Text 11168, 79 rader
Skriven 2007-01-31 02:41:47 av Amy Guskin (14605.babylon5)
     Kommentar till en text av rec.arts.sf.tv.babylon5.moderated
Ärende: Re: A quick note from your hosts
========================================
>>On Tue, 30 Jan 2007 20:58:16 -0500, Wesley Struebing wrote
(in article <octvr2pc83cebg0dmgv5333djoedeq8o2i@4ax.com>):

> On Tue, 30 Jan 2007 23:29:03 GMT, Amy Guskin <aisling@fjordstone.com>
> wrote:
> 
>> 
>> I hated United Healthcare when I had them, too, for about three years (the 
>> PPO).  This year, my husband's company (I'm self-employed so we get the 
>> insurance through him) changed to Aetna.  My prescriptions have gone up 
>> considerably, so I'm feeling very nostalgic about UHC these days.  :-(
>> 
>> Aetna's PPO goes by "POS," which I assume stands for "piece of shit."  :-p
>> 
> My insurance is UHC PPO.  And, for once, we've been pretty-well
> pleased with them.  There are few "AAARRRGGGHHSSSSS!!!!!", mostly
> dealing with their long-term prescription provider Medco
> (365wellstreet), but it apparently isn't relegated to just them.  Our
> doctor says she can't "prove" it, but it appears that the big
> prescription companies collude - one will cover one drug and one will
> cover another - but not both by one provider.  So, if you're in the
> boat, like my DW, where, say, Nexium is the only drug that really
> works on your reflux, you're screwed if you use Medco.  "It's not
> covered."  And if you have a different plan, something like, say,
> Plavix (this is just an example - not necessarily accurate) won't be
> covered.  It's like they're forcing physicians to prescribe what
> *they* want the physicians to prescribe, not vice versa. <<

I'm _very_ glad UHC was good to you and Molli when you needed them!

I have a lot of issues with them, but it may just boil down to it not being 
like Blue Cross/Blue Shield major medical back in the day, which was the 
Cadillac of health coverage.  I miss their coverage, but I don't miss the 
filling out of paperwork!

One thing I dislike about all the plans is the fact that they make it 
cost-prohibitive for you to use a local pharmacy for your ongoing 
prescriptions.  So, you get those meds from the mail order house, but then 
something happens and you need an 'on-demand' prescription for something in a 
hurry (dermatological/allergy emergency, unforeseen mishap that lands you in 
the ER, sudden illness, etc.).  Then your prescriptions aren't all in one 
place, which means you're potentially at risk for a bad combination of meds 
(because you don't have a single pharmacist cross-checking everything you're 
taking).  In general, it's preferable (IMHO) to have a local pharmacist, 
someone whose face you know and with whom you're comfortable asking 
questions.

But the biggest specific thing that made me not a fan was a simple phone call 
that turned into a near-aneurysm right before my second shoulder replacement. 
 I had called them about something very minor, just two weeks before I was 
due to go into the hospital.  Now, I'm fairly obsessive and careful, and I 
had done everything necessary to get the paperwork in order, all "t"s crossed 
and "i"s dotted, before that point.  And the person I was speaking to, 
instead of answering my simple question, proceeded to tell me that my surgery 
wasn't covered, and that neither my doctor nor the hospital were in network.  
I started out calmly, telling her that I thought she was mistaken, and I made 
sure she had my correct patient ID and all that nonsense.  This went on for 
quite some time before I started yelling, and by the time I hung up I was 
convinced I was either going to have to cancel my surgery or be out something 
like $80,000 for it.  When I'd had some time to calm down, I called again and 
immediately asked for a supervisor, went through the entire story with her, 
and found out that the person I'd spoken to was...simply mistaken.  
Just...wrong.  I had nearly had a stroke, thought I was going to have to 
cancel my surgery (and at this point the top of the bone was necrotic, which 
means _dying_, and that's not good!), and they weren't even all that 
apologetic!  I mean, that was a pretty serious mistake to have made, and 
someone who was less tenacious than me might have simply assumed they were 
screwed, and cancelled their surgery.  So, UHC is not my favorite company.

Amy
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