Insurance rules force local business to change
From the article:
ANDERSON TWP. – As a local business enters its 75th year, it’s going through a lot of changes. Kunkel Pharmacy is now Tri-State Compounding Pharmacy and Kunkel Medical, and they’ve stopped being a regular pharmacy.
The change wasn’t part of a new rebranding strategy – it was the result of law and insurance company changes that forced owner John Dinkelaker to sell the pharmacy portion of his business.
It all started when changes in how Medicare covers prescription drugs went into effect.
“When the insurance companies got into the fray, they said we had to be a member of a group to provide services for customers,” Dinkelaker said.
The former Kunkel Pharmacy, 7715 Beechmont Ave., was part of the preferred network until this year, when some Medicare health plans removed “any willing provider” from which pharmacies would be reimbursed by insurance companies, Dinkelaker said. That meant customers not using a preferred provider would have higher out-of-pocket costs for prescription drugs.
We are now seeing Medicare Part D and Medicare Advantage programs … cutting the pt’s freedom of choice out of the equation.. with “restricted networks”… which they call preferred networks.. sounds better .. right ? Forcing pharmacies and other healthcare professionals to close or change their practices.
We are seeing the DEA strong arming wholesalers to ration or completely shut off independents from buying controlled medications… forcing some pharmacies to close, lose pts/customers and may eventually close in the long run.
We have witnessed the Federal Reserve “screwing with” the money supply .. so that banks can make more money with the Federal Reserve than lending it to small businesses and individuals that want to purchase homes.
I am hearing about people with the ACA.. that are not being able to keep their docs, hospitals and pharmacies… while the number of uninsured are improving marginally – at best.
Several state level “Obamacare programs” have thrown in the towel.
Is it just me… or is there a consolidation of how much of the healthcare market is being controlled by larger and larger “major players” and the common denominator is that a larger and larger share of all of the dollars paid out for health is paid for my various Federal/State agencies.
A estimated 60%-65% of all healthcare is paid for with “bureaucratic money ” http://en.wikipedia.org/wiki/Health_care_in_the_United_States
Compared to 50 yrs ago… that figure was ZERO ! and is that per-cent accelerating rapidly ? Will Obamacare be the final piece of the puzzle to get us near that 100% point… and a complete national health insurance program.. and one entity deciding what and how much healthcare we are entitled to.
As long as you are not at either end of the “bell curve”… young and sick or old and sick… this system might prove to be acceptable.. otherwise… you’re screwed… Sounds like Darwinism is making a return
Filed under: General Problems
I would love to see these HHS bulletins. I have a divorced friend whose ex- husband dropped his 24 year old son from his policy and the child had a skate boarding accident and ended up with a $6000.00 emergency room bill.
http://www.hhs.gov/healthcare/rights/youngadults
My husbands employer based insurance when ACA was signed even though they were ‘granfathered’ immediately changed its rules to match the ACA rules so we were told keep her on. Until this year, we could drop her IF she became eligible for insurance offered at her place of employment, but they didn’t offer insurance to part time. Everyone I know in my town with kids 18- 26 no matter what their insurance was were told to keep them on their plans by their employer benefit managers after ACA was signed. Used to be as long as they were full time college students and single til age 23, which she is anyway. It’s when they’re not students on their own, or married that gets me.
Unless we get out there and VOTE and change the house AND senate at midterms to get some of the backlog moving AND have enough votes to override Obummers vetos, nothing will happen and by 2016, he will have ruined this country and have his wish of SINGLE PAYER SOCIALIST HEALTHCARE WITH VERY LIMITED CHOICES. My husband’s insurance already has started. They have changed theirs and parterned with a big known healthcare group in IN. Copays will be up even with in network docs. I have an out of network doc and to save our budget, I am forced to change. We have to change our pharmacy because the copay difference for generic use is a difference of 4.00 and some of my husbands meds will be covered 100% The pharmacy we have been using is a grocery chain which we get gas points which have helped at times. I’m not happy about any of this. It’s now 300.00 copay to go to the ER for true emergencies when it used to be 100.00…they could not tell us what the definition of a true emergency was. At least I have been to their Urgent Cares enough times to know what they will and won’t handle so I can figure it out for myself and my husband. Due to my husbands bipolar, we couldn’t take the cheaper form. I don’t see the doctor that much or take that much med, but he has several co morbid conditions and we arent’ allowed to split plans. And I don’t mind keeping his son but his 22 yo daughter who refuses to speak to us and almost never uses the doc except for her birth control pills…we have to keep her til she’s 26 even if she gets married…isn’t that rediculous She works part time but isnt offered insurance at her job. (options for under 26…either parent, spouse, her work if eligible, his work if eligible). Im grateful I have insurance, I didn’t have any for 5 years. I only went when I was really really sick and my parents helped pay. I remember when I was a kid, there was no health insurance…every thing was cash, you worked payments out with the hospital, as long as you paid a small something, they didn’t send to collectors after 2 months. We need to go back to that….then prices will drop..supply and demand. People have no idea of true costs. When I couldn’t pay I applied for charity care thru the hospital….it’s there…I swallowed my pride and asked and I was helped…Ask and you shall receive…..I pay it forward when I can quietly….I do my best as to what my higher power asks of me.
I do not believe “you have to keep” the 22 year old daughter on your plan. The ACA gives you the option to keep her on if you choose. If she were a minor child you would probably have to cover her, but she is of the age of majority.
We are required to keep her on until she is 26. We were at the employee open enrollment meeting and I’ve checked the various bulletins from HHS. Only if she CHOOSES to take insurance elsewhere ie becomes eligible thru work, or gets married and her spouse’s insurance is better. Even if she had other insurance before 26 and lost it, she could request her dad enroll her on his insurance until she is 26. Plus it’s also in his divorce decree that he provides insurance, but his divorce was prior to ACA. My ex has to keep our kids on his insurance. Our oldest son graduated college and is off on his own and opted to get his own thru his new job and get off his dads. What I think is crazy is the kid can get married and could still remain on the parents insurance. Luckily if they were to have kids, We don’t have to put THEIR kids on our insurance or her spouse.
There is nothing in the federal health care that requires you to insure adult children. There may be contractual obligations under various separation and divorce decrees to insure these children, or perhaps specific state statutes.
The daughter probably cannot be dropped right now because of IRS regulations which state you can’t change your deductions unless their is a qualifying event because pre-tax dollars are used to purchase these benefits. At the next open enrollment period, you should be able to terminate the 22 year old.