain that your customers/clients appreciate prompt payments...and they spread the word.
Apologies for being off subject - I had ordered a custom item from a large retailer. 30 days later, that item still hadn't arrived and after many phone calls I learned that it was never ordered. I went to the retailer to get a refund and was told I would have to pay a 're-stocking' fee! They not only had my money for a month - and failed to order the item - they wanted to charge me to put it back!! There wasn't a person in that place that didn't hear exactly what I said!! I wasn't nice at all...and NO, they didn't get to charge me that 'fee'.
Hopefully ethical pharmacists and pharmacy employees will do some good for customers. Overpriced medicine is an atrocity motivated by pure greed.
Nice work all around!