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General Health Care/Health Cost thread


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1 hour ago, Nice Guy Eddie said:

 Insurance is $1.5k per month in premiums? I just checked any my employer has it at $333 with a $500 annual deductible.

That's a helluva deal, most employees don't have access to premiums in that range. But let's go ahead and say that's the norm and see what a monthly budget might look like for the median income HH:

Housing $2k, Groceries $1k, Health/dental/life insurance $500. Now let's also add in gas and insurance while driving paid off cars - $500. And add in utilities - $500. And let's factor in childcare - $750. Those are all at the lower range of reality. 

So if my math is right, your $64k take home for the year paid for those necessities with a whopping $1000 left over. Pray to God you don't have to miss more than a few days of work due to illness for you or a child, or pay for any clothes, or kid has a cavity and the insurance doesn't cover it all, or replace the tires on your car, or buy a new water heater for your house, or.... life happening.

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2 hours ago, Nice Guy Eddie said:

Insurance is $1.5k per month in premiums? I just checked any my employer has it at $333 with a $500 annual deductible.

Debating whether or not to weigh into this thread, but for now- you need to factor in what your employer pays, because that’s pre-tax compensation.
We can’t really have a meaningful understanding of healthcare costs or the effect of health insurance costs on income and entrepreneurship without thinking in those terms. 
Part of why voters in the workforce struggle with this is because they don’t understand that most of what they pay for with health insurance premiums is a combination of administrative costs and predictable, routine care. 
in other words- they are paying a middleman to do paperwork and pay bills they could easily covers if they simply had the money in their pocket instead of paying it to the carrier along with the carrier’s vig.

That’s part of why HDHPs are so much better for the worker and so much cheaper for workers to use in almost any scenario- you get the carrier’s price, but you pay it directly with pretax dollars in your possession. 

Edited by Bozo_Casanova
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59 minutes ago, Bozo_Casanova said:

That’s part of why HDHPs are so much better for the worker and so much cheaper for workers to use in almost any scenario- you get the carrier’s price, but you pay it directly with pretax dollars in your possession. 

I'm on a HDHP. $35 a paycheck for family coverage, employer's contribution is $900 per paycheck. Out of pocket max is $9k per year, which we have hit only once thankfully. Deductible kicks in at $3k/$6k. Using pre-tax dollars to pay for all medical expenses is huge, and one reason that I strongly favor having HSA's accessible to all. Need to be able to start building that account in your early working years before expenses start taking off. 

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21 hours ago, Incredulity said:

Would you be willing to update how self insurance has worked for your company?

It has worked well for us, but it is a captive and not a fully self insured. We are self insured up to a pretty large amount and then have back end coverage on the total plan. We’ve been virtually flat on costs per employee since preCovid up until the past year or two and haven’t raised premiums for employees in years. Drugs have been skyrocketing the last year or two, so that is all starting to change now. However, we would be paying it either way. The benefit to the self insurance program has been clarity in everything around our medical plan so we know what costs are. It also can be a downside because we know more than we probably should know about people.

I can give you some more specifics if you’re interested in anything with it.

Edited by Brew
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15 hours ago, Vegas64 said:

I could be brainrotted and broken, but my first knee jerk reaction is "$8k/year to fight cancer is a fantastic deal."

It’s not $8k to fight cancer. Someone else is just toting the note on it which is the problem with the system. People don’t understands what the costs really are.

From running a semi-self insured plan (we’re in a captive so we do have some back end coverage) we’ve seen the costs of things changing. I have 3 employees on scripts that are more in total than my entire drug spend 3-4 years ago. 

Edited by Brew
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2 minutes ago, Brew said:

I can give you some more specifics if you’re interested in anything with it

I am just curious because a friend of mine’s wife is working in the healthcare insurance space and was going on and on about larger companies saving big money via self insurance.  Sounded a bit like a, too good to be true.  Saw your post in this thread from 5 years ago so it sparked my curiosity.

Is your comment about knowing too much a HIPPA concern, or other?  

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6 minutes ago, Incredulity said:

I am just curious because a friend of mine’s wife is working in the healthcare insurance space and was going on and on about larger companies saving big money via self insurance.  Sounded a bit like a, too good to be true.  Saw your post in this thread from 5 years ago so it sparked my curiosity.

Is your comment about knowing too much a HIPPA concern, or other?  

At a certain size it can be a significant cost savings. The insurance company middle man is out of your pocket and they are making a lot of money in the middle. The downside risk is that with fully insured you get to smooth out the ups and downs. A captive is somewhat in the middle where we are self insured up to a point and then have coverage if we hit our stop loss. It worked great for 8-9 years, we’re trying to figure out drug costs now which have become significant almost overnight.

We know what everyone has, what they are taking, what they cost, etc and typically people that don’t perform well cost you the most. Those things are hard to ignore although you have to. We also have to make decisions with plan designs and other things that can be difficult. The rage around weight loss shots has been a significant issue the last 18 months that we have had to deal with and you know you are dealing with people’s lives while also trying to manage costs.

 

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7 minutes ago, Brew said:

At a certain size it can be a significant cost savings. The insurance company middle man is out of your pocket and they are making a lot of money in the middle. The downside risk is that with fully insured you get to smooth out the ups and downs. A captive is somewhat in the middle where we are self insured up to a point and then have coverage if we hit our stop loss. It worked great for 8-9 years, we’re trying to figure out drug costs now which have become significant almost overnight.

We know what everyone has, what they are taking, what they cost, etc and typically people that don’t perform well cost you the most. Those things are hard to ignore although you have to. We also have to make decisions with plan designs and other things that can be difficult. The rage around weight loss shots has been a significant issue the last 18 months that we have had to deal with and you know you are dealing with people’s lives while also trying to manage costs.

 

Can you describe the plan structure(whats covered) process?  Is it truly a-la-carte or do you start with a base then bolt-on?  Do you have to decide each medication ?

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40 minutes ago, Anastasis said:

I'm on a HDHP. $35 a paycheck for family coverage, employer's contribution is $900 per paycheck. Out of pocket max is $9k per year, which we have hit only once thankfully. Deductible kicks in at $3k/$6k. Using pre-tax dollars to pay for all medical expenses is huge, and one reason that I strongly favor having HSA's accessible to all. Need to be able to start building that account in your early working years before expenses start taking off. 

Strongly agree, esp with bolded portion, and of the many things HR/benefits teams need to to better, teaching employees how to use them and explaining why they are better is right at the top. 
I'd also add that in my opinion the worst thing about the ACA was forcing HDHP policies to cover routine care, i.e. checkups, vaccinations, etc. That's preciately the kind of out of pocket expense people with jobs should be paying for out of pocket, counted towards their deductible. Insurance is a risk management product, not a payment service. 

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Yea a HDHP has been amazing me. $0 premium, company pays me like $33 per paycheck as a contribution, and looking at my EOY payslip the company paid around $9500 for coverage I thankfully didn't have to use.

It would be pretty sweet to have that 10k in your pocket instead giving it to a rich fuck.
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Also, I know it's probably way too new for it to happen within 5 years, but would anyone here think that some companies start offering incentives to those who do start a semaglutide treatment/ weight loss injections? 

Avoiding an obvious comparison to vaccine mandates, but if a company starts saying you are too fat to cover on insurance because of the obesity risks would be "eventful" to say the least.

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34 minutes ago, Incredulity said:

Can you describe the plan structure(whats covered) process?  Is it truly a-la-carte or do you start with a base then bolt-on?  Do you have to decide each medication ?

Yes and no, you are using one of the main insurance companies coverage structure and provider networks as the base for provider coverage. We use UMR because they tend to work better with these type plans and in our coverage area. We use their negotiated rates and provider network so we don’t have to negotiate our own and so it’s easy for the employee to understand. Within if we do things like heavily incentivize annual physicals, weight loss, choosing the high deductible plan, etc to help control future costs hopefully.

The drug portion is different. We start with their base plan and tailor it from there. We heavily incentivize generic usage to the point of most are free and disincentivize name brand and drug of the day coverage. We also have nurse managers as part of the captive that work with providers on alternative medications and work with the insured on rebates, grants, and other things that are out there to offset drug costs.

You have a mix of traditional coverage things and then tailored things that we have designed into the plan. We don’t generally cut much of anything out, we just try to reward people to make better decisions s with our dollars. 

Drugs are the killer right now. We have people into the 6 figures on individual drug costs. There are cancer drugs out now that exceed $60k-$70k a month. There are other more routine drugs that still exceed $10k a month. Short of someone having a major medical event or a long-term hospital stay, you just don’t see those kinds of numbers with the care side.

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3 minutes ago, StassneyHorn said:

Also, I know it's probably way too new for it to happen within 5 years, but would anyone here think that some companies start offering incentives to those who do start a semaglutide treatment/ weight loss injections? 

Avoiding an obvious comparison to vaccine mandates, but if a company starts saying you are too fat to cover on insurance because of the obesity risks would be "eventful" to say the least.

Most insurance companies or at least the one I’m familiar with are still fighting coverage of those treatments for weight loss because of issues with FDA approval. It has started changing the last 12 months, but there are still coverage issues. Weight loss can also be an excluded coverage under plans. We did a specific exception for them last year and have a number of people on them (at a ridiculous cost per shot I will add), so we’ll see long-term if it is beneficial.

As far as the second paragraph, they will find themselves getting sued if that’s the case. What you may see is people become more selective in their hiring especially if they are self-insured which will also get them sued if it ever comes out I guess.

Edited by Brew
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6 minutes ago, Fastbreak said:


It would be pretty sweet to have that 10k in your pocket instead giving it to a rich fuck.

Eh, I agreed to my salary, equity, bonus structure. If my employer wants to fight back against the insurance co for their money they paid for me to have good health, thats them.

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13 minutes ago, Brew said:

Most insurance companies or at least the one I’m familiar with are still fighting coverage of those treatments for weight loss because of issues with FDA approval. It has started changing the last 12 months, but there are still coverage issues. Weight loss can also be an excluded coverage under plans. We did a specific exception for them last year and have a number of people on them (at a ridiculous cost per shot I will add), so we’ll see long-term if it is beneficial.

As far as the second paragraph, they will find themselves getting sued if that’s the case. What you may see is people become more selective in their hiring especially if they are self-insured which will also get them sued if it ever comes out I guess.

I saw Tirzepatide was approved recently and thought that might be a big moment or possibly a big "domino" to fall in regards to people with sleep apnea or diabetes.

 

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1 hour ago, Bozo_Casanova said:

Strongly agree, esp with bolded portion, and of the many things HR/benefits teams need to to better, teaching employees how to use them and explaining why they are better is right at the top. 
I'd also add that in my opinion the worst thing about the ACA was forcing HDHP policies to cover routine care, i.e. checkups, vaccinations, etc. That's preciately the kind of out of pocket expense people with jobs should be paying for out of pocket, counted towards their deductible. Insurance is a risk management product, not a payment service. 

Strongly disagree with you there. Incentivizing people to get an annual physical and stay up to date on vaccines is one of the easiest ways to cut down on total spend. Employers should do everything they can to help people stay healthy.

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2 hours ago, Satchel said:

But there are also surveys where a high percentage of people rate their insurance as excellent or good. It’s like Congress ratings. People universally hate Congress but a majority like their own rep.

and while many seem to want Medicare for all, Medicare is really great because it’s highly subsidized by younger taxpayers. I’ve never seen one analysis that describes the costs of all of those younger people being moved into Medicare. Not to mention that Medicare would need to open up more coverage for areas that they never/rarely cover like pregnancies or children’s health.

and finally hospitals and doctors depend on the higher reimbursements from insurance other than Medicare and Medicaid. We can tell them to suck it up and accept less revenue but there are negative impacts to Medicare for all.

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18 minutes ago, royiv said:

Strongly disagree with you there. Incentivizing people to get an annual physical and stay up to date on vaccines is one of the easiest ways to cut down on total spend.

Auto liability insurance is required in most states. Would requiring policies to also cover oil changes, wiper blades, brake pads and tires “incentivize” people to keep their cars roadworthy?

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6 minutes ago, Bozo_Casanova said:

Auto liability insurance is required in most states. Would requiring policies to also cover oil changes, wiper blades, brake pads and tires “incentivize” people to keep their cars roadworthy?

only if an emmissions test was still required

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1 hour ago, royiv said:

Strongly disagree with you there. Incentivizing people to get an annual physical and stay up to date on vaccines is one of the easiest ways to cut down on total spend. Employers should do everything they can to help people stay healthy.

1 hour ago, Bozo_Casanova said:

Auto liability insurance is required in most states. Would requiring policies to also cover oil changes, wiper blades, brake pads and tires “incentivize” people to keep their cars roadworthy?

As an employer, I 100% agree with royiv. Part of the benefit of HDHP is to incentivize people to take some ownership of their health care not disincentivize them from doing things that lead to a long term healthier workforce. You want people to go to the doctor routinely and get vaccinated to catch and deal with things at the earliest possible time. We give people a bonus for having a full physical including bloodwork annually, cover all flu/covid vaccines in the office for families, reimburse for other vaccines, cover generic prescriptions, etc. all to try and manage long-term costs.

Your car analogy is ridiculous.

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8 minutes ago, Brew said:

As an employer, I 100% agree with royiv. Part of the benefit of HDHP is to incentivize people to take some ownership of their health care not disincentivize them from doing things that lead to a long term healthier workforce. You want people to go to the doctor routinely and get vaccinated to catch and deal with things at the earliest possible time. We give people a bonus for having a full physical including bloodwork annually, cover all flu/covid vaccines in the office for families, reimburse for other vaccines, cover generic prescriptions, etc. all to try and manage long-term costs.

 

I’m glad you do all that, but *legally requiring* preventative care to be provided through a third party carrier when your enployees could  apply out of pocket cost to their deductible is simply bad law that accomplishes nothing other than adding cost.

Ive used an HDHP for years, well before ACA required it. At my old employer, requiring preventative care to be included in HDHPs added costs to our plans and had no impact, meaning *zero* impact to  our employees utilization of preventative care. It just made the HDHPs policies more expensive.

Edited by Bozo_Casanova
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1 hour ago, Bozo_Casanova said:

Auto liability insurance is required in most states. Would requiring policies to also cover oil changes, wiper blades, brake pads and tires “incentivize” people to keep their cars roadworthy?

This comparison is fucked. When my dad fell and broke his hip, we couldn't "get a rental" while we price shopped for the best deal. Auto insurance is for accidents with someone at fault. Healthcare is for staying alive.

We should not be ill and injured HUMAN BEINGS like clunker cars and writing them off. Nevermind that auto insurance is optional in life you may never need a car. You don't have a fucking choice to get health insurance in America. You do, or you go bankrupt and die 

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10 minutes ago, Bozo_Casanova said:

How so?

The cost of failure related to car maintenance is yours, not a shared cost or covered by anyone else. You can argue it leads to accidents, but maintenance related accidents aren’t a high percentage. The bulk of maintenance related issues just lead to expenses you have to deal with personally.

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4 hours ago, Anastasis said:

I'm on a HDHP. $35 a paycheck for family coverage, employer's contribution is $900 per paycheck. Out of pocket max is $9k per year, which we have hit only once thankfully. Deductible kicks in at $3k/$6k. Using pre-tax dollars to pay for all medical expenses is huge, and one reason that I strongly favor having HSA's accessible to all. Need to be able to start building that account in your early working years before expenses start taking off. 

Damn maybe I should stop complaining about my plan. I pay $350 a month and my deductible is $600 with a max OOP of $9k. $30 copay to see my PCP, $50 for a specialist, and $500 copay for an ER visit. No access to an HSA.

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Just now, HRSchenker said:

Damn maybe I should stop complaining about my plan. I pay $350 a month and my deductible is $600 with a max OOP of $9k. $30 copay to see my PCP, $50 for a specialist, and $500 copay for an ER visit. No access to an HSA.

Yeah, that's not bad. The non HDHP available are like $250+ per paycheck. So I keep ~$425 in monthly premiums that goes into the HSA to cover expenses. In years where we don't utilize much services, the HSA stacks up. In years where you have an inpatient admission or a couple ER visits, you hit the deductible phases and potentially the oop max. The tax advantaged saving in the HSA make the math work in my favor most years. But only because all the preventative services discussed above are covered at no charge. The HDHP does cause you to pay a close eye and manage expenses, particularly on the pharmacy side. Once there is a high cost biologic or other med in the mix, all the math goes to shit pretty quickly. 

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11 hours ago, Captainant said:

This comparison is fucked. When my dad fell and broke his hip, we couldn't "get a rental" while we price shopped for the best deal. Auto insurance is for accidents with someone at fault. Healthcare is for staying alive.

EXACTLY! you need insurance for catastrophic, expensive, unforeseen events. Using a risk management product to pay for things you know you need, can afford, and happen on a schedule only adds cost to those things.

why pay insurance carriers a profit for predictable, inexpensive things? That’s money that should go elsewhere.

11 hours ago, Brew said:

The cost of failure related to car maintenance is yours, not a shared cost or covered by anyone else. You can argue it leads to accidents, but maintenance related accidents aren’t a high percentage. The bulk of maintenance related issues just lead to expenses you have to deal with personally.

Sure, but in addition to accidents a major avoidable social cost caused by automobiles is productivity loss caused by broken cars.
it’s Similar to the productivity loss caused by lost time at work due to avoidable illness and poor self care. 
Look, we want people to get preventative care. That’s not the question is whether forcing people to insure predictable inexpensive events is an incentive.
There are plenty ways to incentivize them. Using insurance to pay for it is a lousy, terrible, no-good way to do it. 

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10 minutes ago, Bozo_Casanova said:

why pay insurance carriers a profit for predictable, inexpensive things? That’s money that should go elsewhere.

Because patients have no rights and are used as cash dispensers by fuckwads with MBAs lobbying and bribing until the law statutorily protects their business plan? A fucking Advil costs $200 at a hospital BECAUSE OF INSURANCE COMPANIES. And guess what? I don't have any say if they get between healthcare and my family.

And if you don't have "insurance" than you won't even get admitted to any type of care short of the ER

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12 minutes ago, Bozo_Casanova said:

EXACTLY! you need insurance for catastrophic, expensive, unforeseen events.

You know that I agree with most of your takes on the subject, but the reality is that we live in a world where the cost of many drugs now makes almost any medical condition a potentially financially catastrophic one. It's not just the inpatient hospitalization for an AMI, or the individual diagnosed with a serious cancer. Biologics accounts for ~40% of US drug spending, and 70% of the growth in us drug spending. Long litany of autoimmune and inflammatory conditions involved, and the costs can easily get to high five figures. Shit, a fucking corticosteroid inhaler alone can run $250/mth. Got a couple kids with asthma and the baseline all-in for management can be $10k per year even if you are able to keep them out of the ER/UC. The major high cost centers are facilities and pharmacy. Until you control those costs, utilization management will be used to contain premiums and keep them from spiralling totally out of control for everyone. Doesn't matter what financing system we use, single or multi-payer, we have to bring drug pricing under control.   

 

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19 minutes ago, Captainant said:

Because patients have no rights and are used as cash dispensers by fuckwads with MBAs lobbying and bribing until the law statutorily protects their business plan? A fucking Advil costs $200 at a hospital BECAUSE OF INSURANCE COMPANIES. And guess what? I don't have any say if they get between healthcare and my family.

And if you don't have "insurance" than you won't even get admitted to any type of care short of the ER

Advil is a good example- when you pay for advil it’s inexpensive. When you multiple layers of buyers exist between you and the advil that adds cost. HDHPs should go back to what they used to be: low-premium insurance policies against unpredictable, catastrophic events, used by people who could afford to pay for their own preventative care  (ie the entire  middle class) if they had pre-tax money set aside for that purpose. 

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1 minute ago, Anastasis said:

You know that I agree with most of your takes on the subject, but the reality is that we live in a world where the cost of many drugs now makes almost any medical condition a potentially financially catastrophic one. It's not just the inpatient hospitalization for an AMI, or the individual diagnosed with a serious cancer. Biologics accounts for ~40% of US drug spending, and 70% of the growth in us drug spending. Long litany of autoimmune and inflammatory conditions involved, and the costs can easily get to high five figures. Shit, a fucking corticosteroid inhaler alone can run $250/mth. Got a couple kids with asthma and the baseline all-in for management can be $10k per year even if you are able to keep them out of the ER/UC. The major high cost centers are facilities and pharmacy. Until you control those costs, utilization management will be used to contain premiums and keep them from spiralling totally out of control for everyone. Doesn't matter what financing system we use, single or multi-payer, we have to bring drug pricing under control.   

 

Agree on all counts.

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Just now, Bozo_Casanova said:

Advil is a good example- when you pay for advil it’s inexpensive. When you multiple layers of buyers exist between you and the advil that adds cost. HDHPs should go back to what they used to be: low-premium insurance policies against unpredictable, catastrophic events, used by people who could afford to pay for their own preventative care  (ie the entire  middle class) if they had pre-tax money set aside for that purpose. 

Lotta "should"s that won't stand up to the might of the shareholder my guy. Why give those pissant sick people better care when they could return an extra 2% next quarter??

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20 minutes ago, Anastasis said:

 Biologics accounts for ~40% of US drug spending, and 70% of the growth in us drug spending. Long litany of autoimmune and inflammatory conditions involved, and the costs can easily get to high five figures.

 

I'm on a bilogic and my EOB/Statements show that my insurance company paid close to $150k this year. That's crazy, but I am old and dumb (like most Americans) and don't understand all the crazy mechanics and math. I'm sure most folks needing biologics (read: old and ill) are just thinking "Just give me my medicine and tell me what I owe as a copay or what my employer takes out of my check, I don't need to know how the sausage is made."

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2 minutes ago, Vegas64 said:

I'm on a bilogic and my EOB/Statements show that my insurance company paid close to $150k this year.

Yeah, that's high but not uncommon. Wait until one of the biologics really lands solid with an Alzheimer's indication and Medicare financing melts down. 

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I’m amazed at the expectations some people have for healthcare costs when they get older. 

Due to family health issues, the last few years we’ve hit the family max out of pocket costs. Combined with sky high premiums, we are talking tens of thousands of dollars per year. 

We can afford it, but I worry about most Americans who just can’t. Those folks would have to just forego care and I guess die early. Sucks. 

Even with the ACA, with subsidized premiums, the costs could be $30k+ per year if you have an expensive health issue like cancer. 

I see people online fretting over a thousand dollars. 

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11 minutes ago, Dbeasy said:

I’m amazed at the expectations some people have for healthcare costs when they get older. 

Due to family health issues, the last few years we’ve hit the family max out of pocket costs. Combined with sky high premiums, we are talking tens of thousands of dollars per year. 

We can afford it, but I worry about most Americans who just can’t. Those folks would have to just forego care and I guess die early. Sucks. 

Even with the ACA, with subsidized premiums, the costs could be $30k+ per year if you have an expensive health issue like cancer. 

I see people online fretting over a thousand dollars. 

Agree. I’m seeing a lot of commentary on this thread from people who are out of touch with what a whole lot of working class families with kids would consider inexpensive. 

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47 minutes ago, Anastasis said:

You know that I agree with most of your takes on the subject, but the reality is that we live in a world where the cost of many drugs now makes almost any medical condition a potentially financially catastrophic one. It's not just the inpatient hospitalization for an AMI, or the individual diagnosed with a serious cancer. Biologics accounts for ~40% of US drug spending, and 70% of the growth in us drug spending. Long litany of autoimmune and inflammatory conditions involved, and the costs can easily get to high five figures. Shit, a fucking corticosteroid inhaler alone can run $250/mth. Got a couple kids with asthma and the baseline all-in for management can be $10k per year even if you are able to keep them out of the ER/UC. The major high cost centers are facilities and pharmacy. Until you control those costs, utilization management will be used to contain premiums and keep them from spiralling totally out of control for everyone. Doesn't matter what financing system we use, single or multi-payer, we have to bring drug pricing under control.   

 

there was a period of time I did not have insurance (I was on my ex-wife’s plan, and my cobra was about $600 a month 20 years ago), so I used in-house pharmacy located near New Zealand(Vanuatu?).  They won’t send you any narcotics, but you can buy antibiotics and prednisone and any asthma drug that suits your fancy for far less than you can buy it in America - with no prescriptions.       I would get six Ventolin  inhalers made by Glaxo for the Indian market that came out to about $10 per inhaler.  The only thing they didn’t have is the little counter telling you how many times you’ve used it.   The drug itself worked just fine.    I tend to get respiratory infections, and I could buy Z packs for far less than the cost of going to urgent care to get a script - and paying full pop for the drug. 

It is not the preferred way to get healthcare, mind you,  but was a lifesaver for someone who needed a cheaper way to get maintenance drugs with no insurance back in the day when pre-existing conditions could be used against you in a way the ACA later prohibited.

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17 minutes ago, Gatorubet said:

I would get six Ventolin  inhalers made by Glaxo for the Indian market that came out to about $10 per inhaler.

That was about the US generic price 20 years ago before the FDA required reformulation away from CFC inhalers to HFA and triggered a bunch of patent law protections that allowed the price to go nuts here.  

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13 minutes ago, Anastasis said:

That was about the US generic price 20 years ago before the FDA required reformulation away from CFC inhalers to HFA and triggered a bunch of patent law protections that allowed the price to go nuts here.  

God Bless Capitalism! It truly ensures the most efficient allocation of capital for the greatest good.

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8 minutes ago, Anastasis said:

That was about the US generic price 20 years ago before the FDA required reformulation away from CFC inhalers to HFA and triggered a bunch of patent law protections that allowed the price to go nuts here.  

IMG_3930.thumb.png.91966522f5c118803d1aab8761cab014.png

 

The generic is still about $12 per inhaler.  The cost of name brand Glaxo Ventolin is about twice that.     both are still a hell of a lot better deal than walking into Walgreens and buying it without insurance.  folks without insurance need to look at GoodRX coupons as well, as for reasons unknown it often produces really good discounts.

 

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1 minute ago, Gatorubet said:

folks without insurance need to look at GoodRX coupons as well, as for reasons unknown it often produces really good discounts.

I have used GoodRx for my boy's inhaler many times. If you are going out of pocket, it is worth it to take a look. But as I understand it those cards really fucking suck for the shop doing the dispensing. Would like to hear @HRSchenker's perspective. 

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PSA if you need imaging and either do not have insurance or have a high deductible look at this company 

https://radiologyassist.com/
 

I send a lot of patients to them and they are amazingly cheap. They shop around for cheaper cash price for you. Since you pay cash you probably can’t count it toward your deductible, but I have had patients whose “allowable” by their insurance company is 2500 for an MRI get one for 300 or so. I also use it if I feel an MRI is warranted and the insurance company denies it. Patient then can appeal the denial based on the positive findings 

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10 minutes ago, Sawbonz said:

PSA if you need imaging and either do not have insurance or have a high deductible look at this company 

https://radiologyassist.com/
 

I send a lot of patients to them and they are amazingly cheap. They shop around for cheaper cash price for you. Since you pay cash you probably can’t count it toward your deductible, but I have had patients whose “allowable” by their insurance company is 2500 for an MRI get one for 300 or so. I also use it if I feel an MRI is warranted and the insurance company denies it. Patient then can appeal the denial based on the positive findings 

Thanks for sharing. For shits and giggles, I plugged in an x-ray that I had done at one of Houston Mehodist’s imaging centers last year. Their charge for a 3 view x-ray was $1,258 and, shockingly to me, my insurance allowable for that study was $1,258 and was applied to my deductible. On principle, I was not paying that much for a service that the Medicare allowable for it is $28. I ended up paying $200 to make it go away and they discounted the rest. I just plugged that same study into the link you shared and their price is $40. I also plugged in an MRI that my wife needs done and the price is $275.

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I have never taken the time to try it, but it looks like in Texas at least if the cash price you pay for a covered service is less than the in network allowable, you can submit the receipt to the insurance company and have them apply it towards your out-of-pocket

Edited by Sawbonz
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