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Crashrat posted:I think a lot of the health insurers have been disingenuous in their press releases as well. actuaries aren't worth poo poo without useful data
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Oct 31, 2017 18:42
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evilweasel posted:actuaries aren't worth poo poo without useful data An insurer who does not collect lots of data is an insurer who does not last long. The insurance business is predictive by design.
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Oct 31, 2017 18:59
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Dance Officer posted:An insurer who does not collect lots of data is an insurer who does not last long. The insurance business is predictive by design. here is every single piece of data on major league baseball that has ever been collected, now design a model for setting the odds for the winner of the super bowl
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Oct 31, 2017 19:01
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Wouldn't RomneyCare have been a useful model for what early usage of ObamaCare would have looked like?
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Oct 31, 2017 19:02
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Sir Kodiak posted:Wouldn't RomneyCare have been a useful model for what early usage of ObamaCare would have looked like? So I'm not familiar specifically, but I imagine Romneycare succeeded because it was implemented in a blue state that didn't try to judicially sabotage it. I imagine Obamacare would look very different (note: but still not great) if it hadn't been kneecapped by the Roberts court.
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Oct 31, 2017 19:03
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Sir Kodiak posted:Wouldn't RomneyCare have been a useful model for what early usage of ObamaCare would have looked like? somewhat, yes, but insurers who didn't compete in Mass might not have had all the relevant data nor the data about how well it would translate to other regions or the peculiarities of obamacare it's not like the were working from a complete blank slate in 2013, and they have been collecting data since then, but it is not at all surprising that without the counterpart to decades of directly relevant data they have on employer plans it has been more difficult to accurately predict costs - and because of how the exchange works, whoever does the worst job predicting costs (in the downward direction) in a perticular market will tend to get the most people since it's the cheapest plan so you've got a selection issue there as well
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Oct 31, 2017 19:05
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Lightning Knight posted:So I'm not familiar specifically, but I imagine Romneycare succeeded because it was implemented in a blue state that didn't try to judicially sabotage it. I imagine Obamacare would look very different (note: but still not great) if it hadn't been kneecapped by the Roberts court. the issue is basically how well insurers could model the risk pools on the exchanges, which is a seperate issue from the overall heath of the system. republican sabatoge certainly made it more difficult though, but i suspect not nearly as much as just not having the right data
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Oct 31, 2017 19:06
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Dance Officer posted:An insurer who does not collect lots of data is an insurer who does not last long. The insurance business is predictive by design. The people being newly covered weren't insured before. That is the problem. There wasn't any good data on the group. You can't statistically model, with any certainty, a population you have little or no data on.
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Oct 31, 2017 19:09
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evilweasel posted:somewhat, yes, but insurers who didn't compete in Mass might not have had all the relevant data nor the data about how well it would translate to other regions or the peculiarities of obamacare That makes sense, thanks.
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Oct 31, 2017 19:13
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evilweasel posted:the issue is basically how well insurers could model the risk pools on the exchanges, which is a seperate issue from the overall heath of the system. republican sabatoge certainly made it more difficult though, but i suspect not nearly as much as just not having the right data The incredibly long and changing open enrollment periods were very annoying. We couldn't even get a full year's worth of data because 40% of the enrollment didn't show up until April/May. After realizing the health of the population, most insurers changed their products offered in 2016 and removed their broad PPO. This happened in 2016 instead of 2015 because we didn't have enough data for our 2015 rate filings as those were filed back in April 2014, so we priced 2016 rates based on 2014-2015 experience for products that no longer existed. 2017 was based on mostly 2016 experience, so it was one of the first time we were pricing with data for products that were actually being sold in the year we were filing, and 2018 was the first year we had a complete 12 months of data with enough run-out. It has been an interesting 4 years.
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Oct 31, 2017 19:15
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Odd - all the BCBS plans I'm seeing are PPO. Especially in the states where it's just BCBS on the Exchange they're all PPO plans. And while I get that there's no perfect model this is also a subject that's been studied at great length well before the PP-ACA was ever dreamed up. Was it possible for them to perfectly generate a risk model? No. But just taking this... Committee on the Consequences of Uninsurance posted:Persons uninsured for the full year incur total average annual expenses for health care services that are less than two-fifths of those of someone with either full-year private or full-year public coverage. Now is that a perfect data point? Hell no. But they get more granular still by looking at total utilization.  And also total spending  Now again I'm not claiming you can make a perfect risk model out of this. Of course you can't. But this concept that "well no one could have possibly known how much those poor people would use their insurance" is nonsense. This has been a very thorough studied topic in public policy for decades. All sorts of quantitative and qualitative data abound from theses, dissertations, books, and endless troves of peer-reviewed published articles. Hell the Kaiser Family Foundation on its own is basically a huge source of vetted data on the uninsured all on their own. The concept that organizations behind a huge chunk of the American economy - and were part-and-parcel of the drafting of the PP-ACA - had no time to gather information and start preparing some honest information to base their risk models around is nonsense.
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Oct 31, 2017 23:22
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Crashrat posted:Odd - all the BCBS plans I'm seeing are PPO. Especially in the states where it's just BCBS on the Exchange they're all PPO plans. The per capita spending of someone that is uninsured and the per capita spending of someone that was previously uninsured but now has insurance are two very different numbers. Also, BCBS is not a single company. The BCBS brand is licensed by the BCBS Association to a variety of independent corporations.
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Oct 31, 2017 23:45
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Reik posted:The per capita spending of someone that is uninsured and the per capita spending of someone that was previously uninsured but now has insurance are two very different numbers. I don't know how else to write what I said. I repeatedly said that you couldn't make a model off of those data points alone, but you can make extrapolations from those data points. At the bare minimum you can realize that their utilization is going to be at, or likely greater than, that of the average person that had health insurance previously.
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Oct 31, 2017 23:51
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Crashrat posted:I don't know how else to write what I said. I repeatedly said that you couldn't make a model off of those data points alone, but you can make extrapolations from those data points. Why can we realize that? Wouldn't some percent of our enrollment be healthy people simply buying insurance to avoid the mandate penalty?
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Oct 31, 2017 23:57
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Crashrat posted:I don't know how else to write what I said. I repeatedly said that you couldn't make a model off of those data points alone, but you can make extrapolations from those data points. yes, they made extrapolations, the problem was those were not good enough. you dont really understand what you are arguing against, nobody is like we had no data at all. ita that the data was not good enough so many insurers underpredicted utilization. because of how insurance works, 'close' can be 'not good enough'
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Nov 1, 2017 00:03
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You have to remember that the PPACA also introduced basic coverage requirements, eliminated coverage and enrollment consideration for preexisting conditions, did away with yearly/lifetime maximums, and introduced out-of-pocket maximums. These are all huge changes to the way health insurance worked. Together with the availability of low-cost, low-deductible, low-copay CSR plans, I hope you can see why prior data on usage would only be tenuously related to post-ACA usage. Even if you had information on usage by previously uninsured individuals, prior to the ACA those individuals would likely be a) moving to catastrophic plans, b) moving to Medicaid, or c) moving to employer coverage, all of which are very different situations from obtaining a CSR plan. Reik obviously knows more about this than me, but I imagine all of those factors needed to be considered in the models, and modelling each would require many many assumptions for which there was no quality data.
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Nov 1, 2017 00:26
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I live in Hawaii and I got kicked off Medicaid for the last three months of 2017 and had to sign up for a plan through the federal marketplace. The most cost-effective plan for me seemed to be silver HMO through HMSA. Just a bit more expensive than bronze, much cheaper than gold. So, I log in to get signed up for 2018. Premiums are higher than last year, but the tax credit is also higher to compensate. Also, somehow the premium for a silver HMO plan in Hawaii through HMSA is higher than a gold. I could get a gold plan for basically the same amount I'm paying for this silver plan for the last couple months of 2017. However, the bronze HMO plan for 2018 is far, far cheaper than either, so I'm going bronze for 2018. I'm 34 and healthy, so I don't anticipate going to visit the doctor except maybe to get a checkup and a flu shot. So hey, roll the dice and hope I suddenly don't get diagnosed with a chronic disease or anything.
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Nov 2, 2017 02:53
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paperwind posted:I live in Hawaii and I got kicked off Medicaid for the last three months of 2017 and had to sign up for a plan through the federal marketplace. The most cost-effective plan for me seemed to be silver HMO through HMSA. Just a bit more expensive than bronze, much cheaper than gold. I wouldn't really pay attention to the metallic nomenclature. All that really matters is HMO vs. PPO, what network, and premium/deductible/OOP max. Because in my state you's have to be an idiot to sign up for the state BCBS gold plan. It's the exact same network as the silver one, but you get a higher premium, higher deductible, and higher OOP max. They don't even get a relaxation on the office visit or prescription copays. Literally the only reason anyone would sign up for it is some misguided belief that "well it says gold so it must be better than silver."
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Nov 2, 2017 07:49
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How is that possible, I thought gold plans had to have a higher actuarial value than silver.
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Nov 2, 2017 07:55
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VitalSigns posted:How is that possible, I thought gold plans had to have a higher actuarial value than silver. This is what HMSA offers: https://hmsa.com/health-plans/individuals-families/metallic-plans/ I don't get the pricing in the slightest.
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Nov 2, 2017 08:46
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VitalSigns posted:How is that possible, I thought gold plans had to have a higher actuarial value than silver. They literally do- the actuarial value (percent of expected cost repredented by the premium) is tiered by metallic level. The answer to "why are these prices different" probably has to do with the provider network or formulary placement. Zauper fucked around with this message at 11:52 on Nov 2, 2017 |
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Nov 2, 2017 11:49
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paperwind posted:This is what HMSA offers: https://hmsa.com/health-plans/individuals-families/metallic-plans/ It's the Silver Plans that look out-of-whack compared to everything else. I'm guessing that when Trump eliminated the government subsidies for cost-sharing-reductions, it has a disparate impact on each of the individual silver plans. Because of the cost-sharing-reductions, the silver plans are a mix of people who get the cost-sharing-reductions and people that don't. So the "same plan" has a range of actuarial values between 70% (True Silver) and 94% (Extra-Platinum) depending on income level. The cost-sharing-reductions are still around - except they are paid for via higher premiums on silver plans instead of the government. If you are making more than 200% of the FPL, I would not recommend that you purchase one of the silver plans. Either way, I would recommend you talk with a health insurance navigator instead of us. esquilax fucked around with this message at 14:04 on Nov 2, 2017 |
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Nov 2, 2017 14:00
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VitalSigns posted:How is that possible, I thought gold plans had to have a higher actuarial value than silver. This is the insurance companies reacting to Trump cutting off CSR payments and is why that was a dumb idea in the first place to sabatoge obamacare, at least when telegraphed so far in advance.
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Nov 2, 2017 16:06
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Be sure to tell your friends about enrollment. https://www.youtube.com/watch?v=873z7x4RNZ4
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Nov 2, 2017 17:59
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evilweasel posted:This is the insurance companies reacting to Trump cutting off CSR payments and is why that was a dumb idea in the first place to sabatoge obamacare, at least when telegraphed so far in advance. It seems the general tactic was that the insurers sent in their premiums to their state regulators, one with CSR payments and one without, and the premium increases for CSR being stopped were all concentrated in the Silver plans to increase the APTC at as much as possible. Kaiser Family Foundation put out a nice webpage showing rate changes. Places like Oklahoma and Tennessee - which had increases in the 70%-ish range for 17, 70% for 16, 50% for 15 - have seemed to finally find their utilization and cost levels so they're actually dropping back down quite a bit except for rural areas. On average, though, most of the country @ 250%FPL is looking at either a reduction or at most a slight increase in their premiums. For people who have never had insurance because even a Bronze plan was more than they could spare each month it's highly probable they will be able to afford a Bronze plan at zero cost. Playing with the numbers myself the poorest Americans should definitely be getting on the exchanges because their APTC dramatically exceeds the cost of a Bronze plan, which means they'll be getting a nice chunk of change come tax time in 2019. However - the KFF page is leaving out the huge changes in how utilization is trying to be stamped down. Most plans I've seen don't start covering prescription benefits or office visits until AFTER the deductible is paid. The only exception to this I've seen is, thankfully, for outpatient mental health - but even then I'm not usually seeing copays, and instead seeing coinsurance. If the psych or therapist visit is $100 to the insurer, and you're paying 30% coinsurance, that's not break-the-bank expensive for the average household...but it is tough to stomach paying additional visits. Maybe we can make this chat about mental health for a bit since we have some people who work in insurance. How do insurers feel about the mental health requirement of the PP-ACA? I imagine psych visits aren't the biggest burden cost-wise. In fact if I had to hazard a blind guess that guess would be that actuarial value of psych visits is pretty high because the insured is likely to be able to better take care of themselves, the insured is more likely to engage in preventative health, and the insured is less likely to engage in high risk behavior. I can't imagine an insurer would prefer an unmedicated bipolar person to a medicated one. But what about therapy/counselors? This is a level of benefit that most people don't even realize the PP-ACA started covering. Cognitive-behavioral therapy can takes years to have a real effect. Don't get me wrong, I'm a huge fan of CBT and what it can do to improve people's lives, but I can't imagine insurers are too happy about paying for it. The only thing I can think of that holds back the onslaught of how expensive CBT can be to pay for is the general aversion to seeing a therapist that Americans tend to have, which keeps utilization low.
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Nov 5, 2017 19:36
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Crashrat posted:It seems the general tactic was that the insurers sent in their premiums to their state regulators, one with CSR payments and one without, and the premium increases for CSR being stopped were all concentrated in the Silver plans to increase the APTC at as much as possible. They were concentrated in the Silver plans because that is the only Actuarially sound place to put them. You can't justify raising the rates on Bronze, Gold, and Platinum plans for a benefit they don't receive. quote:Kaiser Family Foundation put out a nice webpage showing rate changes. Places like Oklahoma and Tennessee - which had increases in the 70%-ish range for 17, 70% for 16, 50% for 15 - have seemed to finally find their utilization and cost levels so they're actually dropping back down quite a bit except for rural areas. Fun fact, there's only one insurer on the exchange in Oklahoma. quote:On average, though, most of the country @ 250%FPL is looking at either a reduction or at most a slight increase in their premiums. For people who have never had insurance because even a Bronze plan was more than they could spare each month it's highly probable they will be able to afford a Bronze plan at zero cost. Playing with the numbers myself the poorest Americans should definitely be getting on the exchanges because their APTC dramatically exceeds the cost of a Bronze plan, which means they'll be getting a nice chunk of change come tax time in 2019. Insurers are never "not happy" about paying for benefits as long as they can rate for it. Behavioral health is an incredibly complicated field of medicine, and it's true that people can be seeing a professional for CBT for years or even the rest of their life and there be no reduction in overall medical spending for that person as a result, but as long as the insurer is aware of those costs and able to include them in the premium they don't care. Yes they want to keep premiums down, but every insurer has to cover behavioral health costs, so it's not like they're at a competitive disadvantage for covering it. Cover it, rate for it, and manage costs the best you can.
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Nov 6, 2017 21:22
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I suspect there is a lurking issue with mental health care coverage in that it has been undersupplied for so long that most companies are not properly covering or rating for it. If all historical data estimates are based on a quarter of the need actually being met, there's going to be a lot of resistance to attempts to properly meet the need, whether that means lack of provider networks or aggressive denials of aggressive (but justified) coverage requests. Said another way, the first provider to budge and start covering things that other providers aren't covering is very definitely at a competitive disadvantage, even if all of them *should* be covering it.
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Nov 7, 2017 19:33
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This is a long loving post. Sorry. It seems some insurers have been playing with this over the first few years of exchange plans. While they're required to cover it there's no requirement for how much the insured has to pay on their end. So I've seen BCBS plans that started out with outpatient mental health as an office co-pay. A year later the equivalent plan made that same outpatient care no cost. Now this year BCBS seems to be going away with office visit co-pays entirely, and instead switching to full pay until deductible is met followed by a 30-40% coinsurance after that - and mental health was included. Yes I realize each state's BCBS is different - just talking about the ones I've looked at, which are by no means a representative sample. I think this is BCBS approach is swinging a little hard the other way. The attempt to discourage utilization makes sense if you're talking about emergency room visits - does that laceration really need stitches or should you try a tourniquet for 30-60 minutes to see if the bleeding is stopped - but applying it to specialists and ESPECIALLY primary care visits is heavy handed. But they're even doing it for mental health. I have no doubt the approach will reduce utilization, but the entire point of discouraging utilization is for when it's overused. If you're a recently diagnosed psych patient it can take months, or even years, to find the right balance of medications for you. These situations can turn bad fast and those patients need to have as few barriers as possible between them and seeing their psychiatrist to get things adjusted. But beyond that those mental health patients who are actively receiving psychiatric care (even if it's outpatient) should almost be required to also have cognitive behavioral therapy as part of their treatment. Medication can only do so much for mental health - we don't have a magic bullet. Story time - skip to next bold header if you don't care Most people don't realize how difficult psychiatry is to practice. Drugs pass FDA review, sure, but then it turns out they don't work on your patient because in almost every psych case the patient has multiple diagnosed conditions and the drugs are basically never tested in those environments. Add on to this the truly awful things that happened with the marketing of Risperdal by Johnson & Johnson that led to many psychiatrists blindly prescribing it to people who absolutely should have never been on the drug...but the drug rep convinced them, and the psychiatrist just kept increasing the dosage. Hell I've lost track of how many psychiatrists I know that have patients with chronic migraines and at least one psych condition. The psych puts them on an atypical antipsychotic. The patient gets migraines so they see a neurologist, get a brain MRI w & w/o contrast, and no one finds anything physically wrong so they give the patient a bunch of different triptan-class drugs to try to take out the migraines. The patient's migraines are daily so they take the triptans too often, and the neurologist stops refilling them because of rebound effect. The psych says they have no idea other than that they absolutely have to stay on the atypical they were prescribed (which is usually Risperdal or Abilify). And none of them realize that the reason the patient's migraines can't be treated is that both of those drugs have an effect on the serotonin receptors (5-HT1B & 5-HT1D) that the triptan-class migraine medications have to work on to treat migraines. For Abilify we know it has a strong affinity for those receptors, but we don't know if it's an agonist or antagonist. More troublingly - since it's so commonly prescribed - Risperdal is an antagonist albeit a weak one on those receptors. And patients can come in on *huge* doses of Abilify or Risperdal. So huge that even though a triptan migraine medication might have a higher affinity there's just so damned much of that atypical antipsychotic in their blood that the triptan doesn't really have a chance of attaching to the serotonin receptor site. The solution is generally either getting the patient on Geodon as a first step - which is what an insurer would prefer since it's available as a generic - or getting them on Latuda. Insurers really don't want to cover Latuda because it's only available as a patented brand name right now. Which would be fine assuming Geodon could treat everyone. It can't. For a huge myriad of reasons just because a drug happens to be an atypical antipsych that doesn't mean it's going to work on the patient. Indeed the drug could make things worse. Sometimes it feels like throwing spaghetti on the wall and seeing what sticks. So sure the Geodon's partial agonism of the same receptors helps alleviate migraine symptoms AND lets the triptans work...but if it doesn't solve the psych problem you've accomplished nothing - the patient might as well literally not be treated with an atypical at all if it's not working for them. Which leaves you with Latuda. Now the patient has a drug that's less likely to cause migraines, and if there are migraines, then Latuda doesn't even touch those serotonin receptors - which means those migraine medications now work without any other partial agonists competing at the site. Hooray right? Wrong. Because Latuda is loving expensive, and insurers not only require step therapy to prove that a whole list of cheaper drugs don't work, but for 2018 a lot of them are not only requiring the insured to pay in full up to their deductible for all prescriptions...but for non-preferred brand name drugs the coinsurance is as high as 40 loving percent which can make a patient's month of being sane without headaches cost them around $500 just for the Latuda in 2018. Yeah there's a prescription savings card, which shaves off a maximum of $125 for a patient, but that's not going to do jack poo poo for a patient that could barely afford the $100 it was in 2017. Even Botox for migraines won't do a damned thing if you're still on an atypical psych that causes migraines. You have to change the treatment. And I never even touched on non-compliance in the above, which just fucks up everything, because unsurprisingly mental health patients have some of the biggest aversion to taking medication. It's almost as if their perception of reality is wrong. It's almost as if they have a disease. Not that any insurance company gives a drat. End of Story Time TL;DR - Practicing psychiatry is tough, there's rarely a clear route forward, and it requires actually learning about how the drugs work in conjunction with all of the other drugs the patient is taking for all of their conditions. Its labor intensive because they don't even make software (yet) to do this for you - the doctor or pharmacist is going to have to actually spend the time to manually research it. Yeah there's some stupidly expensive software out there for doctors...and even though it would literally just be a cross-tabs for Ki(NM) the software doesn't do it. Or atleast the stupidly expensive software that uses public domain information I've seen doesn't do it. A lot of doctors - pretty much ALL pharmacists - can't be bothered to learn the basics outside whatever the pharma rep told them or what's on the computer screen because they're expected to have such high production levels. Reading the prescribing information? Maybe...and then forgotten before the end of the day outside what the medication was for. So sometimes the only route forward is a drug that costs a lot, and insurance says "nah you can either fork over $500 a month or have constant migraines - doesn't matter if it's literally the only treatment available". So I see 2018 as being a very bad year for mental health. * The stigma against getting help is still just as bad as it always was * The only thing working against that was the reduced cost of getting help * The cost for getting help is going WAY up in 2018 * Insurers treat mental health medications as if they're all equivalent and the patient should just take the cheapest one * poo poo doesn't work that way * Patients get hosed over Mental health alone is a major reason I support a drastic change in our healthcare system - single payer at a minimum. There's no reason whatsoever a person should have to choose between being: * a threat to themselves and others * constantly living in pain from medication * giving up a huge chunk of their income just to be able to live a normal life. Telling someone they get 1 of the above is hosed. That's basically where we are right now with mental health. I really was excited in 2017 for the changes BCBS made to make mental health more accessible and affordable for patients - a lot of people finally were starting to get the help they needed - but come 2018 those same people are going to stop seeing their doctor, not refill their prescriptions, and definitely skip out on therapy. Which means all of the money spent by insurers to let these people start their treatments might as well have been thrown in a dumpster fire. Crashrat fucked around with this message at 09:42 on Nov 8, 2017 |
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Nov 7, 2017 21:45
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Crashrat posted:
This isn't true - the Mental Health Parity Act of 2008 and the subsequent regulations make it so that mental health and substance abuse services need to have cost sharing that is no higher than the cost sharing required for other (non-MHSA) benefits. The testing for compliance with this is actually pretty onerous and strict
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Nov 7, 2017 21:59
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Crashrat posted:Because Latuda is loving expensive, and insurers not only require step therapy to prove that a whole list of cheaper drugs don't work, but for 2018 a lot of them are not only requiring the insured to pay in full up to their deductible for all prescriptions...but for non-preferred brand name drugs the coinsurance is as high as 40 loving percent which can make a patient's month of being sane without headaches cost them around $500 just for the Latuda in 2018. I'm not going to tell you this isn't a lovely situation, I'm just saying maybe you should re-direct your anger from BCBS to the pharmaceutical company charging $1,000 a month for Latuda? https://www.law360.com/articles/892460/sunovion-gets-2-latuda-generics-blocked-sues-over-a-3rd
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Nov 7, 2017 23:41
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esquilax posted:This isn't true - the Mental Health Parity Act of 2008 and the subsequent regulations make it so that mental health and substance abuse services need to have cost sharing that is no higher than the cost sharing required for other (non-MHSA) benefits. Right so BCBS is just applying the same 30% coinsurance, after deductable, to both normal PC visits and to specialist visits. Problem solved for the parity problem. Reik posted:I'm not going to tell you this isn't a lovely situation, I'm just saying maybe you should re-direct your anger from BCBS to the pharmaceutical company charging $1,000 a month for Latuda? Just because a generic rolls out doesn't mean the price drops. New generics tend to price, at best, 20% lower. A good example of this is something like generic Nuvigil (armodafinil) which Teva makes both the brand and generic version of so they're literally the same thing. Cost-wise Texas's Department of State Health Services puts Latuda in their Tier 1 prescription - meaning their state psychs can prescribe that for the state to cover it without any prior authorization. It's literally easier for someone in Texas to seek public assistance for mental health than to go through the private sector. Further I really glossed over the step therapy bit. There's nothing quite like knowing a drug is highly unlikely to work, but you've got to put the patient through a therapeutic regimen of several other drugs before the insurer will cover it. You don't just start taking one atypical and switch to another atypical. You have to titrate up to a potentially therapeutic dose. Then they have to stay there for 6 weeks. If it doesn't work, and the patient is basically a non-functioning adult who has to be driven around just to get to the doctor's office, then you get to titrate them back down. Titrating up and down on its own may be able to be done in as little as a week or it could take several weeks to a month. While there are 'standard' titration schedules they're typically pretty aggressive and can send even a fairly stable person off into a lovely existence fast. So most psychs go slow and do it over a month to be safe. All said and done I've seen BCBS require at least FOUR other atypicals be used before they'd cover Latuda. So 6 weeks at a therapeutic dose followed by 4 weeks in titration down, usually another 2 weeks to reach therapeutic dose, and you've now got a regimen that takes 3 months to complete...and BCBS wants that done 4 times before they'll cover a drug that everything the patient has presented with telling you that Latuda is what will work. That's a solid year of someone having their mental health constantly hosed with all to make an insurer happy that there wasn't a cheaper option available first. All while a bastion of progressive thought like the government of the State of Texas will let their state-funded doctors prescribe it on day one without being second guessed and made to jump through all of those insane hoops. Have private health insurance so you're stuck dealing with the hell I've described above PLUS Latuda being too expensive? Texas will loving pay for it for you. With all of the above in mind are you still certain you want to say this is entirely Sunovian's fault? Crashrat fucked around with this message at 06:20 on Nov 8, 2017 |
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Nov 8, 2017 06:16
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Crashrat posted:
Maybe this is why social insurance shouldn't be handed to for profit insurers to salami slice into profitability
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Nov 8, 2017 06:21
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Reik posted:I'm not going to tell you this isn't a lovely situation, I'm just saying maybe you should re-direct your anger from BCBS to the pharmaceutical company charging $1,000 a month for Latuda? Jesus loving Christ, Reik, have you no shame? Is someone paying you money to defend the loving insurance companies online?
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Nov 8, 2017 06:23
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WampaLord posted:Jesus loving Christ, Reik, have you no shame? Is someone paying you money to defend the loving insurance companies online? Maybe, just maybe, I have an informed opinion on the actual causes of the significant healthcare costs in the US.
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Nov 8, 2017 06:32
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Aren't you the guy that got pilloried earlier this year for defending insurance companies until you admitted you work for an insurance company?
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Nov 8, 2017 06:34
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Reik posted:Maybe, just maybe, I have an informed opinion on the actual causes of the significant healthcare costs in the US. That's why when you were singing the praises of private Medicare Advantage plans, you conveniently left out the fact that their only advantage is a law barring Medicare Part D from negotiating prescription drug prices, right?
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Nov 8, 2017 06:35
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Reik posted:Maybe, just maybe, I have an informed opinion on the actual causes of the significant healthcare costs in the US. and as you have assured us repeatedly, your role in determining who's expensive enough to be worth risking prosecution for rescission over- I'm sorry, "identifying policies with a suboptimal risk profile"- plays no role in this exercise
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Nov 8, 2017 06:39
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Crashrat posted:Right so BCBS is just applying the same 30% coinsurance, after deductable, to both normal PC visits and to specialist visits. Problem solved for the parity problem. That’s a lot of words and effort for a glorified Geodon.
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Nov 8, 2017 06:41
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Nocartax posted:That’s a lot of words and effort for a glorified Geodon. Latuda has a far narrower set of pharmacokinetics than Geodon. If you read the post I made above the one you quoted you'll see where I explain how specifically with migraine patients Latuda is pretty much the only option because it doesn't interact with 5HT-1B or 5HT-1D at all, which means it doesn't have to compete for affinity with the triptan-class drugs that are used for migraines. For migraine patients Latuda literally means they can live a normal life with both their psychiatric condition managed AND their migraine condition managed - they don't have to choose one or the other - and that's nothing to scoff at. Both can be debilitating to the point of permanent disability. Crashrat fucked around with this message at 09:32 on Nov 8, 2017 |
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Nov 8, 2017 07:07
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Lightning Knight posted:Aren't you the guy that got pilloried earlier this year for defending insurance companies until you admitted you work for an insurance company? I have never denied that I work as a credential Actuary for a health insurance company. I also think healthcare should not be a for-profit industry and support single payer/UHC. VitalSigns posted:That's why when you were singing the praises of private Medicare Advantage plans, you conveniently left out the fact that their only advantage is a law barring Medicare Part D from negotiating prescription drug prices, right? I have stated that the issues around drug prices and medicare part D need to be addressed, but insurers do not make money off of incredibly high drug costs, they lose a ton of money when a new drug like Sovaldi hits the market. Medicare Advantage plans have other advantages: they use the Medicare fee schedule as opposed to negotiated rates, they have a risk adjustment model similar to the one used in ACA, they utilize value-based incentives for insurers in the form of the star ratings and shared savings programs, they can participate the the ACO Medicare shared savings program, etc.
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Nov 8, 2017 18:50
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