Ask MetaFilter questions tagged with insurance and medicine

How can I make my insurance pay for homocystinuria protein powder?

Jacen Solo — Tue, 28 Jul 2009 09:29:24 -0800

I have homocystinuria, which means that I should get as little methionine in my protein as possible. The doctors recommend I take a special methionine-free protein powder, but the insurance won't pay for it. What is the step-by-step for making them come around? A little background: homocystinuria means that if I get too much of the amino acid methionine, it'll end up turning into homocysteine, which builds up to a toxic level and (in theory) gives me a stroke. Now, I lived the first 18 years of my life without knowing this, and eating whatever I want; I also didn't end up with any of the really scary symptoms on that Wikipedia page, like retardation---although I am a bit abnormally skinny/tall/thin/long-limbed. Nevertheless, now that I know about it (genetic tests), I'd like to avoid the whole stroke thing.

So, the doctors say that I should stay on a low-as-possible protein diet, and in particular avoid certain bad foods. Then I should supplement my food intake with special methionine-free protein powder, like HCY 2 or HCU Express. So far I have not been able to do this, because my insurance refuses to cover it; instead I have been just avoiding bad foods "most of the time," and not getting any supplemental protein. This is sad, especially since it feels a bit counterproductive when I'm trying to make my weightlifting work for me and my low-protein vegan diet.

The insurance story: I have student health insurance through Aetna/Chickering. The doctors wrote me a prescription for one of those powders, but when I went to order the powder, I couldn't apply my insurance to the purchase. (I don't know exactly how that worked; my parent handled the details at the time, a couple of years ago.) I tried filing an appeal, twice, including letters from the doctor explaining why this was actually necessary for me. But the insurance company sends me a form letter saying "no you can't do that, it's a dietary supplement, not a medicine; no insurance for you." Thus, I can't get my protein powder.

I'm ready to try fighting this one out once again, but this time with the wise guidance of the AskMeFi hive mind. What's the procedure for fighting with the insurance about something like this? How can I be most effective? What's the step-by-step escalation process? Do I ever involve outside agencies, like state government or something? (I'm in California.) Should I try to contact the media and get them to make a sob story about evil insurance companies? (Mostly kidding about that last one...) Keep in mind that I've already tried the appeals process, and it didn't work; I guess I need to push harder. Feed me your wisdom on how to do so :).

Insurance Cancels Allergy Drug Coverage

morallybass — Sun, 28 Sep 2008 20:42:19 -0800

My insurance company (Blue Cross/Shield MA) is dropping all prescription drug benefits for allergy drugs in favor of over-the-counter medicine like Claritin. I have serious allergies and take Alegra 180. What can I do? My insurance company (Blue Cross/Shield MA) is dropping all prescription drug benefits for allergy drugs in favor of over-the-counter medicine like Claritin. The rationale being that all allergy symptoms can be treated by this class of drug.

I have very serious allergies and take Alegra 180. I've tried Claritin, Zyrtec, and a variety of other drugs and finally settled on the serious prescription allergy drug I have been on for the last 5 years.

What can I do now that my insurance seems to be revoking all coverage?

Help me find medical insurance in Boston.

nightengine — Wed, 14 May 2008 12:33:21 -0800

Help me find medical insurance in Boston. My family and I are moving to Boston in a couple months so I can return to school. Up until now, my employer has provided our medical insurance. However, I will not be employed while in school, and my wife (a music teacher) is still looking for a position. I can elect to use COBRA, but the premiums are outrageous. I vaguely know Massachusetts has a law requiring all residents to be covered by insurance. So I have several questions. First, how long do we need to reside in MA to qualify for any plans offered to residents? Second, where do we go to look for plans? Finally, which plans do MA MeFites recommend or avoid like the plague? If we can't look for policies through whatever state mechanism exists, please recommend a broker or other solution.

We are a family of three (two adults and a 4-year-old). Any plan we consider will have to have (a) decent prescription drug benefits and (b) mental health coverage.

Switch from OTC to prescription meds

0xFCAF — Tue, 12 Feb 2008 09:38:28 -0800

Will my doctor switch me from an OTC medication to prescription if I just ask nicely? My employer's health insurance plan has a $0 co-pay for prescriptions. Currently I'm taking Prilosec OTC (paid for out-of-pocket) as recommended by my dermatologist to prevent heartburn aggravated by a different prescription. I'd like to a) not have to pay for it and b) not have to spend my time cutting the pills out of their blister packs.

Medically the Prilosec is working perfectly, so will a reasonable doctor object to switching to a prescription equivalent? I'm assuming there's some slightly different formulation that's not OTC-approved but has the same efficacy profile that I can switch to. If you happen to know the name of such a thing, that'd be good to know.

Barring all of the above, if there's a proton pump inhibitor that just comes as pills in a bottle rather than the ridiculous Prilosec packaging, I'd love to hear about it.

Preventive Medicine

MrMulan — Tue, 22 Jan 2008 11:22:02 -0800

Why don't insurance companies cover or help cover gym memberships? I have had multiple jobs, and exactly 1 offered $300 if you went to the gym for a certain number of times every quarter.
Is it the insurance company that offers the benefit or the employer that needs to insist on it? (and probably pay a premium for the privilege)

Are there any reasons insurance companies shouldn't do this, or have the bean counters (accountants) already crunched the numbers, and figured out that the cost involved in running the program, tracking the participants, and issuing the reimbursements does not result in lower health care costs?
But then aren't the few companies who offer it (Cigna?Oxford?) not meeting their fiduciary obligations to their shareholders? Or are their bean counters using a different accounting formula to show a savings to the company in reduced health care costs?

Should I claim my psychiatric meds on my insurance?

soulbarn — Mon, 16 Oct 2006 10:09:44 -0800

Here's the situation: I changed health insurance plans about two years ago ago. I have a good plan, based in Californa, that costs me about $250 a month. Since starting the coverage, my major medical expense - for about a year - have three monthly medications which I take for recently-diagnosed bipolar disorder. I have never claimed these expenses on my insurance, nor have I ever put any of my psychiatric costs on a claim. The reason is that I've been advised not to do this, especially with a bipolar diagnosis, since, in the words of my psychiatrist, "once that's on your record, you'll have a very hard time if you need to change insurance plans." (I should add that the diagnosis, while scary, and the resulting treatment, has changed my life so much for the better that I'd sell pretty much sell a kidney to keep paying for the meds, if I had to.) I do want to keep the option to change plans open to me - if I move, or take a job that has group coverage, or for whatever reason.

However, my medication is expensive. Of the three that I don't claim, one costs about $30 a month, because it is available generically. The other is about $125 a month, and is not on the insurance company's formulary, so I wouldn't get reimbursed for it until meeting a (high) deductible. But the third one retails for $150 a month, and is on the formuary, which means I could get it for $25...

The expense, with my premium, is getting so high that I'm very tempted to put the third medication only on my insurance. It is for Lamictal, which is used for bipolar, but is more often used as an anti-convulsant. My question is whether just putting this one - not the other two - on the policy, at a different drug store (I buy my other meds on a cash basis), will constitute that "black mark," considering that I will likely continue to take that medication for the forseeable future. Does the insurance company care or know what the purpose of the medicine is (I could get my family doc to prescribe it, rather than my psych, if need be.) Am I being paranoid?

Just one more bit of background: I've been continuously insured for about ten years; I did claim an anti-depressant for a while, on my old policy, and it did lead to me being rejected by a couple of companies when I switched insurers - though I was accepted by my current company, of couse. I also just had what is probably te first major medical claim of my life (I'm 40 years old) - I had to have surgery on my sinuses, after a year of chronic sinus infections and related asthma attacks, neither of which I'd had earlier. I take two asthma medications, one of which is non-formulary, and the other of which is costly, and which the insurance company only covers about 10% of the cost until my deductible.

So, is the savings of about $100 a month worth exposing the private part of my medical history to my insurance company?

What level of medical insurance should I get?

lorimer — Fri, 15 Sep 2006 07:40:31 -0800

MEDICAL INSURANCE: I'm getting some for the first time in 8 years. Clearly I should have at least catastrophic, but help me decide whether having more is worth the cost. Also: any opinions about HealthyNY insurance? This year I'll have a little more money than usual (i.e., I won't be scraping by exactly day-to-day), so it's time to get some (very low-cost) medical insurance. I'm trying to decide whether to have just catastrophic/accident coverage or have basic general coverage. I live in NY and my income is definitely low enough to qualify for HealthyNY (about $180/mo without prescription coverage), but not low enough for Medicare.

I'm female, late 20s, in excellent health except that I'm 30% over my median ideal weight. Low blood pressure, low cholesterol, have never smoked, no drugs & little alcohol, no STDs and very careful about preventing them, very careful/healthy in general. Over my entire life I've had no medical issues, no mental health issues, & virtually no medical expenses (just preventive care plus a few one-time prescriptions for things like chicken pox as a kid). My only risk factor I can think of is that I was exposed to a fair amount of 9/11 dust (but I've shown no signs at all of lung or breathing trouble).

My current preventive-care costs are just an annual gyn exam + pap smear (very cheap at Planned Parenthood) and dental exams. So, under $200 a year.

Also: If I couldn't afford it some months, are you generally allowed to "hop on and off" and just be covered at the times when you did pay that month -- or do you lose your coverage as soon as you can't pay and have to re-apply when you can afford it again?

Thanks for any insights!!

Can I have two health insurance policies?

soulbarn — Tue, 03 Jan 2006 14:35:05 -0800

I currently have an excellent health insurance plan - however, it does not cover a medication my doctor would like to prescribe. It is available on my spouse's plan, however. I don't want to change insurers because my doctor only accepts my exisiting company, and I want to keep her. However, I can get onto my spouse's policy for quite a bit less than the monthly cost of the medication. Is this legal? Ethical? Are there any pitfalls? Would one insurance company be able to share information about my medical history with another? Would there be trouble for me if I became seriously ill? Thanks!

As a man, is there any way I can use my health insurance to pay for birth control pills?

tweebiscuit — Sun, 13 Nov 2005 12:28:18 -0800

I'm about to start my first salaried job, and will therefore have health insurance. My girlfriend has none. We'd like a method of birth control that's safer and more effective than condoms, but neither of us can afford birth control pills out of pocket. As a man, is there any way I can use my health insurance to pay for birth control pills? If not, what are my other options? Again, this is the first health insurance plan I've had since I was covered by my parents, and I haven't gotten the paperwork yet, so I'm not sure exactly what the terms are -- but in general, is this something that's doable? Alternatively, what are my other options, short of a vasectomy? It galls me that, in this situation, it seems that my ability to take responsibility for our reproductive safety is limited. (Apart from condom use, which in my mind is not a long-term solution.)

PDX infant healthcare

mecran01 — Mon, 09 May 2005 08:52:50 -0800

I'm on vacation in Portland, Oregon and our lame insurance won't pay for any healthcare. Anyway, there's a $200 deductible. I can go to an urgent care for $200, but was wondering if anyone knows of a pediatrician somewhere that will take walk-ins that might cost a little less than Urgent Care. I know there's a free clinic in Vancouver, but we don't really qualify, although I suppose we could go there and make a large donation. Our daughter has shown signs of what we thought was a cold, intermittent fever, and now she has puffy allergy face and a rash. Her breathing is fine, but she's been cranky for a couple of days.

(Travel) health insurance for a Moroccan visiting the US?

Gooney — Thu, 03 Feb 2005 11:16:45 -0800

My boyfriend wants to have his mother from Morocco come visit us in the US. She has some health problems including Diabetes.

Does anyone have any information about how we can get some health insurance for her while she is here visiting just in case we need for some reason seek medical assistance during her stay?