• Health care maze

    By Ji Lee and accompanying this NY Times opinion piece.


    • The picture is funny, bit it and the article really demonstrate how complicated our healthcare system can be.

      I mean, the guy in the article had no idea how much his treatment would cost, and nobody could give him any idea. Now, I am changing insurance plans, and I get monthly allergy shots, and I’m not sure how much more or less I’ll be paying out of pocket. But this is not a huge deal, since I am paying $18 per shot now. This guy is potentially paying tens of thousands of dollars out of pocket.

      This is why Medicare needs an explicit out of pocket limit imo.

    • Why didn’t he just read the PPACA mandated Summary of Benefits and Coverage. Like all other mandated disclosures, I am sure the SBC would have provided a clear answer to all of his questions.

      Someone should tell Time Warner and the participant about ERISA claims procedures.

    • @ Benefits Jack,

      If you read the article, the question was, what would be the out-of-pocket cost for a specific expensive drug. For the most promising policy, the answer depended on the price that the CVS had contracted with the insurer to
      Part of the question was what was the price CVS charged members of the health plan which had contracted with CVS to provide some degree of drug coverage. And even CVS had trouble answering the question.

      I doubt the mandated summary of benefits covers individual drug prices.

      • @sao.
        Sorry. Just trying to sarcastically note:
        Companies spending billions on dislosures no one wants or asked for, and no one uses, or reads with a “near death” financial penalty for non compliance, and
        A participant and company should know how to use claims/appeals process to get accurate answers.
        Just ask dol/IRS/HHS and they’ll tell you how the tens of billions spent on ppaca compliance is solving participant problems,meeting needs.

    • Here in England Revlimid is free to the over 60s. The cost to the NHS has been negotiated at about $57,000 a year for the first two years and those still taking the drug after that have the entire cost paid by the manufacturer. Surely it’s an abdication of responsibility for the US government not to negotiate similar deals for Medicare.