Mar 5, 2012 -- 11:03AM, Jasr wrote:

Mar 5, 2012 -- 10:54AM, Unworthyone wrote:

The fact is, because of medical privacy laws (HIPAA) only the prescriber and patient are supposed to know 'why' a particular medication was prescribed. 

The prescriber, the patient, and the private insurance carrier.

That is the truck-sized hole in the HIPAA law that nobody wants to talk about.

Even if the insurance carrier is privy to the information, the employer is not supposed to be.  Nevertheless, if the doctor writes "to mitigate menstrual pain" who is the insurance company to override the decisions of a duly licensed physician?

I'l share an amusing personal story.  When my daughter was about three years old, she fell and fractured her two upper front primary teeth.  The pediatric dentist said, based on her age, small size, and low weight, he wanted to perform his treatment with the benefit of an outpatient setting and an anesthesiologist in attendance.  I got insurance approval over the phone, and the work was completed without complications.

A few weeks later, I received the EOB from the insurance company, and the claim was denied.  The stated basis for the denial was "submitted procedures are not medically necessary."  Can you flippin' believe it?

Within moments I was on the phone to the insurance company with a strategy and the conversation went like this:

Me: I see here you denied this claim because the procedures were not medically necessary.

Insurance Rep:  Yes, that was our determination.

Me: First, let me thank you. I don't know what I would do if you weren't there looking out for me and my family.  Now, how do you spell your last name?

Insurance Rep: Why do you need the spelling of my last name?

Me:  That's just for the subpena.

Insurance Rep:  Subpena?  Why?  Are you going to sue me?

Me: Sue YOU?  Of course not!  I'm going to sue the dentist!

Insurance Rep: Sue the dentist?  Why?

Me:  Because the dentist presented the case to me as 'medically necessary.'  And clearly, based on your determination, it was 'not medically necessary.'  Any healthcare provider who would have the gall to present treatment as medically necessary when clearly it is not has got to be guilty of malpractice.  I intend to sue the dentist for malpractice and you are going to be my star witness.  I can't wait to get you on the witness stand so you can explain to the jury why this dentist's treatment was not medically necessary.  Are you ready to do that?

Insurance Rep:  Let me get back to you.

Three days later I received a check in the mail for the entire denied amount from my insurance company.

Mar 5, 2012 -- 11:45AM, Jasr wrote:

Because preventive care is good policy; it improves populational health, it improves quality of life, and it saves money in the long run.

I know you probably already know this, but here is the rub in this issue for me.

There ARE many preventive care actions that ARE FREE!! ....

- eating a healthy diet and limiting calories to maintain a healthy weight

- exercising [which doesn't require a membership at the gym].

- refraining from smoking and excessive alcohol intake [can actually save money]

- reserving sexual interaction to within the context of a committed relationship where you can be certain both partners "care".

- "destressing" your life, by not overcommitting [I mean really, we NEED down time]

- "destressing" you life, by living within your means and staying out of debt.

The only PROBLEM with all of these, is they depend on Personal Responsibility.  All they demand is "caring cost" on the part of the person, no money necessary. 

But the American Public will have none of that.  All of the above FREE measures are shunned by the American Public, but then, the Pubic wants to turn around and demand that the measures that "cost money", ... more specifically,  .... The Measures that allow them to be Personally Irresponsible, but cost money .. be free of charge.

Do you not see the hypocrisy of that??!! 

Do you not see why a person like me who sees this hypocrisy cries "foul"??!!

Mar 5, 2012 -- 12:07PM, rabello wrote:

I can't wait to see if, when all is said and done, if birth control pills or any other contraceptive method that requires a prescription by a physician turns out to really be "free"

rabello ... of course is not going to be "free".  Free in the context of this discussion is "Free of Charge".  Someone is going to pay for it.  And here is who. ....

- the women who use b.c. pills, through their premium

- the women who do not use b.c. pills, through their premium

- the men who have sex with women who used b.c., through their premium

- the men who do not have sex with women who use b.c., through their premium

- old people who no longer have use for b.c. .. through their premiums

- children [parents] who are not even sexually active .. through their premiums

- employers, who will then pass the cost on to consumers, or cut jobs, thus transferring the cost to the public or tax payers.

- tax payers .. through all government programs.

So .. out of all those groups ... only TWO will benefit from the cost they will pay, so that the women who use B.C. pills, and the men who have sex with them, can be free of worry that they not get pregnant.

Oh .. and as I've said, the real groups who NEED to be on B.C., won't use them.  So you are not going to see a decrease in unwanted pregnancies ... in fact, in Hawaii, pregnancies increased.

So .. no .. it's not going to be "Free" .. it's going to be "free of charge" to the individual, who will saddle on a small, ... very small fraction of the cost for their convenience.

Mar 5, 2012 -- 12:22PM, Bodean wrote:

Mar 5, 2012 -- 12:07PM, rabello wrote:

I can't wait to see if, when all is said and done, if birth control pills or any other contraceptive method that requires a prescription by a physician turns out to really be "free"

rabello ... of course is not going to be "free".  Free in the context of this discussion is "Free of Charge".  Someone is going to pay for it.  And here is who. ....

- the women who use b.c. pills, through their premium

- the women who do not use b.c. pills, through their premium

- the men who have sex with women who used b.c., through their premium

- the men who do not have sex with women who use b.c., through their premium

- old people who no longer have use for b.c. .. through their premiums

- children [parents] who are not even sexually active .. through their premiums

- employers, who will then pass the cost on to consumers, or cut jobs, thus transferring the cost to the public or tax payers.

- tax payers .. through all government programs.

So .. out of all those groups ... only TWO will benefit from the cost they will pay, so that the women who use B.C. pills, and the men who have sex with them, can be free of worry that they not get pregnant.

Oh .. and as I've said, the real groups who NEED to be on B.C., won't use them.  So you are not going to see a decrease in unwanted pregnancies ... in fact, in Hawaii, pregnancies increased.

So .. no .. it's not going to be "Free" .. it's going to be "free of charge" to the individual, who will saddle on a small, ... very small fraction of the cost for their convenience.

Like I said:

"I can't wait to see if, when all is said and done, if birth control pills or any other contraceptive method that requires a prescription by a physician turns out to really be "free"

and will add..

or if men will get to continue to have responsibility-free and worry-free sez like they get to, now, where all they have to say is "she didn't MAKE me be responsible"

Mar 5, 2012 -- 12:25PM, fodaoson wrote:

Who is talking about free birth control ?  (from the link in the OP )

“If my body indeed does enter early menopause, no fertility specialist in the world will be able to help me have my own children. I will have no chance at giving my mother her desperately desired grandbabies, simply because the insurance policy that I paid for totally unsubsidized by my school wouldn’t cover my prescription for birth control when I needed it.”.

 

The person in question, not the  person giving a testimony but her friend ,  was paying for the health insurance and  most probably had a co pay.  “Birth control” pills have several medical applications and were developed and marketed for those applications ,  with contraception being a side effect.

The new mandate under the ACA makes insurance companies cover the cost of birth control at no cost (i.e., no co-pay either).