I hate Insurance Companies | ADHD Information
oh i know, it is so hard to make them understand with out getting ugly adn rude..adn then you have to fight once again for your child..THAT IS WHAT WE DO BEST..FIGHT FIGHT FIGHT!! it seems that when you finally get everyone on board the insurance company says nope not doing it...
we have tryed every medication out there but Daytrana patch, my 7 year old can not swallow pills!! so we have methyln chewables so far that works as long as we crush it up he doesnt like the aftertaste. WE changed insurance companys not by choice and for 3 weeks with no meds i had to fight to allow the chewable because thwy wouldnt budge on the patch!!
I moan about living in uk sometimes but at least our kids meds are free and no insurances to pay either.Saying that we are limited as to what is available.i feel your pain and join in your hate. for a specialist visit! lucky so far - dd hasn't needed any counseling and her meds are prescribed through her pediatrician. and the meds range. most are a month. but the patch is because it's so new. i really looked into all the different prices before we went for the appt. to start meds. it's upsurd! and the insurance co.'s love to fight with you at every turn.
Beckysmom39050.380775463
chjones,
Here is a little information on the author of that article (he also has a regular newsletter):
http://www.healthwatcher.net/Quackerywatch/Hulda_Clark/Bolen /index.html
http://www.quackwatch.org/search/webglimpse.cgi?ID=1&que ry=tim+bolen
He is a colorful character, to say the least.
well - here's an article that might be of interest to those who live in California. (whether it is completely biased or not - i don't know. take it up with the author of the piece!)http://www.bolenreport.net/feature_articles/feature_article0 42.htm
FEATURE ARTICLE
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< ="https://www.paypal.com/cgi-bin/webscr" method="post">California Legislature Votes to Kill the Health Insurance Industry....
Opinion by Consumer Advocate Tim Bolen
Sunday, November 26th, 2006
There is a war on in the United States over health care. On one side is the "status quo" represented by the medical monopoly, the pharmaceutical industry, the health insurance carriers, and an entrenched bureauracracy wholly beholden to, and run by, the people they are supposed to regulate.
The US system, according to the World Health Organization, is rated 72nd in quality, but number one in cost, worldwide. The "Death by Medicine" study shows that the system itself is the number one killer of Americans. The number two and three killers of Americans are heart disease and cancer, diseases which those of us outside of the "status quo" know are curable, and preventable - but those cures and preventive treatments are being suppressed by agents of the "status quo."
On the other side is a beleaguered America simply trying to find ways to survive.
(1) The medical monopoly is so evil, in itself, that medicine is no longer an honorable profession. For it isn't about helping people - it's about gouging money out of an unsuspecting public. For instance: there are five million legitimate health professionals working in the United States, three million of which are licensed by individual States, and two million of which are unlicensed. But only seven hundred thousand (14%) of those can bill health insurance, Medicaid, or Medicare for their services.
Why is that? Because the American Medical Association (AMA) has a contract with the US Department of Health & Human Services (DHHS) to write billing codes (about 6,500 CPT Codes) for ALL health professionals - but will not invent codes for anyone but those seven hundred thousand medical doctors (the number one killer of Americans). This, of course, means that all four million three hundred thousand other health professionals in the US, in order to get paid, must bill THROUGH an MD using "their" codes - so that the MD gets a cut of the money (and increases the costs). There are only two exceptions - out of the approximately 6,500 CPT Codes available, there are four codes for Chiropractors to use, and one for Acupuncturists.
(2) The pharmaceutical industry is so corrupt few Americans believe anything they say - despite their massive television advertising campaigns. Since the drug industry got permission from the US FDA in 1998 to advertise directly to the consumer the only change we've seen is a 500% increase in the price of prescriptions. The money seems to go for television news hour advertising.
(3) The US health insurance industry is rotten to the core. The biggest group of individual bankruptcies in the US are those that had health insurance for an illness and found out, the hard way, how the health insurance system actually works.
For instance: If you have an 80-20 policy, supposedly where the insurance company pays 80% and you pay 20%, and you end up in the hospital, generating a bill for 0,000, you are, very suddenly, handed a bill (to be paid immediately) for ,000. Do you think the insurance company is going to pay ,000? No, they are not, for the have a "deal" with the medical monopoly, and they generally pay, by my calculations, only about twenty two cents on the dollar - so their part of the hospital bill is going to be 22% of ,000 or ,600. Hardly 80%. YOU will write bigger checks than the insurance company will...
Only God can help you if you have a 50-50 insurance plan.
Worse yet, is that the average cost to a US employer for this health insurance is ,7000 per year, and employers in the US with over two hundred full-time employees are REQUIRED to provide coverage. Out of that ,700 premium, by my calculations, only about 9% goes to pay health claims. The rest is divided up long before - 40% commission to the health insurance broker that sold the policy to the company, 35% goes to overhead (insurance companies own marble buildings), 10% goes to the stockholders as a dividend, and 6% goes to miscellaneous, including the costs of lobbying Congress. That leaves only 9% to pay claims.
And if that isn't enough - several sleazy health insurance companies are filing "fraud" charges against health professionals with licensing boards simply because they don't want to pay claims - and several of those boards are actually prosecuting doctors over those billing disputes.
(4) The bureauracracy that regulates health care in the US is shameful. There is no arguing for the system. It has turned against America, and is operating not to regulate the industry, but to protect it from competition and change. Period. There is nothing more to be said. Facts are facts. Change is necessary.
Things are being done to fix these problems...
I don't need to go into detail here about how each of these problems, described above, is being attacked. Read my other newsletters, and you'll get the idea. Today I'm going to tell you about how just one of those issues is being addressed in, and by, the State of California. The health insurance issue.
Why is it important to study what California is doing? Because California is the fifth largest stand-alone economy on Planet Earth. It is a vibrant State, with vibrant people. What happens here migrates to other States quickly.
Sit down before you read this next section. You're going to be shocked...
The California Legislature, both the Senate and the House, have passed Senate Bill 840, which in effect, will make it illegal to sell health insurance within the State of California. The bill is heading for the Governor's desk.
I have, below, copied a section from a website for a group called "Health Care For All," where you can go to get even more information about SB840. The section is self-explanatory.
A bill creating universal healthcare through a publicly financed administration in California, authored by Senator Sheila Kuehl, D-Santa Monica, was introduced to the Senate in February, 2005. A copy of the bill is now available from the legislature. Download bill here. For ease of use, get our Table of Contents for the bill.
Available for download is a comprehensive Fact Sheet from Senator Kuehl's office. We offer a 10-page Word document about the Features of SB 840. Also available is a shorter summary, SB 840 Summary. See also a Fact Sheet in Spanish.
Principal workers on this bill are consultant Judy Spelman and Senate staff member Sara Rogers.
You can download a list of the co-authors for SB 840.
See a list of endorsing organizations that support SB 840. See a recent statement by the League of Women Voters- California showing their position on this bill.
The bill incorporates the following features:
Security - Everyone is covered. No one will ever lose coverage for any reason.
Choice
- Everyone can choose their doctors and other providers. Under this
single payer plan, health care delivery is in the private sector.
Comprehensive Benefits - Everyone has full benefits that include prescription drug coverage and mental health care.
High Quality -
Doctors and patients, not administrators, make medical decisions.
Hospitals can afford safe staffing levels for registered nurses.
Primary and preventive care are priorities.
Efficient Administration - Huge savings result from removing insurance companies from health care. Provider and patient paper work is slashed.
Fair Cost sharing - Employers and employees pay a modest health care premium, which is less than most pay now.
Fair Reimbursement - Providers receive fair and full compensation for their services.
Cost Controls
- Health care inflation is controlled by efficient administration,
global health care budgets, bulk purchases of drugs and durable medical
equipment, coordination of capital expenditures, and linkage to growth
of the State Gross Domestic Product.
I am an Orange County California Conservative Republican. SB840 is sponsored by Liberal Democrats and I wholly support it. Absolutely. It can't happen soon enough. I applaud the bill's sponsor, Senator Sheila Kuehl and her staff for their efforts.
Stay tuned...
Tim Bolen - Consumer Advocate
I JUST FOUND OUT OUR KIDS CAN HAVE BOTH INS. AND MEDICATE. THE MEDICATE WILL PAY FOR WHAT INS. DOESN'T. ARE YOU AWARE LAST YEAR THE INCOME REQUIREMENTS CHANGED. WE COULDN'T BEFORE BUT NOW WE CAN. I ALSO LEARNED ITS ALL IN HOW THE DR. RIGHTS UP THE DX TO BE BILLED. IT'S ALL ABOUT WHAT CODES ARE USED BY A DR. IS WHAT CHJONES IS SAYING.
Sorry OP, insurances can be so frustrating at times.
Our insurance won't cover Concerta for my son because it is a preexisting condition. Our one year is up in April that we'll have been on the insurance, by then maybe they will cover it.
The same thing happened to us...I feel your pain !!! My son started out with Focalin XR...we, too, got the first month free....the Focalion was AWSEOME for him !! When I went to fill the 2nd month...DENIED ! I was SO mad !!! So his doctor put him on Addrall XR 20 mgs a day. It works ok but the Focalin worked so much better.my dd is taking adderal XL in grape flavored applesauce and she says that she doesn't taste it. just an fyi!
shelley
my dd is taking adderal XL in grape flavored applesauce and she says that she doesn't taste it. just an fyi! ~shelleyA
Thanks Shelley! I'll give it a try! :)
Hi I am just fustrated right now. My Ds is 5 and was diganosed in Aug with ADHD. Well he was put on Ritalin sr and then taken off due to having obsessive behaviors. He was put on Adderall XR well I got the first script filled through a free trial from the makers of the med. Well this month when I went to get the new script filled, because it was going through insurance it got denied by the insurance. Now while on Adderall XR he was the best child I could have asked for. I fought with the Dr and insurance and the insurance still denied due to the fact that he is not 6 (even though he is the size of a 6 year old) nor has he failed on 2 other meds. He is now on generic Adderall he started on 5 mg twice a day and they had no affect on him. So today I called and the upped him to 10 mg in the AM and 5 in the PM. Next week he will go up again to 10 mg in the AM and 10 Mg in the PM. Why can't I just have him back on the XR where he just takes one pill a day. Sry this was long. Just had to vent.....I know what you mean! I really wanted my son to be able to try the Daytrana patch... but my insurance doesn't cover it. 
He does great while taking his Adderall XR, but he can't swallow pills and he hates taking it mixed in applesauce because it tastes nasty. We've tried icecream, syrup, chocolate syrup, nothing helps. I made the mistake of mentioning the patch to him, and now we can't get it.
I hope you are able to get the XR soon, and not have to go through the different doses throughout the day.
Thank You!!!I also know what you mean about insurance companies. My DS was prescribed Metadate CD did not work then on Concerta 18, 35, then 27mg. My ins. didn't cover any of them so I had to pay full price and what is so sad about this is the only prescription that worked was the 27mg of Concerta so now I am stuck with all of these "million dollar" pills because he only took a week worths of the others. My insurance company does cover the adderal but my doctor usually doesn't prescribe that one. The Concerta 27mg. works very well and I guess sometimes we have to do what we have to do for are children. It just means we might be eating beans and cornbread for awhile and less shopping. 
I feel bad for you guys and luckily have not had your experiences. Can the doctors give you samples?
I THINK ANYTHING DR.'S PERSCRIBE A PERSON SHOULD GET NO ARGUEMENTS FROM THE INS. COMPANIES. ARE YOU A WARE IT'S THE DR.'S INSIDE THE INS. COMPANIES THAT DECIDE WHAT GOES THRU BASED ON WHAT YOUR POLICY WILL COVER. I WAS TOLD THIS BY OUR INS. COMPANY UHC. I think lawmakers should pass a bill that makes insurance companies cover any medication that is proscribed for a child until they turn 18 years of age.I hate how they can decide what can be prescribed to your child, OK indirectly, but if a MD decides that what your child or any person needs, then insurance companies SHOULD HAVE to cover it. Its such a bunch of crap to put parents and families through this to try and do the right thing for a child or themselves or a loved one!My son is on Focalin XR and simple Focalin. We too have to get it filled every 3 months. We have to go in and have him write a new RX for it. It has something to do with the laws here in Ohio for us.
Our RX for Tyler are running us a month. VERY expensive to us, but it's my kid. I do what I have to do I guess! 
My son has medicade, and is on strattera but they only approve 3 mons at a time. So every 3 mons I have to call the DR and have them fill out the form that medicaid needs. Then I have to call medicaid and have them look it over and get it approved and if he had not have tried 2 other meds first and failed then they would not pay for what he is taking now.
That is so stupid why in the world do they have to approve a med every 3 mons that he has already been taking for 6 mons.
The other day I was on the phone between the pharmacy, the DR, and medicaid from 9 45am to 3 15pm. And then when I finally got his med filled. I got home and he was suppost to have 60 pills and he only had 6. So on monday I have to go through the whole thing again. I was SSSSOOOO Mad!!!!