<p><a href=“http://www.fchp.org/providers/pharmacy/~/media/Files/FCHP/Imported/Sandostatin_octreotide.pdf.ashx”>http://www.fchp.org/providers/pharmacy/~/media/Files/FCHP/Imported/Sandostatin_octreotide.pdf.ashx</a></p>
<p>Monthly cost in this instance is
$5,010 a month.</p>
<p>It is amazing that the LA Times has to vet a WSJ opinion piece.</p>
<p>"but did say that the old plan cost $5,000 a month in premiums to cover four family members. When it was canceled, BC/BS offered a substitute plan with a monthly premium of $11,000, which Dr. Blackwood quite properly concluded was out of line. "</p>
<p>Wow. Georgia insurances sound cheap by comparison.</p>
<p>:). That is good, Texaspg. :)</p>
<p>And how many families can afford 5,000 a month in premiums?</p>
<p>I don’t know if anybody here is from Southern California, but if you read the LA Times you would know that Hiltzik, the author of the article, is a hardcore left-wing liberal who thinks anything less than a single-payer-govt-takeover of healthcare is an outrage. He has written numerous articles defending Obamacare, although he thinks it doesn’t go far enough. He is hardly objective.</p>
<p>He is being disingenuous to suggest ACA has nothing to do with this. Because of the essential benefits every policy has to have and because every person with pre-existing conditions must be covered with restrictions on how much you can charge based on age, the only way to keep premiums at a level which would satisfy the regulators was to severely restrict networks and formularies. This denial of life-saving drugs and treatments wasn’t happening prior to 2014 to the degree or scope we are now seeing.</p>
<p>Also, to blame it on the fact it was a federal exchange as opposed to an exchange created by the state is nonsense. The same thing is happening in California. The same dynamic is at work regardless if it is federally-run or state exchange.</p>
<p>BTW, to say the answer to this problem is to go hat in hand begging for charity from the drug company is absurd.</p>
<p>The denial of lifesaving drugs was indeed happening to a large degree… when people with pre-existing conditions were denied insurance. The plan this woman had was pricey: $60,000/year for a family of four is a fortune. That particular plan was in its death spiral: only very sick people would remain in such a plan. It would soon have been cancelled, as Hiltzik points out, to get rid of the expensive subscribers. </p>
<p>And then that woman would have had no insurance at all, because no insurance company would take her on. </p>
<p>GP, you seem to pining for the good old days when sick people could have great insurance provided they paid $60,000 a year. But I wonder about how a woman with the same kind of cancer, but who couldn’t afford $60,000 a year, would have fared in those good old days. Most people can’t afford $60,000 a year.</p>
<p>Uhhhh…I would give begging a shot.
I read somebody was given the drug for free for a year. </p>
<p>CF, you love your straw man arguments. Hiltzik is hyper-partisan so be careful with his reporting. We know nothing about this policy. Maybe it was zero deductible policy for 4 people covering 100% of all expenses. That type of policy would cost a lot of money. </p>
<p>Sick people could have insurance for a lot less than that in the good old days. Once you had insurance in the individual market, the insurance companies couldn’t cancel your policy nor raise the premiums for getting sick. The problem was a relatively small percentage of the population with preexisting conditions who couldn’t get insurance. There were other ways of dealing with this problem rather than messing with the insurance for millions of people.</p>
<p>You can try asking the insurance company to subsidize the drug, but it is not an ANSWER to the problem of narrow formularies which are not making life-saving drugs available to subscribers. Think about it.</p>
<p>Think about paying $60,000 a year for insurance, GP. Think about what percentage of American families could do that.</p>
<p>CF, read my post again!</p>
<p>
</p>
<p>They could raise the premiums for the whole plan, and they could cancel the whole plan. And they did. How do you think this family ended up with that insurance policy in the first place? They ended up there because the insurance company kept raising rates every year and they couldn’t leave.</p>
<p>There are probably tens of thousands of people in the plan. Her illness is not going to cause an increase in the premium for the entire group. </p>
<p>Like I said, if you have a plan with no deductible for four people it could cost a lot of money. We just don’t have enough information for you to make up hypothetical scenarios for this woman so you can justify the existence of Obamacare. </p>
<p>Exactly, Fang. They weren’t allowed to boot someone for getting sick (although they sometimes did anyway). But they could force you to downgrade your coverage year after year, by raising the plan’s premium by 10, 15, 20 percent or more, year after year. And as you point out, you had no choice but to go along if you wanted to cling to your ever- dismissing coverage.</p>
<p>“although they sometimes did anyway” </p>
<p>It was against the law to boot someone because they got sick.</p>
<p>“you had no choice but to go along if you wanted to cling to your continually dismissing coverage.”</p>
<p>You could do what I did and move (without underwriting) to a policy with a higher deductible. I did this numerous times and was very happy with the insurance I had, certainly happier than the lousy insurance I was offered for 2014. </p>
<p>
</p>
<p>GP. Do a little arithmetic here please. A plan with no deductible is not going to cost more than the premiums for a plan with a deductible, plus the deductible. </p>
<p>That is, if you were offered a plan for $20K a year with a $20K deductible, that same plan with no deductible couldn’t cost more than $40K, because nobody who was not a complete moron would pay $60K for a no-deductible plan when they could get the same plan for $40K just by paying the deductible. </p>
<p>So what premium and what deductible do you imagine this family could have had? Remember, the total of premiums and deductibles has to add up to more than $60K. After you tell me that, tell me how many people could afford your proposed plan.</p>
<p>“That is, if you were offered a plan for $20K a year with a $20K deductible”</p>
<p>Where did this come from?</p>
<p>“You could do what I did and move (without underwriting) to a policy with a higher deductible. I did this numerous times and was very happy with the insurance I had, certainly happier than the lousy insurance I was offered for 2014.”</p>
<p>Did you have underwriting problems?</p>
<p><a href=“Who really cost Mrs. Blackwood her cancer medicine?”>Who really cost Mrs. Blackwood her cancer medicine?;
<p>I want to repost this again. I know bluebayou doesnt like ACA, but he does post some good stuff. I respect that.</p>
<p>I want to highlight this because this shows what happens to people when they get something bad. Anthem looks very bad to me here. What plan is out there for 10,000+ a month? Anthem was SCAMMING this woman.</p>
<p>"Blackwood didn’t respond to my request for more details, but I did reach his father, Robert, a family physician. He wasn’t sure of the reason for the cancellation either, but did say that the old plan cost $5,000 a month in premiums to cover four family members. When it was canceled, BC/BS offered a substitute plan with a monthly premium of $11,000, which Dr. Blackwood quite properly concluded was out of line. </p>
<p>She finally made a deal with Humana, after receiving assurances that all her treatments and medicines would be covered 100%, after the deductible. </p>
<p>But Humana’s agents couldn’t verify that Sandostatin was in its formulary–that is, covered by her plan–until she signed up. She did, and in mid-February belatedly was informed that it’s not covered. Humana refuses to cover the bill, which year-to-date is $14,000. The family says the disapproval is under appeal.</p>
<p>Dr. Blackwood acknowledges that health insurance pre-ACA “wasn’t a perfect system.” He told me that when the ACA was enacted, “my concern was about how it was going to affect my practice. But this other side of the coin”–how it affects his family–“is probably a bigger challenge.”</p>
<p>But let’s try to figure out what’s going on here. First, we don’t know why Blue Cross/Blue Shield canceled the old plan. We can say almost certainly that the sole reason isn’t that the plan failed to provide benefits required under the ACA, because even adding those couldn’t conceivably justify raising the premium to $132,000 a year for a family of four. </p>
<p>As for Humana, its most expensive plan in Virginia for a four-person household appears to be a silver-level plan costing about $1,500 a month, with a maximum family out-of-pocket of $12,500 (for in-network care). It isn’t clear if this is what the Blackwoods signed up for, though Dr. Blackwood told me he believes they bought a silver plan from Humana. "</p>
<p>If Humana’s word was good this woman was going to save so much money. </p>
<p>I dont see how this story is good for Humana or Anthem. Anthem offers a family a policy for $11,000 a month knowing they have policies that can insure this family for $1,500 a month or so. </p>
<p>WOW!!!</p>
<p>WOW!!!</p>
<p>yes, but if there was no Obamacare, you wouldn’t be dealing with this 10,000 a month plan. Presumably her plan wouldn’t have been cancelled.</p>
<p>I don’t think I had underwriting problems but I was happy with the plans offered without underwriting.</p>
<p>LOL, thanks dstark for quoting the entire article for the reading-challenged posters. You’re too much! </p>
<p>GP says, “There are probably tens of thousands of people in the plan (the health insurance policy that was costing this woman 60K a year.” </p>
<p>There may have been tens of thousands of people in the plan, but I doubt there were even ten healthy people. No healthy family would pay $60K a year, when they could get a similar policy for less than half as much just by changing insurance. Only people who couldn’t change insurance-- expensive sick people-- were left in that plan. Everybody else left. </p>
<p>That’s the way it works. The insurance company jacks up the rates every year, and each year the subscribers get older and sicker. And when the subscribers left in the plan get too sick and cost too much, the insurance company cancels the plan because it no longer makes money.</p>