Epi pens do expire. We used the expired ones to “practice” on oranges.
2 Likes
yes, they do expire. Likely they’re good somewhat after the date. Sorry, when I said I have had it since the 1970s, I didn’t mean literally the same epipen LOL, but the Rx/need.
As others said, you can use the “expired” ones to practice on old fruit, which we did in teacher training.
2 Likes
My friend’s D had a very severe peanut allergy. She was required to provide epipens to the school, and they couldn’t be expired. She said that in addition to being ridiculously expensive, even with good health insurance, they had a very short time to expiration. She would never have not provided what her D needed, but she was concerned that other parents were unable to do the same for their children.
1 Like
I had to have my parathyroid removed because it had been nicked during a thyroid surgery and was malfunctioning. The ONLY remedy for my problem was surgery. The surgeon would not do surgery without an ultrasound prior to surgery to help locate my parathyroids. Nonetheless, the insurance company would not pay for the ultrasound on the alleged ground that it was not medically necessary. It makes no sense. The hospital ended up having to pay for it bc it couldn’t charge me for something the insurance company said was not medically necessary. Strange.
2 Likes
I am over 65. I signed up for Medicare & purchased supplemental insurance for over $300 per month, on top of Medicare. When I was notified that the cost was increasing, I signed up for one of UHC’s PPO Medicare Advantage plans “sponsored” by AARP & purchased the dental rider. All my doctors were in network. For a while all was fine except for a few minor issues.
Then I needed to see an oral surgeon. The first 10 or so I called–using the list provided by UHC–said they did not accept UHC or were retired or, in one case, I found her obit–which wasn’t recent. I finally found one who took it. However, when I got there he said he would charge me more. I had wasted so much time trying to find a doc that I agreed.
UHC paid not one cent of the charges. I had to go for a dentist for treatment after that. The dentist asked for preauthorization. All of the charges were denied. It took UHC about two months to make a decision. The “platinum” dental rider I had cost me more than if I had paid everything the plan did pay for out of pocket. So, I am not so happy with UHC.
I 'll need cataract surgery sometime in the next 2 years. I decided to be proactive and figure out which Medicare Adv plan has the best coverage for the surgery during the annual “open enrollment” period.I invested at least 20 hours trying to figure this out, but couldn’t. Below is what I think is right after my research, but I may be wrong.
Original Medicare only pays for standard monofocus intraocular lenses (IOL). In some states it only pays for “conventional” catarract surgery. In other states, it pays for LASIK, if the doctor’s charges are the same for both. NY is not on the list of those where you can have LASIK.
As long as you’re having surgery, most docs will insert non-standard IOLs if you need them. I know I’d benefit from a toric lens in one eye. I’ve worn a toric contact lens to correct astimatisms in that eye for decades. I cannot see at all well with glasses since they do much worse correcting my astigmatisms. I’m also near sighted and would benefit from the insertion of a special lens to deal with that. However, that’s less important to me because glasses can correct that.
Original medicare will not pay for a toric lens–at all. Some MedicareAdvantage Plans will not. Some will. Others will pay the same amount as they would for a standard IOL. So, if they pay a doc $1500 to insert a standard IOL, they pay that for a toric lense and the patient pays the doctor the difference in price. From what I can figure out by asking friends and reading the blog of a doctor who does the surgery, in NYC the difference in cost if you have the “only lens original Medicare will pay for” policy and “you pay the difference in cost” policy is between $7,000 and $15,000 per eye. The information is NOT on the EOC statement on UHC’s website.
Googling, I got to a UHC site–it might be outdated–that said how cataract surgery cost varies among the MedicareAdv plans UHC offers and to call the customer service number on your card to find out what your particular plan pays.
I did. I spoke to at least 6 represenatives over several different days and not one understood my question. They are not native English speakers and the concept of an IOL was beyond them. Every time, they would read from the website that UHC will pay for one pair of contact lenses for a new prescription after catarract surgery up to something like $250. I kept saying over and over again, I am NOT asking about contacts. I am asking about the lense the doctor puts in your eye during surgery. One told me that my plan only covers “in network”–which is NOT true. He also told me UHC doesn’t pay for cataract surgery. I asked him to send that to me in writing; he told me that he wasn’t legally allowed to do that. Another said he would mail it to me–and of course I’d get it long after the time to choose a different plan expired. He knew that. A third just sent me a link to the EOC, which does NOT answer my question.
I called Medicare on the last day I had to switch. The Medicare rep understood my question. However, she said that she could not answer my question without having the medical code for the specific procedure with the specific type of lens. As I understand it, inserting a toric lens would have a differenct code than inserting a standard IOL. WIth those codes, she could tell me what each MedAdv plan in my zipcode pays, but without them, she can’t.
I don’t have a surgeon yet. It will probably take me at least 2 months to get an appointment with a eye surgeon for catarract surgery.
You’d think that UHC would make some effort to help a MedicareAdv plan make the decision whether or not to keep her plan, wouldn’t you? Nope. From what I can figure out, all the “customer service” reps do is search the EOB and read the “answer” from that.
So, I switched to a different company…It may be the case that UHC has as good or better coverage as the company I switched to, but when I called I got someone who understood what a IOL is and pointed out how to find the answer on its website.
3 Likes
I’m in Oregon, but here, no company, Medicare or Advantage pays for anything but a standard IOL. Nor, do I think they should. Cataract surgery is not a refractive procedure to reduce dependence on glasses or contact lenses. It is a procedure designed to remove a cloudy natural lens. That’s what’s medically necessary. The rest is a premium experience to be borne by those who can afford it. Sorry to rain on the parade. 
6 Likes
Yes, that is how I understood it. I too will need cataract surgery in a few years and wear toric contacts - I will likely pay the difference to get toric lens replacements.
1 Like
My H is getting cataract surgery in 2025. We will be happy to pay for whatever he and the opthamalogist believes is best for him, even if it increases our out of pocket cost. He’s having challenges wearing soft lenses and will have even more challenges wearing just glasses for the last 2 weeks before we go in to see her and discuss when he should have his surgery and what is being proposed.
1 Like
I totally empathize. Anything involving ACTH is a nightmare.
We had a similar struggle first in finding a pediatric endocrinologist with actual experience with a Cushing’s patient, and then getting the insurance coverage for multiple pit surgeries to tackle tumors and drug coverage - right now it is Isturisa, which bills at around~$20,000/month. We had to undertake multiple rounds of appeals and reviews to get the approvals.
FWIW, when that kiddo was in post-surgery phases stepping down the replacement cortisol, my husband had to sit outside in his car outside the school building all day with a rescue shot in case of adrenal insufficiency as school nurses in our state can’t administer cortisol injections. Plus, there’s likely a BLA to fight for in the future…
3 Likes
I was pleasantly surprised that I had no problems getting approved for my biologic drug that has a retail price of $3500/month and I have no idea what the insurer is paying. My lung doc has someone who does a lot of pre-authorizations as part of her job. It seems that the drug is effective and I may have to take it for the rest of my life. My copay is $35 for 30 days and I believe about $70 for 90 day supply.
6 Likes
If that’s the policy, that’s the policy. I just wanted an answer.
However, my understanding is that while some MedicAdv plans take that position,others say that if the catarract surgery is medically necessary and the patient will end up with substantially better vision if a “premium”–using your word–lens is inserted, it will pay the physician what it would pay if a standard lens were inserted and the patient pays for the difference in cost between the standard lens and the premium lens.
It’s not going to cost anyone else or the government extra money for the surgeon to insert a toric lens rather than a standard lens. It’s only the cost of the lens that varies.
It’s kind of like saying, the insurance company will pay for one pair of eyeglasses up to X dollars. One company says if you choose to get progressive lenses or bifocals, we won’t pay anything. The other company says if you want progressive lenses or bifocals, you pay the difference between the cost of a standard pair of eyeglasses and the ones you choose.
I wanted to pick a plan that has the latter attitude towards catarract surgery. I can pay roughly $7,000 out of my own pocket to get a toric lens. Or, I can go to a plan that ONLY pays for the standard lens and pay roughly $15,000 for the same lens.Or, I can get a standard lens and shell out for contact lenses with the MedicAdv plan paying a portion of the cost and not be able to see as well.
And, having just looked it up, the cost for a toric lens inserted into an Oregon eye is less than half the cost of a toric lens inserted into a NY eye.
3 Likes
The way it is here is that insurance will pay for a spherical, single vision IOL. If you want anything else, say a toric, a multifocal, or a light adjustable IOL, you just pay the difference.
Your prices are HIGH! Wow! 
After a successful cataract surgery, a patient should end up with great corrected vision. The premium portion is reducing that about of correction to get there. Even with a standard IOL, almost all patients wear very thin glasses. Premium comes in when they want no glasses.
BTW, “premium” is not my word. That’s an industry and insurance term.
2 Likes
Again, my main issue was simply that none of the UHC reps knew what an IOL (or intraoccular lens) was and could not tell me if my UHC plan would pay anything towards the lens if I have a toric inserted.
If someone had told me “your plan only covers a standard IOL. If you choose a different lens, it won’t pay anything” or “if you choose a different lens,UHC pays the amount it pays for a standard lens and you pay the difference” that would have satisfied me. I just wanted an answer.
And even with a toric lens, I’ll almost certainly still need glasses.
5 Likes
It’s pretty disappointing that they couldn’t explain that!
Don’t take my word as gospel, but everyone should cover a standard IOL, and you should only be required to pay the difference.
Good luck! Fingers crossed!
2 Likes
When I went through annual enrollment this year I wanted to know how much a specific medication would cost under the three insurance options I had to choose from. No one was able to tell me that. This medication can be very expensive depending on how the plan treats coverage so the answer could very well have affected my decision. Instead, I was forced to make an uninformed choice.
5 Likes
It’s a kind of bizarre “marketplace” with so little transparency. Another way that information is hidden, or at least very subtle, is in their coverage guidelines. In my family, higher risk for certain cancers means that various imagery, medication, or surgery are sometimes recommended. Coverage guidelines for all of these vary widely and lead to many unpleasant discussions with insurance companies. Fortunately, reconstruction after mastectomy now MUST be covered per federal law (preceded ACA).
For my BCBS policy, 3D mammograms are covered as initial screening if you opt for them. I chose to get regular one but was told to return to have a 3d mammogram follow up. You guessed it—no coverage for the follow up and even more upsetting, no one could tell me how much it would cost—not the medical facility nor the insurer! It was irritating.
Since then, I’ve always gotten 3d mammograms for dense breasts and no other return visits needed.
5 Likes
I will say that BCBS has been the best option when we’ve had that chance (not available to either me or DH now).
Yes, for the most part, I’ve been pretty happy with our local BCBS with a few memorable exceptions. At least it’s not that it’s been awful with a few notable good events. Mostly I can speak with someone that will try to help me with whatever the issue is.
One thing that I found fascinating is that originally when I checked about which states and institutions someone in HI could use if they needed a lung transplant or similar, it appeared there were NONE on the West Coast at all and I believe the nearest one was in AZ. More recently when I checked (since I’ve gotten Medicare A&B as my primary), I have learned that UCSF is participating & preferred for lung transplant, as needed. Maybe the difference is now I’m under Medicare as primary. It sure is confusing.
Here’s a relevant article about claim denials.
And this article as well.