OK so big brother saw me and the RN case managers called

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HabsHockeyFan
Veteran Member


Date Joined Jan 2006
Total Posts : 3130
   Posted 10/31/2007 9:31 AM (GMT -7)   
I work in insurance so I understand why the carriers have nurse case managers.  They really do help those who have uninformed or unhelpful docs and can be a great resource.  BUT...I am an educated consumer with a fantastic GP and a well respected GI.  I looked up Imuran and 6mp to see the costs...deciding which one is better by price now.  Heck, while I'm in there I'll see what the costs of Humira are.
Big mistake becuase the next day the case manager called to "discuss my benefits".  I know it was just to find out how to control my medical care costs.  I explained that I am an underwriter who analyzes future care costs every day, my doctor is very involved in my care, I spend time researching on my own and I understand my medical diagnoses well---I do not need their intervention.  I don't think they were happy.  Oh well, they can manage someone who does not do it on their own...I just don't like that just looking up something can red flag you...what if I looked up meds for someone else and they had cancer...would I be labeled as having cancer???
 
By the way... holy crap (pun intended) Humira is pricey!
Dx'd '90 (emergency rupture), symptoms ignored long before that, '03 fistulas and bad flagyl reactions, B12 weekly, Pentasa [until I surrender to the bigger meds]
I'm riding on the escalator of life....


njmom
Veteran Member


Date Joined Apr 2006
Total Posts : 1884
   Posted 10/31/2007 10:00 AM (GMT -7)   
We just got bill a for our consultation last month with a Mt. Sinai doc...$790! Luckily, it was a mistake because the insurance company should have been billed.
 
What really gets me is I've seen other bills, like a $1,200 X-ray - but the insurance insurance carrier gets a discount, which means it only has to pay $300.   
 
I suspect this is one reason why the costs are so high for the uninsured - the insurance carriers are paying ridiculously small amounts, so the medical providers are really sticking it to the uninsured in order to make up the difference. 

hspenser
Veteran Member


Date Joined Dec 2005
Total Posts : 544
   Posted 10/31/2007 10:05 AM (GMT -7)   
Big brother of 1984 just took longer than orwell thought.....here in the tampa area they are now putting up over 100 video camera's to watch for crime....I know they already have 1000's of these through out the country and world....but it does make one think about true freedom when it is possible to track your every move, or listen to every call you make, and conversation
you have.  What happened to you for many folks just falls under "good business practice".
 
As for the cost of the Humira....I don't understand how those without insurance can afford it....I know that the producer of Humira will help some of those who need it....but what about the person of middle income who doesn't have any insurance?  They earn too much to get help and not enough to afford the $1,600 to $3,200 monthly expense.  If I didn't have insurance, the first $50,000 of my yearly pre-tax earnings would have to go for the humira. 
 
dx IBS 1999   UC 2000   CD 2001
Tested BIOGEN TYSABRI (gave me 2 years of remission)
currently on Low Dose Netroxene (started Jan. 19, 2007)...against Dr's wishes, he was pushing for Remicade.  Stopped the Naltrexone July 28th...started Humira Aug 31st, 2007...current dose two shots every other week.
Crohns is currently active and has been since April of 2005
51 yrs old


Glad Bag
Veteran Member


Date Joined Mar 2007
Total Posts : 699
   Posted 10/31/2007 11:01 AM (GMT -7)   
Habs....what do you mean you "looked it up"? did you go on your insurance company's website to look at the cost of drug copays? or were you looking them up somewhere else on the net? I don't really believe that the ins. co's are that sophisticated yet that they can respond that quickly to someone doing research on the costs of meds. Are you sure that's why they called you, or is it maybe a coincidence?

as for big brother....sadly since 9/11, we have lost our constitution in the states...but not to fear, we will get it back. Elections are coming and last election was decided by less than 600 votes! that means we can call make a difference...

We have it far better than many other so called "civilized" nations. IN the UK, they don't even have a constitution, and there is one closed circuit video camera for every 15 people, more are added daily. If someone 'watching" a CCVC sees you litter, they can chirp in on a speaker and tell you, "hey, pick that up!"

Yes, there is a tendency towards more surveillance these days, but what do most of us have to hide? most of us are pretty average people, whose day to day activities would bore the hell out of anyone constantly watching anyway?
"All we need is love....love is all we need"


HabsHockeyFan
Veteran Member


Date Joined Jan 2006
Total Posts : 3130
   Posted 10/31/2007 12:00 PM (GMT -7)   
Glad...I looked on their site. had to to find out what my cost would be. I am sure that between that and having scopes and other tests that I have not had in 3 years flipped a trigger in the case management department.

And you're right...we may be watched more than ever, but we still have it pretty good. I have always been a "rule follower" type person so I don't worry if anyone watches or listens in....heck let them even smell while I'm in the potty. As long as I am still able to express my opinions, I am not worried. I just hate that I knew this was coming as soon as I typed on their site.....find someone who needs your help because I'm always right and I know it :-)
Dx'd '90 (emergency rupture), symptoms ignored long before that, '03 fistulas and bad flagyl reactions, B12 weekly, Pentasa [until I surrender to the bigger meds]
I'm riding on the escalator of life....


RedAdmin
Veteran Member


Date Joined Aug 2003
Total Posts : 1017
   Posted 10/31/2007 12:48 PM (GMT -7)   
I had a case worker with my last insurance. Basically I had to check in on where I was to get her to approve continueing my meds. I agree and thought it was a real pain, but it was what I needed to do to get the Cade.
Red (Lee Ann)
 Happy Bunny 
      When life gives you lemons, squirt juice in your enemy's eyes.


rootsmith
Veteran Member


Date Joined Jan 2004
Total Posts : 598
   Posted 11/1/2007 1:37 PM (GMT -7)   
I got a phone call a few months ago from my insurance asking me if I was interested in taking part in a group "based on the type of claims I have made". Something called "Complex Care" I was very embarassed.
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin and now trying good ol' zoloft

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