This is my thought, as well. When your private insurance company stinks, you find a new insurer. When you're forced to pay the government for health insurance, you're stuck without options. Health insurance isn't one of the services that I trust the government to be able to run well. They don't have a particularly great track record where efficiency, customer service, and speed are concerned.
> This is my thought, as well. When your private insurance company stinks, you find a new insurer.
You can't, because the health insurance is provided by your employes so you get whatever they give you.
My health insurance (blue shield) is absolutely terrible (right now I need some medicine they refuse to let me have because it cuts into their profit margins) but there's nothing I can do about it.
And that's after paying $2500/month for the privilege.
Blue Shield is notorious for not paying out enough of premiums for care. If you're having issues though, figure out who your PBM. (Pharmacy Benefits Manager) is that Blue Shield is contracting the pharmacy adjudication out to.
Basically, get in contact with them, try and get an override, or get them to explain why you are not covered. If it isn't in the formulary your employer opted into, you're hosed; but there is usually one way or another to get them to give in, they will just make you go through maximum hoops.
Ask for their clinical people if you can't get any traction. They will likely be the ones with hand on the knob for whether a drug is "worthy of coverage" or not.
They will tell you to check a website. Look up your thing in their formulary, if not there, abort. If in there, but high-tier, prepare for the prior-auth gauntlet.
I gave up on BCBS and have resigned to paying out of pocket, but you might get luckier than me. They will generally fight tooth and nail to be difficult, but just keep a cool head and keep escalating. It's been a while since my last butting of heads but I'm gearing up for round 2.
Also remember: You can pay out of pocket, but you'll be at the whims of that pharmacy. They'll generally help you work through coupons.
You have now reached beyond my "letters/phone calls to Congress" threshold. Generally doesn't get an instant response, a d may take months, but surprisingly does occasionally get some traction. More out of spite than anything else. However, there is increasing regulatory attention being directed at the space, and even some states have insurance regulators you might be able to hit up.
It's unfortunate, but there are some drugs that insurers are simply not willing to be on the hook for, and if you're the unlucky person suffering from a rare, expensive to treat condition; the only way around it is to make a lot of noise and waves, and be open to trying alternative regimens.
No one should have to go through that though. Good luck.
>You can't, because the health insurance is provided by your employees so you get whatever they give you.
That's not true, is it? You could decline coverage and then go purchase a policy of your own elsewhere. Yes, that might be expensive but the original claim was "Y'all actually have one of the best systems in the world, it's just way too expensive." and that still tracks.
Even better, you could purchase a policy through the Obamacare exchanges.
If the government offers you bad medical care, you turn to the black market or you fly to the US to get the procedure done because the government has banned alternative care. This is a very normal Conservative talking point and the inherent competition in US healthcare is arguably the biggest benefit of its current system.
> That's not true, is it? You could decline coverage and then go purchase a policy of your own elsewhere.
What other choices exist, there's only a few giant insurers anyway.
> Even better, you could purchase a policy through the Obamacare exchanges.
I have no direct experience, would love to be wrong, but what I've heard is that even the top-tier plans are extremely limited in what they cover and where they are accepted so it's even worse than company-provided plans.
Sorry to hear that. My experience with government insurance has been with Medicare, Medicaid, and the VA, and to say I've been unimpressed is an understatement.
I guess I should be thankful my insurance is ~$1000/mo, and hasn't left me with the horror stories some seem to experience.
Here is the breakdown from this article for 2020: https://www.census.gov/library/publications/2021/demo/p60-27...
8.6% are uninsured
Of the insured:
- 54.4% of the ensured on employer based insurance
- 10.5% purchase theirs directly
- the rest get theirs from one government program to the other (Medicare 18.4%, Medicaid 17.8%, TRICARE 2.8%, and VA and the like 0.9%)
So your comment only covers less than 10.5% of people at the moment... a little more than the number of people who have no health coverage (a good portion not out of real choice).
And that does not even cover how horribly this sort of market functions: you never know how good or bad your coverage actually is until you go to use it for a particular problem, and then you don't really know that until it is over and you are maybe bankrupt. Health insurance is the worst place to try and use market forces to regulate it... well maybe after military, fire, and police...
In theory, single payer should offer more choices. With private insurance, you are stuck with certain doctors and hospitals, and can only change plans at years-end.
