Cancer and health insurance (teacher's)

Discussion in 'Teacher Time Out' started by Peachyness, Jul 21, 2012.

  1. Peachyness

    Peachyness Virtuoso

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    I'm watching this tv show called Breaking Bad right now and I'm curious. The main character, who is a high school chemistry teacher, is battling lung cancer. In order to pay for his treatments and leave money for his family when he passes away, he is producing meth. His partner is selling it. I'm in season two right now.

    Anyways, what I don't get is why doesn't his health insurance cover the costs of cancer treatment? Apparently, I read online that it's because he has "crappy health insurance."

    I know it's just a tv show, but is this true in real life? I don't know any teachers personally who went through therapy for cancer so I do not know how well treatment is covered by health insurance.
     
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  3. JustMe

    JustMe Virtuoso

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    My mother in law worked for the state and sadly passed from cancer. All I know is that it was said more than once how thankful they were to have taken out an extra cancer policy. I have one for myself and husband through school.

    You like the show?
     
  4. Peachyness

    Peachyness Virtuoso

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    The show is pretty deep. Originally, I only started watching it because I always liked the main character, Byran Cranston. I used to LOVE watching Malcolm in the Middle where he played the dad.

    I'm hooked on the show now because everything is spiraling out of control. And I need to see how it plays out. It's pretty deep, depressing, etc. But very interesting.
     
  5. Ima Teacher

    Ima Teacher Maven

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    I've never had cancer treatments, but I did have to deal with a serious illness. From July of 2001 to December of 2001, I was out nearly $6,000 in co-payments alone. I was hospitalized four times, and I had four surgeries, which were separate from the hospitalizations. There were tests and doctor visits. At one point I was taking 16 prescription medications per day. My dialysis treatments alone were $268 each, and I had them three times a week. Other than my primary care doctor, all of my other doctors were out of town, which required a drive of anywhere from 40 to 100 miles round trip.

    It was really tough for awhile. In addition to dealing with all of that, I had to worry about whether I had enough sick days to cover the 45 days of school I missed that year. I couldn't afford to take a deduct day, so I worked some days when I really should have stayed home.

    By the time I was given the all clear, it had been more than a year and I was nearing the $10,000 out of pocket mark. And just to make things more complicated, my treatments caused a 100 pound weight gain in 3 months, and I had to buy a completely new wardrobe before I could even return to work! My shoes didn't even fit. That's one of those things that insurance doesn't even apply to.

    The worst part is that I had the BEST insurance offered!
     
  6. mollydoll

    mollydoll Connoisseur

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    Jul 22, 2012

    My first teaching job had cancer insurance as an extra $50/month.

    I had a surgery and had to pay for 30%. This was considered to be good insurance.

    I had a similar one plus a week long hospitalization with military insurance and had to pay very little. Congress is doing its best to li it this and our copays are going way up, plus yearly enrollment fees are going up a lot. This is really revolting; one of the benefits of the sacrifice and lower pay for military service is supposed to be good healthcare. People don't realize that the benefit costs are figured into military pay--it's not a freebie.

    I'm not getting care I need now because I can't afford the copays any longer. They are over $300/month, plus $80 for meds. The hospital won't work with ,e because they don't do payment plans or assistance with copays and each visit has a new account number. So, I'm basically screwed. After over a year of this, I just can't do it any longer. For the past year, every single penny I have has gone for medical bills. I'll likely end up in the hospital for a week again because I'm not getting the care, but that will be covered.

    That whining doesn't compare to your ordeal Ima! How awful; my heart goes out to you.
     
  7. Peachyness

    Peachyness Virtuoso

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    Wow.... I don't want this to become a political thread.... but I've always been very disappointed with our health care system.... and I'll leave it at that.

    In one district I worked at, I chose the cheapest plan. I was paying around $900 a month. But it covered everything. My copay was very little.
     
  8. mollydoll

    mollydoll Connoisseur

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    Honestly, most health care systems have huge issues. I have relatives in Ireland who have to go private at large expense in order to get necessary treatments in a timely enough manner. My aunt was going to have to wait 4 months for a biopsy to see if she had breast cancer (she did--waiting 4 months would NOT have been good). Not that the care is all bad, but wait times for things can be outrageously long.

    When I lived in the Netherlands, I was often shocked by the things that were not considered routine. I had a friend with a high risk pregnancy but it wasn't treated as such and she had horrible problems. That wouldn't have happened here.

    The grass is always greener.
     
  9. Peachyness

    Peachyness Virtuoso

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    True. Very true.... and sad. :(
     
  10. Cerek

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    From what I've seen over the years, most group insurance policies will cover routine illness and hospital expenses and will also help a great deal with any major health issues that come along, but still may have "gaps" on their coverage when it comes to cancer and other chronic illnesses.

    The two school districts I've worked in so far had insurance reps come by offering supplemental policies to provide additional coverage for different areas or circumstances that our standard insurance may not cover adequately. Cancer was one of the main areas the supplemental policies targeted.

    I would say most school insurance provides coverage for about 60-80% of the costs that could be incurred from cancer, but the remaining 20-40% can still add up in a hurry with multiple hospital stays, chemotherapy, very expensive medications and time lost from work. The supplemental policies generally help cover these costs that the individual would normally pay out of pocket.
     
  11. bros

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    My health insurance is rather good (My mom works for the town as a court clerk, and they got the same insurance as the teachers union up until earlier this year)

    It's paid for numerous things, for only $36 a month. Paid in full (no co-pay) for a $101,000 test (a 10 day Video EEG)

    My mom's insurance + medicaid luckily covers all of my numerous medical expenses (including $600 a month in prescriptions)
     
  12. teacherintexas

    teacherintexas Maven

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    I can't speak for cancer treatment on a teacher's policy, but I can as a cancer widow. My late husband had (what seemed to be) much better insurance than mine. For the normal tests and medications people tend to need with ear infections and common ailments, his insurance was far superior.

    Until he was diagnosed with a rare cancer, that is. Three different doctors, two were from one world renowned cancer hospital, had prescribed a particular chemo drug combination, but since it was "off-label" and had only been approved for breast and colon cancer, my husband's insurance company denied the chemo meds saying they were not medically necessary. When speaking to his insurance company, often leading me to tears, they never once could even name a chemo protocol they would allow.

    One of his paillative care medications was very expensive, and I had quite a debt to pay after he died. I don't regret doing this as I was incensed that the insurance company seemed not to care if my husband lived, but I sent a copy of a photograph of my husband in his casket, a copy of the letter they sent me saying his chemo was not necessary, and a two dollar check every month for a couple of years. They quit sending a bill after that.
     
  13. teacherintexas

    teacherintexas Maven

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    My late husband also had a cancer policy. It paid a total of two thousand dollars, and I had to send in over a hundred pages of paperwork to get that.

    His chemo drugs were four thousand a week.
     
  14. JustMe

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    That makes me furious.

    My papaw's VA insurance denied him...saving his life was too costly, apparently.
     
  15. teacherintexas

    teacherintexas Maven

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    I can relate.

    I belong to several online organizations that were created after we went through this type of cancer. There are many people who had further stage cancer but were treated with the drug combo my late husband's doctors wanted who are at the three, four or five year survival mark. I truly am happy for these people, but it does make me feel my late husband's insurance company murdered him or at least hastened his death.

    Yes. I know I can't change what happened, and I did every thing I could to save his life from spending hours on the phone with the insursnce companies and advocacy groups and politicians and anyone else I thought could help to only sleeping at most three hours a night as he was in pain the most during the night hours. I would have traded places with him if I could have. But I can't help but wonder what if.
     
  16. JustMe

    JustMe Virtuoso

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    At the risk of sounding dramatic, blood is on their hands. It breaks my heart what you had to endure and that your husband wasn't given the chance he deserved.

    A person does the "responsible" thing and pays for an insurance policy...and often it's greatly beneficial. But that means NOTHING when you're the one dropped, ignored, unserved...and left to die. :(
     
  17. Aliceacc

    Aliceacc Multitudinous

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    I'm in a Catholic school. Technically our's isn't an "insurance company" it's a "benefit trust." No one ever recognized the name of the actual company, but we're part of the Magnacare network, and they all recognize that.

    The only issue I had was when I orignally needed an MRI so the surgeon could get a good look at the tumor before he went in. Apparently teh biopsy and "10 cm in diameter" weren't enough; they wouldn't approve the MRI until they actually saw the phrase "breast cancer" on the report. Once they saw that, it was cleared.

    Our insurance paid all but a maximum of $2000 per calendar year. (It's a little convoluted-- a dedcuctible, then I think it's 15% until you reach that $2000 mark). But after that, they paid it all. It WAS a little ovewhelming seeing all those bills come in. My sister arrived at my house one day to see me in tears, wondering how on earth we would pay for it all. But once the bills were actually submitted, it was a non issue. The rest of the mastectomy was covered. Radiation was no problem, nor was the thyroidectomy that followed a few months later.

    Something else that you guys may want to be aware of: in 2004, Peter took out a policy wtih AFLAC that we pretty much forgot about. Someone at his school mentioned it a few months ago, and we have since submitted claims. AFLAC pays for preventative care, so I've been reimbursed $75 per year for my annual mamo.They also pay living expenses for Cancer patients-- I just submitted that claim last week, so we'll see how it pays. The idea is to pay your living expenses-- and ones like those $2000 per calendar year-- should you be unfortunate enough to end up with cancer. It might be worth looking into.
     
  18. KinderCowgirl

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    My Dad always says it used to be that teachers weren't necessarily paid well, but they always had good benefits. With budget cuts that's just not the case anymore. I just read that our district is changing our insurance again to one that will be cheaper for them-I'm assuming more expensive for us.
     
  19. Aliceacc

    Aliceacc Multitudinous

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    Prayers for a good outcome, kinder.
     
  20. bandnerdtx

    bandnerdtx Aficionado

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    I totally understand what you're saying. I have a heart condition that needs to be monitored regularly but doesn't really interfere with my quality of life. I can live with it. I'm due for a checkup with my cardiologist, but I'm going to have to pay over $200 for an office visit. My district's health insurance requires us to pay a $2000 deductible before any of our coverage kicks in, and after that we still have to pay 20% of whatever medical costs we have.

    I also have a cancer supplement, but there's no guarantee that it will cover the "gap" that another poster mentioned. As someone else mentioned earlier, I don't want this to be a political statement, but I hope the government option does force private insurance to be more competitive and lower the costs they are pushing on us. :(

    *sigh* Kinder, I hope your situation turns out okay. :hugs:
     
  21. KinderCowgirl

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    Thanks Alice-I don't think it will be serious-definitely will have at least minor surgery, but at least it's summer and I won't have to take off from school.
     
  22. Cerek

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    Unfortunately, this is how most health policies work, even group insurance.

    Each policy will carry a deductible (usually $250 or $500, but sometimes more) that must be met before the insurance begins paying anything. After that, the insurance generally pays 80% of the cost with the patient still having to pay 20% until meeting an out-of-pocket maximum such as Alice mentioned. That will generally be anywhere from $1,000 up to around $5,000, but usually falls around $2,000-$2,500. After that out-of-pocket max is met, the insurance begins paying 100% of all subsequent bills.

    Whether PPACA, or ObamaCare as it is more commonly known, will "fix" this or not is debatable. It does contain a provision that prevents insurance companies from denying coverage or charging a higher premium to those with pre-existing conditions. This is a good thing, on the surface, but forces insurance companies charge the same premium for everyone, regardless of health risks. It also eliminates waiting periods (which were typically 1 year) for anything related to a pre-existing condition. However, this isn't really a new provision. In 1996, Bill Clinton's administration passed the HIPPA legislation. While it is known primarily for protecting patient confidentiality, it also contained a provision that prevented those with pre-existing conditions from having to endure multiple waiting periods if they changed providers. Once you had met an initial waiting period with ANY carrier, that transferred to any new insurance carrier you might have, as long as you had no break in coverage. In other words, if you got insurance through Job A and went through the waiting period there, then you could move to Job B, Job C, etc and not have to undergo any additional waiting periods, as long as you had continuous coverage during the job moves.

    As for competition among health insurance carriers, that could have been achieved by simply removing the restraints that prevent health insurance carries from competing across state lines. Right now, health carriers are restricted to just their state. That is why you have BCBS of State A, State B, and so on, rather than just have BCBS nationwide.

    If health insurance companies were allowed to compete nationally like property and casualty insurance (auto insurance, homeowner, etc), then we WOULD have increased competition with Geico, Progressive and others offering lower-rate health coverage as an alternative for those that just want basic coverage.

    Whether good or bad, we will see in about 18 months how well PPACA actually does what it claims to do.
     
  23. czacza

    czacza Multitudinous

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    Lung cancer....:blush:even in a serious thread, LUNCH cancer makes you wonder...just what was he eating?
     
  24. bandnerdtx

    bandnerdtx Aficionado

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    Agreed! Let's hope it's for the best, or at least makes it better. I know that what we have now simply doesn't work.

    The support staff at my school (cafeteria workers, secretaries, aides, custodial staff) can't afford our school insurance. Even the least amount of coverage costs more than their monthly salaries if they are trying to insure their entire family. That breaks my heart. The working poor can't afford to get sick.

    Here's something that bothers me. My sister and her husband are, for all intents and purposes, indigent. Neither has a job (my sister by choice and her husband because of a severe disability). They've NEVER had insurance, even when her husband was working steadily as a self-employed handyman. (Keep in mind, they have no children.)

    So about two years ago, my BIL's health problem became so bad that he couldn't work at all. Heck, he couldn't physically get out of the bed! It was horrible. For two years, they jumped through every hoop Medicaid held up, going from doctor to doctor. Each doctor said he needed surgery or he would never be able to walk correctly again. Even with all the doctor's saying, "Yes, he MUST have this surgery" it still took Medicaid two years to process everything and make it happen. So good news: he had the surgery two months ago, and his life has been given back to him! He's pain free, happy and working side jobs as a handyman again. Here's what upsets me: the entire surgery cost him $30. :dizzy:

    I've been an active participant in the work force for over 20 years. I've always had health insurance for me and my daughter. I pay all of my premiums and deductibles, and if I had that surgery, it would have cost me THOUSANDS of dollars and put me in *serious* debt. As a single mom who makes way too much to qualify for any type of assistance and who is trying to send my daughter to college next year, that drives me crazy. To think that somehow I can take on that kind of debt, that I should HAVE to take it on just to be healthy, is ludicrous.That's one of the big problems we need to fix, IMO.
     
  25. Aliceacc

    Aliceacc Multitudinous

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    Kinder, you have a credit card for emergencies. Surgery is an emergency. Use the card as necessary in order to protect your health.
     
  26. chicagoturtle

    chicagoturtle Fanatic

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    Check if this is appropriate in your state, but you can't get turned over to collections if you are on a payment plan, so you may not need to put it on your credit card. I am not sure if this only applies to hospitals, but I have always worked out a reasonable payment plan with the local hospital here for my various needs due to being somewhat of a medical mystery.
     
  27. Cerek

    Cerek Aficionado

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    Getting turned to collections isn't the death toll hospitals and others would like you to believe. Collection agencies are often MUCH easier to work with regarding a payment plan because they get their percentage as long as they collect something. And being turned over to credit collections might hurt your credit score somewhat, but it won't kill it. Besides, we should be buying less things on credit anyway.

    I've had as many as 24 different medical bills that had to be paid every month. As I told one hospital that insisted on receiving a higher payment than I could afford, "If it is any consolation, none of the 20 other providers I have to pay each month are happy with the amount THEY get either, but I give them what I can and that's all I can do."

    When a hospital or doctor's office threatens to turn me to collection agency, I tell them "Go ahead. THEY will accept the amount I'm willing to pay each month and will deduct their percentage from it, so you're office will actually end up with less money than if you just took the money yourselves. This is the amount I can pay. It doesn't matter to me who I write the check to." They usually become a bit more flexible in the amount they will accept after that.
     
  28. Peachyness

    Peachyness Virtuoso

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    Changed it! Whoops!

    But, speaking of cancer and lunch... I had to watch a documentary for my nutrition class on the correlation between food and cancer. It was VERY interesting and an eye opener.
     
  29. bison

    bison Habitué

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  30. bros

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    Also, with bills being turned over to collection agencies, if the collection agency doesn't deal with it properly, you can have the debt totally wiped for pennies on the dollar (i.e. if the company the hospital sends after you sells the debt to another company, in some states you only have to pay what the company bought your debt for (and they usually buy them in large package deals, so they get them for a fraction of how much you owe)

    Also, with a $2000 yearly deductible, I am so happy my insurance doesn't have that, it wouldn't take long for me to hit one though. Already spent $500 in 3 months in co-pays. And this week I get to go to my cardiac electrophysiologist, who costs a lot :p
     
  31. Aliceacc

    Aliceacc Multitudinous

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    The way ours works is that there'e a $200 annual deductible. Once you pass that, the insurance kicks in and you pay a percentage (I want to say 15% but I could be wrong) up until where you hit that $2000 max. At that point the insurance covers the remainder of the bills.

    My "black cloud period" covered 2 calendar years. So of all the medical treatement I received: 6 surgeries, 2 biopsies (one breast, one thyroid), radiation, a mamo, a sonogram, an MRI, and endless doctor visits, I paid a total of $4,000.
     
  32. teacherintexas

    teacherintexas Maven

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    That is how my late husband's was supposed to work. He had higher deductibles ($500) and a higher max out of pocket ($2500). His illness was from October to March so I had two calendar years to pay.

    But....they only paid for things deemed medically necessary. And the kicker is, they only paid for things THEY deemed medically necessary. About five different doctors personally called the insurance company for us, but that didn't change much.

    So his chemo was not included in the max out of pocket percentage.

    His insurance company basically got to decide what treatment he was to get, instead of the doctors.
     
  33. TeacherShelly

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    Teacherintexas, that is unbelievably painful what you went through. All you said (the expense, the stress, his pain, your exhaustion, ultimately losing your husband) combined with spending precious time on the phone. I am so sorry. Talking to detached administrators while going through that AND losing that time with your husband ... (sigh).
     
  34. bros

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    My current insurance has a co-pay deductible, if you spend 2k a year in co-pays, they cover the rest of the co-pays for the year for that person)

    Insurance companies can be rather... rude at times. Like when I was born, they refused to pay the full $150,000 bill for my 2 1/2 month hospital stay post-birth in the NICU, leaving my parents with a $50,000 bill
     
  35. Peachyness

    Peachyness Virtuoso

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    I just don't understand how health insurance companies can make the claim that a med/operation/treatment/etc isn't needed or necessary when a doctor has requested it? Clearly, the doctor knows what they are doing. What right do they have in making that decision?

    I'll tell you what, I'm terrified of ever getting truly sick.
     
  36. Ima Teacher

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    On more than one occasion I've had a doctor who had to fight with insurance to cover something. Sometimes it works, and sometimes not. For instance, when I had an outpatient surgery years ago, I needed to be sent home with pain medication. The problem? I'd had severe allergic reactions to all the commonly prescribed pain relievers. (After my initial allergic reaction, my body was hyper-sensitive to medications, and I had reaction after reaction.) I was able to take one medication, which only came in the form of IV or intra-nasal. Insurance only paid for the IV form in hospital settings, and they did not pay for intra-nasal at all because they said there were other options. (True, but not for me.) I had to pay $108 for ONE DOSE of the medication. I was able to get the money reimbursed after an argument with the insurance company, but it was still a hassle.
     
  37. KinderCowgirl

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    Ima I had a similar fight with my acid reflux meds-although I didn't win. :( They insisted the meds were available over the counter-which was true, however I was prescribed 40 mg and the tabs OTC come in 15 mg doses--so I ended up taking 2 every day and getting 30 mg-not as effective as the prescription could be.

    If you ever want to be really depressed watch Michael Moore's documentary Sicko. The stories that were profiled: for example this one little girl was deaf and they authorized one cochlear implant-apparently it was too costly to do the surgery in both ears. This one lady was charged $1,000's because she was med-evac'd after an accident to the hospital. The insurance co. said she didn't pre-authorize the charges--she was unconscious at the time. :dizzy: I think it's more common than most people realize.
     
  38. smalltowngal

    smalltowngal Multitudinous

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    Me too, Peach!
     
  39. JustMe

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    You would think spending a great deal of insurance would ensure you would be taken care of when in need. Not so. It's disgusting.

    I remember when my papaw, a Vietnam vet, was told he was just too expensive to take care of anymore. So he withered away at just over sixty years old and died. I often wonder how some lawyers sleep at night defending clearly guilty and evil people, and I think the same of those who make the medical decisions that cause people to suffer and die.
     
  40. Peachyness

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    I know I could NEVER work in an industry like that. :( Telling people and their families that the cost of their care was just too much.... ugh.

    Kinder, I did see Sicko, I think it was last year. And boy was my blood boiling after watching that documentary.
     
  41. TeacherShelly

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    Jul 24, 2012

    Peachy, I'm scared, too.

    Here's something weird that happened to me. I use albuterol inhalers (Pro-Air) for asthma. One month, the copay was $10, the next it was $50. The pharmacist said the insurance company reclassified it, it was no longer the generic option. No, there was now no generic option. I called and (you know it) talked for 90 minutes to the agent representative and finally made her tell me what Pro-Air's generic option was. When I gave the list of three things she told me to the pharmacist, he laughed. They were the version you put in an IV at the hospital.

    No resolution ever came. It's still $50. Capricious changes and stonewall responses. I cannot believe some of these insurance practices are legal.
     

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