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Started By
Message
Snap Shot Of Our Healthcare System Rx Related.
Posted on 12/12/25 at 10:20 am
Posted on 12/12/25 at 10:20 am
This is just a medication for stomach issues
Dr writes prescription 12/2/2025, sends it to Walmart Rx who sends it to a PBM (Pharmacy Benefit Manager) who "Hee Haws" around for 10 days then denies the medication.
The Insurance company overrides my Dr and decides (without ever consulting me) I don't need the Rx.
Walmart says if I want it filled without insurance approval it's $650.00 for 30 days, with Insurance $30.00.
Dr writes prescription 12/2/2025, sends it to Walmart Rx who sends it to a PBM (Pharmacy Benefit Manager) who "Hee Haws" around for 10 days then denies the medication.
The Insurance company overrides my Dr and decides (without ever consulting me) I don't need the Rx.
Walmart says if I want it filled without insurance approval it's $650.00 for 30 days, with Insurance $30.00.
26
Posted on 12/12/25 at 10:24 am to The Torch
It's a massive scam.
Posted on 12/12/25 at 10:27 am to The Torch
quote:Not covered in your plan. Just a guess.
Walmart says if I want it filled without insurance approval it's $650.00 for 30 days, with Insurance $30.00.
Posted on 12/12/25 at 10:34 am to Diamondawg
quote:
Not covered in your plan. Just a guess.
I have BC/BS Large group insurance that I pay over a $1,000 a month for my third.
And they can’t cover a freaking medication for stomach issues.
Posted on 12/12/25 at 10:37 am to The Torch
I picked up an rx for the baby yesterday and was told I presented the hospital insurance card, not the prescription insurance card. I said I’d just pay for the med out of pocket because my baby is sick. So dumb.
I was nice about it though so the pharmacist found a coupon for me and it only cost $5.44 but still.
I was nice about it though so the pharmacist found a coupon for me and it only cost $5.44 but still.
Posted on 12/12/25 at 10:38 am to The Torch
quote:
The Insurance company overrides my Dr and decides (without ever consulting me) I don't need the Rx.
Huge problem right now that more people should be talking about. I’ve seen this happen multiple times with 2 different very large health insurance companies over the past few years.
Posted on 12/12/25 at 10:40 am to The Torch
You are paying for all the people who don’t and millions of Americans are ok with it so enjoy the continued increases
Posted on 12/12/25 at 10:42 am to The Torch
Then don't go get dental work, it's an even bigger scam
Posted on 12/12/25 at 10:46 am to The Torch
Tell them you’re illegal. They’ll fill it while you wait. Gratis
Posted on 12/12/25 at 10:51 am to The Torch
It’s not what your provider wants you to have, it’s what the insurance companies allow you to have
Pay cash and get what you’re supposed to get or let the insurance company dictate your care
What a shite system we have
Pay cash and get what you’re supposed to get or let the insurance company dictate your care
What a shite system we have
Posted on 12/12/25 at 10:52 am to The Torch
The real answer is that they purposefully deny a certain percentage of claims and hope you just say "frick it" and move on.
I call this "effort arbitrage" Yes, I invented that term (I think)
I have a customer that randomly doesn't pay freight charges. When we contact them, they 100 percent of the time agree to pay them. They are a big company, so if 10 percent of their vendors don't challenge, then it's serious money.
That's what is going on here.
I call this "effort arbitrage" Yes, I invented that term (I think)
I have a customer that randomly doesn't pay freight charges. When we contact them, they 100 percent of the time agree to pay them. They are a big company, so if 10 percent of their vendors don't challenge, then it's serious money.
That's what is going on here.
Posted on 12/12/25 at 10:52 am to 4cubbies
quote:
I picked up an rx for the baby yesterday and was told I presented the hospital insurance card, not the prescription insurance card. I said I’d just pay for the med out of pocket because my baby is sick. So dumb.
See my above post. This is what they are hoping you will do.
Posted on 12/12/25 at 11:28 am to The Torch
Somebody has to pay for other's free healthcare.
Posted on 12/12/25 at 12:01 pm to The Torch
Use a different pharmacy.
Had similar situation where my rx was for a certain amount of ounces but Walgreens only sold x amount of ounces so they wouldn’t fill the script.
Had similar situation where my rx was for a certain amount of ounces but Walgreens only sold x amount of ounces so they wouldn’t fill the script.
Posted on 12/12/25 at 12:09 pm to The Torch
European leeches are to blame and our government for allowing it to happen
Posted on 12/12/25 at 12:20 pm to The Torch
quote:I needed an anticoagulant. My doctor ordered Eliquis. Plan wouldn’t pay for it but they paid for Xerelto. Talk to your plan admin in HR. Bet he/She will tell you the same.
I have BC/BS Large group insurance that I pay over a $1,000 a month for my third. And they can’t cover a freaking medication for stomach issues.
Posted on 12/12/25 at 12:34 pm to The Torch
quote:
Walmart says if I want it filled without insurance approval it's $650.00 for 30 days, with Insurance $30.00.
Pay cash & use GoodRx. My medications are $500 a month cheaper paying cash than using my insurance.
Posted on 12/12/25 at 12:37 pm to The Torch
I fricking knew it was BCBS before you w en said it. They’re the worst and one of the most expensive ever since Obamacare went into effect. They used to be decent before 2010.
Posted on 12/12/25 at 12:38 pm to The Torch
The bigger problem is that your doctor has to treat your issue inside of the standard of care, so this RX probably isn't even addressing the root cause of your issue.
Posted on 12/12/25 at 12:52 pm to The Torch
I’m surprised people aren’t starting to lash out violently at the people making these decisions.
Oh wait
Oh wait
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