Yeah, im looking ahead to six months and hoping for good numbers
1 Like
$50 for a birth in Australia isn’t likely to be true based on all the stories I heard from friends.
Only bill you pay to have a kid in Canada is the parking garage bill.
2 Likes
Trip Report:
Had reason to believe there might be something wrong with my head/brain, so headed (no pun intended) to the local neurologist a couple weeks ago. No appointment. Within about 20 minutes, received a blood test, urinalysis, MRI, and a consultation with the doctor. Happily, nothing was wrong and my issue appeared to be all in my head (pun intended).
The bill? About US$45.
2 Likes
Gonna guess you’re back home in Japan and aren’t still visiting USA #1?
1 Like
Good to hear!
In the meantime, I just got a letter from our insurance company reminding us that if we need an MRI or CAT scan, we need to call them, the insurance company, for a consultation about the possible places we can go. It even says we don’t have to use one of their suggested ones, we just have to have the phone call.
1 Like
The bills from my ER visit are starting to trickle in. I’m up to about $7k out of pocket. I haven’t gotten a bill for the ambulance ride yet. Nor for all of the follow ups.
I am going to guess the ambulance will be 1000-1500.
Negotiate negotiate negotiate
Present to them that times are tough whether that’s true or not
Medical debt does not go on your credit report, and they know this 
I am currently taking Skyrizi due to a life of living with Psoriasis.
I am insured through my wife’s employer for our health insurance.
My prescriptions are covered through CVS Caremark, which is somehow a different insurance.
I need to get my prescriptions filled through the CVS Specialty Pharmacy which is somehow different than CVS.
The cost for a dose of Skyrizi is $8,422.08.
I had signed up through both the Abbvie Patient Assistance Program and another third party called PrudentRX. Both of these combined got my out of pocket cost for my first three doses to zero. This is good.
I get a call after refilling my third dose from CVS Specialty that I have an outstanding copay of $3,486. I need to call Abbvie Patient Support to discuss with them.
I spend 45 minutes on the phone with Abbvie Patient Support because I can’t find my CVS Caremark information. They tell me to call PrudentRX.
I call PrudentRX, they inform me that I am fully enrolled in their program and I need to call CVS Specialty and let them know that my copay should be zero because I am fully enrolled in the PrudentRX Program.
I am now back on the phone with the Specialty Pharmacy armed with this information.
This system is entirely broken.
9 Likes
I’ve ridden that same carousel so many times. I’ve said before that being chronically sick in the US is a full time job, and this is just one example of that. So much time and energy wasted trying to get the system to work just so you can get the care you need while not ending up broke. Sorry you are dealing with it, hope it gets resolved quickly.
2 Likes
I believe that the PrudentRX program is CVS’s own “copay maximizer”. These are designed to suck the maximum copay dollars from the Abbvie and then pay for the rest. They are also designed so that those dollars do not help you towards your deductibles and OOP max.
Here’s a reddit thread from just a little googling: https://www.reddit.com/r/CrohnsDisease/comments/1av9ohp/beware_of_copay_maximizersaccumulators_eg/
You may have certain rights in your state that you should avail yourself of.
1 Like
Things are getting clearer…
1 Like
System working as designed.
1 Like
The “copay maximizers” work by classifying your drug as a non-essential health benefit, but then giving it to you for free. I don’t understand how that’s legal, or whether you can successfully “opt out” as suggested in the reddit.
Copay maximizer strategies work by categorizing particular drugs as “non-essential health benefits” (non-EHBs). This classification has nothing to do with medical necessity; it’s adopted solely to enable the health plan to sidestep Affordable Care Act limits on patient cost-sharing and thereby siphon off the full amount of copay assistance available from the drug manufacturer.
Here’s how the scheme works. By labeling a drug as “non-EHB,” the health plan (or its pharmacy benefits manager, aka PBM) is able to set the patient’s required copays for that drug far above ACA maximums. The health plan tells the patient that the only way to avoid the inflated cost-sharing amounts is for the patient to sign up with a third-party entity (the copay maximizer program). This third-party entity will enroll the patient in the applicable manufacturer copay assistance program and qualify them to get their medication with little or no personal spending. The health plan/maximizer collects the full value of copay assistance available from the manufacturer program, but counts none of that amount toward the patient’s deductible or OOP maximum.
1 Like
JFC
1 Like
so what does a normal human with “pretty good” insurance usually end up paying under this sort of scheme? I have been prescribed rinvoq (retail price: $6500/month), which I’m not taking yet and probably will not take, but I’m pretty sure they are trying to get me roped into this bullshit (abbvie “nurse ambassador” has been emailing me and calling me and sending mail to my house trying to get me on the treadmill despite the fact that I specifically checked the “DO NOT GIVE MY INFORMATION TO THE DRUG COMPANY” box on some paperwork at my now-ex-dermatologist)
I’m just happy people are actually taking these drugs after I’ve seen 10,000 commercials for them during Wheel of Fortune and Jeopardy.
2 Likes