Well technically, sometime less rich people will kill the more rich (like revolution for example, tis never led by the people lmao only rich people jealous of the power of other rich people), take their ressources to become even richer, THEN make the laws, but the og rich one wont get to do so anymore since they ded
Our healthcare system has quite a bit of crazy aswell. Need to see a neurosurgeon for anything thats not an acute emergency? That'll be a 500 day wait, probably 3 years before the actual surgery.
Don't worry, our pharmacy guild is pretty good at scamming the PBS and screwing employees, our private insurers love integrated models of healthcare, and our politicians look to the US for "innovation". We are sleepwalking down this path.
Yehhh it's definitely not perfect. Took over 2.5yrs to get my son into a public paediatrician. Gave up and took him to a private one. Everything is just a mess.
@@lachyt5247 It's Australia. The ratio of surgeons to people who need surgery is ridiculously small. The universities don't want to lower cutoffs and train more doctors domestically either, so expect the wait time to get longer.
saddest thing is: it is so robust and integrated that even actionable satire with enough veracity to show just how vile and inhuman it is, fails to be a "wake up" moment for the masses and a threat to it. it is strong so much it can afford to not care about anyone revealing just how vile it is.
I was just a cashier in a pharmacy for years, and this was the most infuriating part of it. So many people breaking down at the registers because their insurance was being outright cruel. A few good memories of patients threatening to sue their insurance if their loved ones died because they couldn't make the 20 minute drive through weather-affected roads, though. Never seen a company change tune so fast. Hope more people realize they can shake those hideous coffers when it's do or die.
This hits hard. Former independent pharmacist here. These people are the most despicable human beings that live. If you were lucky enough to get a contract with these PBMs, there were times where we would lose money on prescriptions. Every year the contracts would get worse. I loved independent pharmacy but insurance makes it absolutely horrible. I’ll just stay in my hole in the hospital.
As someone who works in subrogation at a law firm and has to deal with Optum on a near daily basis, I just want to say that they are one of the most frustrating companies I’ve ever had the misfortune of working with. Their turn around time is literally MONTHS. We’ve had cases that have been opened, settled, and we’ve received the settlement check before we even hear back from Optum. Absolutely ridiculous.
I'm a hog farmer, so I bought a bottle of epinephrine in case the hogs go into anaphylactic shock while giving vaccinations. I don't even remember the price but it was so cheap compared to what epi-pens cost its saddening. 50ml bottle for $30, maybe? If I can get lidocaine maybe I can do surgery on myself, I can suture a hernia on a pig, lol.
as a former optum employee its kinda worse... few people really pocket the money directly, it gets slushed into internal budget dollars, most of the bloat goes to internal expenses... corporate had strictly defined requirements for promotions for managers and above, one of the requirments, was maintaining an expense sheet of several million (the bottom level was 1 million), which would go up with each level from paygrade 29 to 32. everything was described and applied in autistic detail, and scummed accordingly.
I could go on for HOURS. Don't forget that the largest PBMs Athena also own CVS. CVS can 'sell' at a loss with DIR fees that only CVS meet to ensure independent pharmacies always lose
Thats the good thing, at least here in Germany the biggest insurance companys are tax funded and actually will not pay more than X for this medication (also like 80-90% of all people are in one of those insurance companies, this gives them enormous price control), and they also forced by law to provide certain things for the people that are insured, so the patient has a win-win situation (although, tbf, the democraphic shift is a burden, but its way smaller in this insurance thing, it really really hits the pension insurance ) You only need to pay a few percent for the medication and never more than 10 Euros, and if you spend a certain amount (some percentage of your income) on medication, you get it all back. Same thing if you need to be in a hospital, you just need to pay 10 € per day (never more than 280 € in a year), but you dont need to pay the medications they give you in the hospital.
My company, Capital Rx, is trying to solve all of these issues. We're the first PBM to create a claims adjudicator from scratch in over a decade. This allows us to customize plan benefits, formularies, and networks in any way our clients need. We also use the NADAC dataset for nearly all of our pricing on claims which is completely transparent between client, vendor, PBM, and carrier. We've basically tried to abandon AWP except where NADAC doesn't have an entry for a specific NDC. We've also developed our own in-house PA software, formulary software, patient and plan management software, etc. So far we're covering 10M+ lives. All of this done in just four years.
Interesting. I had a gi related infection my dr prescribed me a antibiotic that my insurance won’t cover and was 2000 and I’m pacing around not knowing what to do and what to say. The whole situation was malarkey so I went back and forth with the pharmacy and insurance and I finally found about one that the insurance covered. So I was taking odazatron, hyoscime, bentyl and miralax. I know that’s a lot.
I wish... the gov't helps fund pharmaceutical research. I wonder how much $$ could be generated to fund healthcare if the gov't got royalties on the patents that were partially gov't funded.
Whenever I have to order an expensive med like Humira and I see the pt has UHC, there is an immediate energy suck. Will it be covered, the pt asks? My reply is who knows and here is the patient assistance program application. Please fill it out in case it is not covered.
This is part of the reason why, even though I have UHC, I don't use OptumRx. I can't choose who my employers use for insurance, but that doesn't mean I have to give them any more money if I can help it.
I'm a pharmacy tech. This Saturday I had an uninsured patient in severe need of an epi-pen, an uninsured patient in need of albuterol inhalers, and a fully insured post op patient whose insurance wanted to deny his Eliquis after a DVT. Ended up calling the hospital to get the Epi-pen changed to a weird generic brand that had a savings card that only works at CVS, then transferring the prescription. Meanwhile the patient was fresh out of the ER and too exhausted to be doing this. I called the inhaler guy's doctor and got the inhalers switched to our $24 brand, then talked the doctor through signing him up for the patient assistance mail order service. Eliquis guy's insurance refused an emergency supply, and neither the hospital he was in nor his GP had any samples. I called every hospital I could find until I found one that had samples of Eliquis to last the guy until his PA went through. He had to drive 45 minutes to get them. Then I called in for the next two days because of a torn ligament in my knee that no one will fix because I don't have insurance either! What is going to happen to our patients if the pharmacy is too busy due to staffing issues to go the extra mile?
Do prescriptions have brand names written on the meds and not generic? (eg: “Prozac is written but you must prescribe Prozac and not generic Sertraline?”)
You are an angel to people like me. I often have issues getting my essential daily meds that I would end up in the ED for if I stop taking them for even a day or 2. I wish I had someone that cared even a fraction the amount you do at my pharmacy.
That’s not even the worst of it… in our oncology clinic we have literally had to watch people die of treatable and potentially curable diseases because the insurance company wouldn’t cover immunotherapy. Some of these are supposedly “good insurances” who won’t pay for literally life saving/preserving treatment. Our nephrologist has had the same thing happen with progressive glomerular disease. When we can treat diseases but the insurance won’t approve treatment it’s a new low. Even worse is that it’s perfectly legal. Right now only we as providers are liable. You cannot sue the insurance company or hold them responsible when there is a poor outcome when they don’t approve treatment. If we change one law that needs to be it
I'd love for there to be data collected on how often insurance essentially decides to let a patient die. I know it happens, I just don't know how often it happens.
It's all about population control. Make your tin foil hat jokes, go ahead, but deep down inside you are afraid I am right. In the words of George Carlin... "Its a great big club and you aint in it!"
Having worked in health insurance, the fact that Americans aren’t rioting in the streets over this racket of a health insurance system we currently have boggles my mind.
There have been many different psychological studies into this (the study was of colonoscopies); humans are generally willing to endure discomfort as long as the spikes in pain are as low as possible. The study was also extended to how people decided to pay off credit cards or use payment plans for things; that people would mainly just be happier with the monthly minimum payment as opposed to the whole amount being paid. As long as these companies can keep the appearance of low month-to-month prices to consumers with payment plans, they can basically charge whatever they want.
I see it more as an insurance industry problem...and not just health insurance, but ALL insurance. Insurance companies are ruth by psychopaths and their underlings are sociopaths that enjoy destroying people's lives. Now, that might sound like hyperbole...but if you understand that psychopaths are driven almost entirely by greed...and sleep just fine at night if they kill millions to get all the toys they like to have to help them alleviate their pervasive boredom...and you know that sociopaths are incapable of experiencing joy, so the closest thing to delight they can experience is watching someone else's life be destroyed, then you understand this is fact...not hyperbole at all.
We can't. You know how much it is to go to the hospital after a cop destroys your face with a baton? It's not like the cops aren't militarized in this country or anything like that.
@@Metzgeweiser You haven't spent much time around cops in other countries have you? Probably haven't spent much time outside the US. Getting bonked by a cop is pretty common the world over. Not exactly a sign of a "militarized police". Now, when beat cops start carrying machine guns on their person on patrol, then you can try and cry militarized police. Would note that, that is so common I'd say more than half of countries have their cops carrying assault rifles and machine guns. Not in their cars like American cops, but at the low ready. Go to Paris and look for the folks in blue uniforms carrying sub machine guns. The Gendarme. Also they have soldiers patrolling the streets. Travel outside of the US... the grass ain't greener, just a different shade of piss.
This was my debate topic in health economics. Gotta love a good pbm, especially when they strongarm patients into getting mail order even if they live somewhere their mail will get stolen/ left out in weather that can ruin the medications. Its great, who needs insulin that isn't expired anyway?
Good way to send someone to the ER while seizing in an ambulance experiencing acute benzodiazepine withdrawal. Do they not factor in the cost of that ER visit that they'll have to pay into their almighty spreadsheet of sorrow?
@@Celastrous The PBM isn't always the insurer as well like the situation in this video. There are fewer PBMs than insurance companies, and there's less turnover than with insurance because different insurers can use the same PBM. Since they're not the ones that ultimately pay for the care, they don't actually care. The insurance company doesn't care about the increased cost either because they're betting that there's enough turnover in insurance that they won't be footing the bill later.
Let me get this straight … we pay insurance premiums, pay for prescriptions, medical co pays and we still need authorization from the insurance company as to who qualifies for a surgery? 🤦♂️. If this is happening to me I can only imagine what happens to those who do not have healthcare!!!!
Fun fact, sometimes your care is better without insurance. Once I went to urgent care because I hurt my foot AND my thumb. When I got to the exam room they asked about my foot so I told them. Then I started talking about my thumb and they stopped me “insurance won’t let us bill for both, you’ll need to book another appointment for your thumb.” I told them I didn’t have insurance and they were like “oh, never mind, let’s X-ray both of those then since we don’t have to go through insurance.” Incredible.
@@davidjohnson9186 that's literally what things are like in countries with universal healthcare. Working in a hospital os hard enough as it is, I couldn't imagine having to navigate a convoluted system of insurance just to treat someone.
I'm in a bunch of healthcare finance classes right now and we talk a lot about examples of provider corruption, over-billing, ordering unnecessary tests, etc. In my time working in healthcare I've never seen corruption from providers but we all get robbed by insurance companies every day.
Just had a baby and the provider charged both my wife and the baby for room and board for 2 days when we were in the same room for 26 hours. We wanted to leave right at 24 hours but conveniently the pedestrian couldn't get our baby's final check up in before leaving in time. When I called about the double charge for room and board, they told me that they couldn't help because they took our baby to the nursery to do the hearing test and state required blood testing, I think she wasn't even in the nursery for an hour.
I have absolutely experienced provider corruption. Went to ER for chest pain. 6 hours of pointless unnecessary tests, more than $6k in bills AFTER insurance, and they conclude by telling me "We don't know what it is, go see a GP." I go to a GP and they take 5 minutes + $10 to tell me that it's a muscle sprain.
The only reason unnecessary tests are ordered is because of Malpractice Attorneys. Who sue physicians for millions of dollars. In states with good tort reform and caps on lawsuits, fewer unnecessary tests. Physicians don’t get any benefits from ordering tests. They don’t want to order unnecessary tests because that’s just more unneeded work.
A lot if not most of the it's admin not the providers in and of themselves. That said as a chronically ill/disabled person many providers happy to bill hundreds of dollars for a 30 minute consultation that you waited weeks for.
Work at UHC, can confirm. Not like you needed me to confirm, you understand completely. I am unapologetically loud about how disturbing our treatment of doctors/patients is and I will continue to be so. Your videos give me the strength (and laughter) to keep on pushing forward with the goal of change from within no matter how much they try and tell us that UHC is some sort of saint of healthcare, protector of patients. Thanks for making these and spreading awareness while also adding in a dose of funny!
Cardiologist here. Whenever I have to do a peer to peer with someone from UHC, it’s easier to help the patient change their code status to ‘No Code’ than to get him anything approved.
Worked at UHC for 3 years in Provider Services. One of the most frustrating experiences of my life, telling healthcare providers who had perfectly legitimate complaints that nothing would be done to help them or change the outcome. Having to listen to fed up people ranting all day was no picnic, even while I knew it was the company they were angry with and not me. Pushed for change as best I could at my level, which was of course futile. Left the job, but I'm still embarrassed to tell people I used to work there.
I worked for Pacificare befoir became UHC had to back to acute care to fight for my patient’s rights. Now they use Navihealth for all prior authorizations which are denied automatically and require a peer to peer even for stroke patients requiring acute inpatient rehab…leave before your soul is sucked dry!
“When you make enough money, you get to write the laws.” And you get to spread disinformation through mass media so half the populace believes they’re getting the best value for money possible too, and will argue on the insurance companies behalf
The news on your TV is not in the business of spreading the truth. They are in the business of making corporations want to spend money on ad space. The commercial breaks are not just what they're selling but the equivalent of the company logos on Nascar jourseys letting you know who really signs their checks and who they treat as "always right". Honest coverage of the healthcare system in the US and the alternatives would lead to a lot of insurance companies (aka "for profit death panels") and pharmaceutical companies not spending money there because those corporations expect a political return on their investment as much as they do when they "donate" (aka: legally bribe) politicians.
Half the populace doesn't think that lol. 1/3 wants the system ripped apart so an actual free market can exist and not a government sponsored monopoly, while the opposite 1/3 think somehow socialized healthcare would fix this without concern for the problems of just creating *another* government sponsored monopoly. The other 1/3 are just clueless and don't know better.
Let's talk about pay medical influencers to post misinformation so common people doesn't take absolutely any preventive measure to avoid an infectious disease that is going to cause them sequelae and dependance from medical care and pharmacological treatment in the next months or years in 10-30% of cases at least.🤦🏼
I weep for all the lost independent pharmacies destroyed by UHC, CVS, and other evil ilk. Bless you for still being here, I adore my independent pharmacy and pray they’re able to weather the PBM bs storm.
Thank you for everything you do! My parents would be in serious trouble if it weren't for their local pharmacy that delivers and is always so kind and helpful with questions. Well worth paying a little more for not using a "preferred" big box pharmacy.
My husband has severe asthma, he’s been seeing his pulmonologist for about 12 years now. The doctor gave him some new trail inhalers and it was helping. He would only use his rescue inhaler maybe once a week. Of course the insurance company refused to take pay for it. Thank God his doctor is still giving the trails until we can figure something else out. This has been going on for about 3 months now. Insurance companies are literally evil.
You can try sending in a request to the manufacturer for the inhalers. All pharmaceutical companies give out their meds for free if you meet financial requirements. Back when I was going to the free clinic, the pharmacy made me fill out these forms every 3 months. I got a free EpiPen, a year's supply of albuterol inhalers, and a year's supply of my steroid inhalers. Unfortunately I have insurance now so I actually have to pay for everything myself. But GoodRx covers you nationwide regardless of insurance status.
That's just crazy! I'm a pulmonologist coming from Greece, working in Sweden. I'm guessing your husband is using some kind of Salbutamol inhaler as a reliever. A 200dose 100mcg ventolin inhaler (called Aerolin in Greece), costs about 2,5$ without insurance and you can buy it from any farmacy without a doctor's receipt. The usual daily inhalers (symbicort, Relvar etc) are more expensive at about 45$ without insurance. I REALLY DON'T UNDERSTAND what is happening in US.
@@kostasvlachos2294 what is happening is that pharmaceutical companies pay lobbyists to encourage congress to vote in their favor and influence the fda. Most of the people in congress have their campaign funded by one or more major pharmaceutical companies.
@@kostasvlachos2294 An Albuterol inhaler retails here at $130. An ipatropium bromide inhaler at $220. An Advair inhaler (long-acting bronchial dilator + inhaled steroid) retails at around $650. ...All these medications have been on the market for at least 20 years.
Fabulous timing, Dr Glauc! Just 3 hours ago I was speaking to the Office of the Insurance Commissioner of WA state, asking how to file a complaint about OptumRX and United "Healthcare." Specifically (this week) their chronic habit of (a) refilling my medications automatically WITHOUT MY CONSENT (auto-refills are turned *off* for ALL my medications for good reason, plus there's that whole "I DIDN'T ORDER THESE" thing... 2 years and counting) (b) auto-filling said meds TOO EARLY (so they can hurry up and profit quicker) and (c) literally trying to take the place of MY DOCTOR by ordering tests and sending me test kits in the mail (DIY tests!) without even talking to my doc. (That doesn't include the f**king "checklist" they send me every year TELLING ME what tests and actions I'm going to dictate to my doctor.) I could continue listing shady shit that UHC & Optum/OptumRx pull *ad nauseam.* But I'm saving the rest for the official complaint.
Omg they send the refills over a month early! I thought it was a mistake but then I quickly realized it wasn't. My auto refills are turned off also. This is my first refill for my household. So hopefully I will be able to get this straightened out. But I'm not going to hold my breath. They told me I was saving money by using them. Damn lie!
Also who did you find out to file a complaint about UHC? I'm so mad at them. They did me so wrong with my infusion/chemo medication. Very long story. But basically I was denied my medication for almost 7 months!
@@flyingartgirls1 do they send your opiates on time for you at least. I'm worried mine won't come on time for my refill date. So I stayed with a local pharmacy since my town doesn't have a CVS or another pharmacy they consider
@@amber13000 In my state - Washington (not DC)- it's the Office of the Insurance Commissioner. There should be a similarly named office in every state. If you're having trouble finding where to file a complaint, ask your state's Attorney General office. UHC & Optum are out of f**king control.
So I needed knee surgery a few years back, and I'm uninsured so had to rely on public healthcare. Between the gp consult, the MRI, the surgical consults, surgury, post op recovery and my two week painkiller supply I had to pay the outrageous sum of $7.80. Turns out the opioids were the only part not covered. I'm in Australia.
Australia seems to have a healthcare system that covers almost everyone and works reasonably well for almost everyone. It would be adaptable to the US but those that "write the laws" will never let that reform happen.
$7.80? OUTRAGEOUS! Pretty sure my mum got everything for free...specialist consults, surgeries, radiation, meds - so many meds - pt, scans, bespoke compression stockings, silver pad bandages...but then again it was skin cancer in NZ, so
@@luciesimpson6437 I believe the issue is this was an elective surgery, they gave me a script for the oxy when they were ready to punt me out that I had to take to a chemist.
As someone who is currently researching PBMs, this is 1000% spot on. Thank you for the great content and for shinning a light on these shadowy middlemen!
Oooof as a pharmacy technician who gets to call insurance companies and hear roundabout logic like this, and then to have to be the one to tell someone their medicine is over $200 or just not covered at all. Let's just say I wish the insurance companies had to talk with people in person to explain why something isn't covered.
Love this! I’d share it, but I literally might lose my job if I did that. Also, the PBMs have gotten so big, they don’t even MANAGE their own stuff. They pay companies to use their employees. PBMs can basically have way less employees on paper, since most of their employees don’t TECHNICALLY work for them. Crazy right?
I've worked at Walgreens as a pharmacy tech for 4 years and as a pharmacy intern over the last year, so I'm all but too familiar with everyone's least favorite pharmacy conglomerate CVS/Caremark. To clarify, CVS/Caremark has its retail pharmacies, mail order, owns its own PBM, and is a large portion of the health insurance market from commercial to employer to Medicare and Medicaid. Now, Texas law HB 1919, effective 9/1/21, prohibits PBMs from directing, steering, or requiring a patient to use a related pharmacy for their prescriptions. Despite this seemingly straightforward law, I have yet to see a reduction in insurance rejections from CVS/Caremark-owned prescription plans that are in network with Walgreens but state that the patient must call CVS to either override the rejection and fill outside of CVS or get told they have no choice whatsoever but to transfer to CVS or their mail order. I have pleaded with the respective patients to research this law and inform CVS that they are blatantly disregarding Texas law so that eventually they might be held accountable, but it looks like these corporations are all too aware no one will ever call them out and take appropriate action.
As a fellow Texan, I'm thinking that this is a plea that might be better directed, or rather, also directed, at state representatives. Maybe at candidates taking questions at campaign stops? OK, the one candidate who famously takes questions at campaign stops. There's cameras and reporters at them, so it might help publicize the problem.
I am in Florida and I LOATHE that the ONLY pharmacy my insurance will allow me to use is Walgreens. It is ridiculous because they treat you horribly. They never have heart or seizure medications when the it is time to refill it...and I refill it every 3 months! How hard is it to have it in stock when it only gets refilled every 3 months? You can complain about CVS all you want, but Walgreens over here is horrible! If the staff were nice it may be different, but they aren't. It is like they know you can't go anywhere else. It is a shame! My insurance is through BCBS.
Ugh we need that law here in Illinois. When i looked into it 2 years ago we had something similar but it only applied to insurance policies that were NOT from your employer. So basically the law is useless to pretty much all of us. Also the info wasn't made easily accessible to the public so those who might benefit won't know anyway.
@@Persephone-t5b That's awful. My local Walgreens is good about having my meds when I need them. They let me know 2 weeks ahead of when it's time to refill, and I haven't had trouble as long as I respond to the reminder within a couple of days. And the staff is really super helpful at the closest one to me. But just because they are reliable for me doesn't mean that's true for everyone, which is why no one should be forced to use only one pharmacy. If they can take your business for granted, they will!
My wife almost applied to a job for United healthcare yesterday, I made sure to show her these videos and she quickly changed her mind. Thanks for the content!
I nearly took a job with UHG, but I missed out on it. Honestly, I had been unemployed for months and was running out of money. I would've taken it despite moral qualms.
These learning about healthcare shorts are both the most painfully accurate, and painfully on the nose, shorts I've ever seen. I get depressed and lose a little faith in humanity each time because they're so true. Yet, oddly, I love them anyway. Maybe, someday, if enough people realize all this then we might actually get change... *United Healthcare laughs at me in billionaire*
Truth. I can go to a specific place for MRIs and have no out of pocket expense, and they never compare my current MRI results with previous MRI results. It I can go literally across the street to a hospital for an MRI, where they put comparisons in the results & the notes are more comprehensive, but I have to pay hundreds out of pocket. Same thing when I have to get a colonoscopy (every 2 years because I have Crohn’s disease). And I’m overweight. The no copay place has a small MRI machine so I kind of have to squeeze in; the hospital has the larger machine. 🤦🏻♀️
Aetna/CVS is just as evil or worse. In addition to having the vertical integration of insurance (Aetna)-> PBM (CVS Caremark)-> mail order , they also have retail locations. Isn’t it shocking that the only “preferred” pharmacies happen to have CVS in their name? They will charge higher copays elsewhere, yet pay those pharmacies less per script than they pay themselves, thus ensuring high profits.
Spot on! I was prescribed a high potency topical steroid, Aetna did not cover. CVS wanted to charge me $180 - called local independent pharmacy - $40 same medication. I now pay out of pocket for all my medications. Oh, and you need a PA for post-op pain medications. NOPE! I will pay cash. Efffff CVS.
Every skit I watch about Jimothy makes me more and more glad to live in Europe. Oh sure, our Health Service is criminally underpaid and the government pockets most of the money they are supposedly spending on hospitals, but at least I can be sure my doctor is not being paid to send me to specific pharmacy and if they try setting murderous prices on their drugs I can just go somewhere else. Oh and some of our drugs are partially refunded by the state, lowering the costs. And I won't be charged 500$ for an ambulance ride to the hospital if I get hit by a car.
Lmao....$500. I live about 5 minutes from the hospital (at the posted speed limits) gonna be about $1500-$2,000 and that's if they don't give me any meds or start an IV,etc.
Depends on what insurance you have. I got a GoodRX card and lowered my son's prescription cost from $200/month to $39/month. If I do my prescriptions through mail order, I get them for free. And ambulance rides are free. So don't think everyone pays what you have seen. They just don't research their insurance properly.
@@retired5218 wait until you need an airlift to a hospital, nearly no insurance covers it, you cant say no because your unconscious and its usually around $50,000. Also most people get their insurance through their job so they don't have much of a choice.
OMG!!! There is so much truth packed in this brief video. This is a 2-minute primer on exactly how insured healthcare is handled in the USA. It is an indictment of the healthcare insurance industry that could be understood by anyone of any political stripe. Having practiced in a semi-rural area of Maryland for almost 40 years (including residency) I saw our healthcare system evolve into exactly what is summarized here in this video. The video is simultaneously hilarious and horrifying. Once again an amazing effort by our beloved hero Dr. Glaucomflecken. A company that may or may not have been mentioned in the video released a booklet of "providers" that was given to employers to give out to their employees. It "rated" each "provider" with a star system with 5 stars being the highest rating. I found I had 4 stars. I called to inquire as to why I had 4 stars as I considered myself a caring, dedicated, and excellent doctor. I was told someone would call me back. Two weeks or so later someone from the insurance company called to tell me that for 3 or more out of my 200 or so patients with the company I had ordered too many tests or specialty consults. The specialists then ordered too many tests. If I wanted to appeal my "star" rating, I could review all 200 patients in my panel and send a detailed letter describing my thought processes and the necessities of my ordering habits. I told the person all that information was already in the medical record for anyone who knows how medicine is practiced to read and understand. Obviously, they didn't care as to why I did what I did. They only cared about their bottom line. Needless to say, I bagged that effort. After I reluctantly, but to keep practicing had to join our local healthcare organization, I attended a mandatory meeting of doctors, nurse practitioners, and physician assistants employed by our organization given by one of the large healthcare insurance companies. The meeting was to introduce the concept of "care management". If implementing "care management" saved money, it would be split 65/35 or something to that effect between the insurance company and our healthcare organization. You know who got the 65%, right? If "care management" is used to prevent duplication of services, wasteful and unnecessary procedures, testing, and to better coordinate care; I was and am always all for it. We all wanted to learn how to practice more efficiently, cost-effectively, and reduce waste. That type of practice is actually better for patients and their health. The meeting started with a PowerPoint projection on a huge screen of the 30 highest-cost patients to this company. Their actual names and diagnoses were used and highlighted in bright red. Since we were all contractually beholden to the company and our employer there was no HIPPA violation. The first name on the list costing the most money (over 3 million dollars) was none other than one of my patients whom I had diagnosed at the age of 12 years with acute leukemia. She was at the time of the meeting 17 and had spent many, many months in and out of one of the nearby children's hospitals during the preceding 5 years. The suited man in charge began using a laser pointer and inquired "For example, what could be done to reduce this from 3 million down to 2.5 or even 2 million dollars?" I felt tears coming up into my eyes as I recalled the years of suffering, stress, and heartache incurred by the patient and her family. Thankfully by the time of the meeting she was in remission and doing relatively well although she needed ongoing specialty follow-up and psychological counseling. My tears turned to rage as he inquired "Anybody? There's nobody here who can add anything to this situation?" I stood up and said, "Why don't we just let her f*****g die and that would save way more than 2 million f*****g dollars." You could have heard a pin drop. I was later reprimanded by one of my superiors for using foul language. I apologized. I am retired now and wonder how I kept my sanity and "boy scout" attitude all those years of my career. I guess a boy scout wouldn't have used the f-word. But it sure felt good!
Horrifying... They gaslit you. They pretended that you did something wrong for cursing, but really, it was because you called them out for being greedy, heartless scoundrels. They were egregiously wrong, but pretended YOU were wrong for cursing. They gaslit you & deflected blame to anyone who dares to speak out. Typical narcissistic response. You are clearly a good person & you said exactly what should have been said. Bravo, sir 👏🏻
And yet, I bet the CEO's of these companies all claim they go to church on Sundays. I don't think Satan had anything to do with this evil. This is all man made corruption.
So true, it’s sad. Yet physicians cannot send blood work to specialized labs for a discount price without being slapped with a Stark Law violation, cannot own hospitals, and in my state cannot own pharmacies or dispense medicine. Anyone else see something wrong here?
@@Celastrous I think what Donna is getting at is that if the laws are so strict on what physicians can and cannot own in order to reduce conflict of interest, it should be the same with insurance companies, labs, and pharmacies.
@@sarahb7626 Pretty sure they mean that not only is all this middle-man nonsense going on, but the laws are set up to dissuade competition in the pharmaceutical industry, meaning all these people bending you over the barrel with these prices are also making sure you cannot be able to go to anywhere else. Like blackmail, only the ransom is your health and ability to survive longer.
Well doctors can own hospitals, but they might have a lot more red tape, but the issue there is, owning or starting, or buying a hospital is expensive, doctors are rich, but even they wont make enough to generally buy out a hospital.
@@Celastrous yes that's what she meant. She meant if physician's can't do any of this because a conflict of interest, then why can insurance companies get away with it!
I work with a non profit independent pharmacy which makes medications affordable for those who do not have insurance. We also serve those who do have health insurance and I can't thank you enough for shedding a light on this issue. Independent pharmacies all over are put out of business thanks to companies like these who make the patient move their medications from their local pharmacy to a giant mail order one like the one you mentioned.
Do you import or reimport medicines? This is what independent suppliers in Germany often do. I see a German inhaler with a printed laber, original label in Greek
I've been following Cubans company. It will be fascinating to see how it plays out. I'd seriously consider using it if he adds the expensive migraine meds i need to his inventory.
Not just most countries, USA spends more on healthcare than ANY other country. All so we can have the insurance company middle-men interfere with the provision of medicine and worsen patient outcomes, all for profit. It's past time to change this, but it really is this bad right now.
@@voicingsomeopinions7006 yup, both out government spending and private spending are larger than the entire public+private spending of many other nations...who get better outcomes for less than half the price. It's just an extortion racket.
🎶I follow the golden rule How can a man resist When the gold in his hand Lets him rule the land With an iron fist🎶 Sorry I couldn’t resist a good Starkid reference
ive been saying this for years. my family owns a small town pharmacy. and weve dealt with PBMs for as long as theyve been a thing. Insurance being able to negotiate prices separate from what uninsured patients have to pay is the very reason American healthcare is so expensive despite not giving any noticeably better care than other first world nations.
I work as an account manager for a mid sized specialty pharmacy. DIR fees and clawbacks are devastating to independent SPs. It’s very difficult to project how many millions of dollars will get clawed back every year. PBMs and insurance companies are ruthless and evil. Vertical integration of these entities should be outlawed for reasons of conflict of interests. It’s bad for patient care.
Jesus, 9 times out of 10 you make me laugh, and the other one time you convince me that we need to dig a hole big enough to fit every single last employee of the healthcare industry and fill that hole with every single last employee of the healthcare industry.
Well that would be dumb to throw EVERYONE in there. Who would help you then when you break your femur? Or have a stroke? Get a splinter in your eye? Or are about to go septic from a UTI? Throw everyone in a pit and pretty soon you'll be joining us in there with your mortal wound or preventable/fatal condition.
Hey now, don't put doctors, nurses, pharmacy workers, and other actual people in there with the soulless suits, the ACTUAL problem with the U.S healthcare system, who don't even understand how to medicine and only care for lining them and their associates pockets.
Just a heads up, Cost Plus Drugs exists now. Basically, Mark Cuban started this company with the sole purpose of selling all drugs with just a 15% markup plus the shipping cost. From what I've been told, they have a decent list of drugs rn and they will continue to add to that list over time. They're not spending any money on advertising so it's existence is mostly being spread through word-of-mouth (plus the couple of times he's been on podcasts to promote it).
Cost Plus works well in some instances, but not in others. Beyond that, their customer service and delivery scheduling is glitchy and inconsistent, especially since they don’t currently have live CSRs. It’s all electronic. Mark Cuban himself even said that patients might have to make some sacrifices initially for better pricing. I think getting more backing within the industry will be beneficial, especially with some PBMs genuinely wanting to get involved to reduce patient costs. This is based on articles I’ve read, so take all of this with a grain of salt.
Oops, one guy missing: United Health owns PBM Unum...and Unum owns medical practices. They just bought Atrius Health, largest (formerly non-profit) doctors' practice in MA. So the middlemen own the doctors. You'll need a beard for that character.
Makes sense about Satan…one of my prescriptions was reclassified as a tier three drug and if I didn’t have a savings card, would cost close to $1000 for a refill. This video couldn’t have been more timely. My Primary care doctor actually tried to file a tier exception for me with my insurance company but was denied in a hot minute; now I see why.😈
@@liesdamnlies3372 savings card like Good RX. They find the cheapest place to get medications and then they help with a discount if your insurance doesn't cover the medication or if you just flat out done have insurance.
@@liesdamnlies3372 The only ones I’ve seen in Canada are drug-specific, provided by the manufacturer & billed to a private insurance company, but they’re pretty rare. I’ve yet to see anything about a “GoodRx” type discount card here.
@@GoBlueGirl78 Yeah pretty sure it's illegal. There's a reason Shoppers won't let you use their discount card for the pharmacy, for example. It'd leave the field wide-open for massive chain pharmacies to out-compete anyone else and then we'd be in the same boat as Americans.
@@liesdamnlies3372 That's a loyalty card, which is different than what we're talking about. The govt sets rules about loyalty cards, which is why you can't use it to get points on or redeem for lottery, tobacco, Rxs, etc.
In an ideal world, they negotiate with drug companies for better prices. That might be through scale (we have 20 million customers so give us a volume discount), it might be through preferential coverage (we'll only cover your drug in the relevant class if you give us a much better price), or whatever. The idea was that PBMs would have negotiating power and would then sell their services for a small commission, much like an investment advisor might. With luck, the PBM would be able to crowbar out more savings from the drug companies than they charge the insured. However, with changes (including but not limited to the ACA) there's much less of an incentive to cut costs and so now they are mostly overhead.
They are unadulterated trash! A bunch of idiots that literally don't know how anything works, but try to force you to take medications they want you to take when they want you to take them. I spent the last two weeks fighting Optum RX while sick over two separate medication denials. The idiot liars literally got on the phone with my doctor claiming my medication was already covered, but when he read to them THEIR OWN LETTER THEY SENT TO ME telling me how they were no longer covering my prescribed medication starting July, their story changed.
@@garrettkajmowicz It's funny Trump tried to pass something that'd cut out the middle men, and let people negotiate this for themselves, which would've reduced costs for everyone. But then it got memory holed.
@@xShadowChrisx Do you really believe that individuals can negotiate prices with corporate America and its greed ? Especially when there is such seriously big money at stake ? Gift for Corporation. Some of the individuals are too sick and enfeebled to do Activities of Daily Living --- let alone negotiate with Satan. What do you believe is practical and realistic ?
This is the best skit so far. The healthcare industry of this country is so broken, and people literally die as a result. I hope it changes, and soon, but the prognosis is not good.
While these videos are funny, they are in the, I am laughing to keep from crying, kind of funny. These insights into the American healthcare system are so depressing, and I'm a Canadian that doesn't have to deal with it personally! Over the last 2 years, I've had 5 CTs, 3 MRIs, a lumbar puncture, an electrocardiogram, an echocardiogram, and more blood tests than I can count. I've seen 2 neurologists, 1 neurosurgeon, 2 rheumatologists, and a hematologist. All of this, and I have never seen a single bill. The first and second line of prescription treatments didn't seem to be working well enough, so I just started a biologic treatment today. I had a case manager contact me directly, and she sorted out government coverage and approval for the treatment, and set up payment of what wasn't covered by the government as a subsidized payment by the drug company? Maybe? I'm not sure. She just said she would take care of it. She then sent the prescription to a pharmacy of my choice, and sorted out payment. I just had to go pick it up. I paid nothing on pickup, but did see that the total cost for this one month's worth of medication (a single shot) was $1672. I can't even imagine if I had to pay out of pocket for any of that, or even having to navigate the insurance system in the US. Having gone through unexpected medical issues these last 2 years, I really feel for my neighbours to the south.
This is particularly helpful to those of us who don't live in US..... Reminds me of a Michael Moore documentary about healthcare and insurance odyssey issues US citizens must endure...
There was a part in that movie where a woman who worked for an insurance company told about a 60's-ish couple who had been denied health coverage numerous times. They'd jumped through multiple hoops for this latest application's requirements. The employee said that when the wife turned the paperwork in to her, she heard them say "everything's going to be alright soon, we're going to have insurance. " She said she quickly looked at their application and knew right away it would be denied. Heart.Breaking.😢 I don't remember much else from that movie but I've never forgotten that part and how just tragic was. Shame on "the system" that it puts human beings in a position like that. Basically playing lottery with their health, having them run like mice in a maze, except the maze has no exit.
So glad to work in the UK where we at least have a set price for prescriptions... Even if our generics companies artificially reduce production to inflate prices to the NHS 😤
You are just confirming to me yet again that I made the smart move to Costa Rica, where all drugs are way cheaper. That $1,200 Lyrica prescription a month runs roughly forty bucks here. The US system is so so broken!
Oh my god I really can relate to this video. I used to work at Optum as Pharmacy Help Desk and I know how hard it is to explain to the customers that United Health Care and Optum are just one. 🤣
Don’t even get me started on PBMs. The one for my insurance denied my Emgality for a straight 2 years because the ICD-10 code submitted with the prior authorization wasn’t specific enough. They didn’t bother to explain this to my doctor. The ICD-10 code section for migraine is also a complete mess because they expect doctors to be hyper specific on where the migraines are episodic or chronic, if an aura is present or not, if migraines last for at least 72 hours, and if they are manageable or not. The hyper specificity of migraine codes makes it really easy for PBMs to deny prior authorizations.
My poor neuro is a headache specialist and we have to fight to get my ajovy and whatever abortive filled. Its always a battle of phone calls, prior auths, then me getting solicitation letters/threatening letters that i have to use express scripts or they won't pay. I hate it so damned much.
This vertical integration thing, controlling every aspect of the supply chain, is exactly what made Pablo Escobar so rich. But it also made him vulnerable because there were multiple areas the law could target him. Unfortunately, this aspect of American Healthcare is perfectly legal so gl
God, I got onto UHC through my engineering job last year and the whole UHC-Optum-OptumRx thing is sickening. I get better prices through goodRx compared to my $10/$15 copay on my essential meds.
I refused to be on UHC's panel for behavioral health. They go out of their way to deny mental health benefits, and the way they abuse their own gatekeepers is shocking.
Vote for the people who want to get money out of our health care system. If we don't come together as a nation to finally say "enough is enough", we'll continue to see our quality of care & life expectancies plummet. Health care is a right!
That was also the moustache of the second Jonathan in the Interview portions and I nearly died when I saw the thumbnail at the sheer thought of a Jonathan involved in United Healthcare 😂
You are a true GOAT, educating us future doctors on things our medical schools will never cover. I hope one day we can a fully change/revamp the US Healthcare system BY physicians, for our patients before its inevitable collapse.
First I laughed, then I raged. Thanks for writing, performing and posting this. We have to change our laws and ban this mass extortion of people seeking wellness. You spell out the travesty so brilliantly and succinctly. I hope with increased awareness, we catalyze action. #SinglePayerNow
"When you have enough money, you get to write the laws." That is a painfully true quote. Great video!
That line sums up just about every problem America has tbh
@@IRLTheGreatZarquon *cough* lobbyists *cough*
The lobbyists are clutching their pearls now the secret has been let out.
Has Anyone Heard Of Uber, Ya That Quote Is So True
The golden rule … he who has the gold, makes the rules
This isn't even jokes or skits anymore, this is just terrifying truth. And the last line is basically been true for all of human history
Well technically, sometime less rich people will kill the more rich (like revolution for example, tis never led by the people lmao only rich people jealous of the power of other rich people), take their ressources to become even richer, THEN make the laws, but the og rich one wont get to do so anymore since they ded
I agree. It just hurt to watch this and know that it was all true.
Nah man just america " gReAtEsT cOuNtRy iN tHe WoRlD" i heard
You mean American history
@@katalinudvardi9816 look up roman history, money was all that mattered back then too. Same is true for countless empires
As an Australian who doesn't understand the crazy that is US health care... This explains so much. It's scary.
Our healthcare system has quite a bit of crazy aswell. Need to see a neurosurgeon for anything thats not an acute emergency? That'll be a 500 day wait, probably 3 years before the actual surgery.
Don't worry, our pharmacy guild is pretty good at scamming the PBS and screwing employees, our private insurers love integrated models of healthcare, and our politicians look to the US for "innovation". We are sleepwalking down this path.
Yehhh it's definitely not perfect. Took over 2.5yrs to get my son into a public paediatrician. Gave up and took him to a private one. Everything is just a mess.
@@lachyt5247 But you have the option to cut in line, by paying it your self. Americans only has the option to pay.
@@lachyt5247 It's Australia. The ratio of surgeons to people who need surgery is ridiculously small. The universities don't want to lower cutoffs and train more doctors domestically either, so expect the wait time to get longer.
saddest thing is:
it is so robust and integrated that even actionable satire with enough veracity to show just how vile and inhuman it is, fails to be a "wake up" moment for the masses and a threat to it. it is strong so much it can afford to not care about anyone revealing just how vile it is.
I was just a cashier in a pharmacy for years, and this was the most infuriating part of it. So many people breaking down at the registers because their insurance was being outright cruel.
A few good memories of patients threatening to sue their insurance if their loved ones died because they couldn't make the 20 minute drive through weather-affected roads, though. Never seen a company change tune so fast. Hope more people realize they can shake those hideous coffers when it's do or die.
This hits hard. Former independent pharmacist here. These people are the most despicable human beings that live. If you were lucky enough to get a contract with these PBMs, there were times where we would lose money on prescriptions. Every year the contracts would get worse. I loved independent pharmacy but insurance makes it absolutely horrible. I’ll just stay in my hole in the hospital.
Very sad pharmacist here... I don't have anything to add to the conversation besides the sadness though
I wanted to laugh, but I feel an overwhelming urge to burn society down because of things like this. You're amazing, thank you for your insights.
Absolutely the best and truest chain of command chart!!!
As someone who works in subrogation at a law firm and has to deal with Optum on a near daily basis, I just want to say that they are one of the most frustrating companies I’ve ever had the misfortune of working with. Their turn around time is literally MONTHS. We’ve had cases that have been opened, settled, and we’ve received the settlement check before we even hear back from Optum. Absolutely ridiculous.
My second video of yours and laughed both times. And learned something. Thank you.
A few weeks ago I got a Optum RX card without asking, and this explains why. Great video.
Call around prices vary greatly.
Also Mark Cuban started an online pharmacy.
Of like the top100 meds
I'm a hog farmer, so I bought a bottle of epinephrine in case the hogs go into anaphylactic shock while giving vaccinations. I don't even remember the price but it was so cheap compared to what epi-pens cost its saddening. 50ml bottle for $30, maybe? If I can get lidocaine maybe I can do surgery on myself, I can suture a hernia on a pig, lol.
Oh my god, every time I watch one of these videos I think we've reached peak US Healthcare madness... and then another video comes out!!!!
I just want it to leave it out here: this man is happy and has no suicidal ideas at all.
I love the Oilcan Harry moustache. I wonder how many folks get the reference? I'm also loving how you roast insurance companies and politics.
Need that chain of command as a shirt
as a former optum employee its kinda worse... few people really pocket the money directly, it gets slushed into internal budget dollars, most of the bloat goes to internal expenses... corporate had strictly defined requirements for promotions for managers and above, one of the requirments, was maintaining an expense sheet of several million (the bottom level was 1 million), which would go up with each level from paygrade 29 to 32. everything was described and applied in autistic detail, and scummed accordingly.
Partially true. Big clients get the rebates. Small clients get screwed.
This is why I’m a proud customer of Kaiser Permanente
I could go on for HOURS. Don't forget that the largest PBMs Athena also own CVS. CVS can 'sell' at a loss with DIR fees that only CVS meet to ensure independent pharmacies always lose
Thats the good thing, at least here in Germany the biggest insurance companys are tax funded and actually will not pay more than X for this medication (also like 80-90% of all people are in one of those insurance companies, this gives them enormous price control), and they also forced by law to provide certain things for the people that are insured, so the patient has a win-win situation (although, tbf, the democraphic shift is a burden, but its way smaller in this insurance thing, it really really hits the pension insurance )
You only need to pay a few percent for the medication and never more than 10 Euros, and if you spend a certain amount (some percentage of your income) on medication, you get it all back. Same thing if you need to be in a hospital, you just need to pay 10 € per day (never more than 280 € in a year), but you dont need to pay the medications they give you in the hospital.
My company, Capital Rx, is trying to solve all of these issues. We're the first PBM to create a claims adjudicator from scratch in over a decade. This allows us to customize plan benefits, formularies, and networks in any way our clients need. We also use the NADAC dataset for nearly all of our pricing on claims which is completely transparent between client, vendor, PBM, and carrier. We've basically tried to abandon AWP except where NADAC doesn't have an entry for a specific NDC. We've also developed our own in-house PA software, formulary software, patient and plan management software, etc. So far we're covering 10M+ lives. All of this done in just four years.
Excellent
This should have more views
Interesting. I had a gi related infection my dr prescribed me a antibiotic that my insurance won’t cover and was 2000 and I’m pacing around not knowing what to do and what to say. The whole situation was malarkey so I went back and forth with the pharmacy and insurance and I finally found about one that the insurance covered. So I was taking odazatron, hyoscime, bentyl and miralax. I know that’s a lot.
That is seriously terrifying. You need oversight!!!!
The hospital hast to be protected from bad actors that will exploit it!!!
I wish... the gov't helps fund pharmaceutical research. I wonder how much $$ could be generated to fund healthcare if the gov't got royalties on the patents that were partially gov't funded.
I understand so little about medicine but I understand how to fix the body then how to pay for it.
This video should be shown to everyone on capitol hill.
Healthcare in America is terrible, wish I new how to fix this mess!
This is why healthcare needs to be a human right in the US like it is in Europe. I’d rather wait in line than go into crushing debt.
Whenever I have to order an expensive med like Humira and I see the pt has UHC, there is an immediate energy suck. Will it be covered, the pt asks? My reply is who knows and here is the patient assistance program application. Please fill it out in case it is not covered.
And this right here is why America needs socialized healthcare along with the abolition of lobbyists
*The Health Insurance Chain of Command - Head: Satan*
Well that explains a lot
The chain of command 🤣🤣🤣
This is part of the reason why, even though I have UHC, I don't use OptumRx. I can't choose who my employers use for insurance, but that doesn't mean I have to give them any more money if I can help it.
I'm a pharmacy tech. This Saturday I had an uninsured patient in severe need of an epi-pen, an uninsured patient in need of albuterol inhalers, and a fully insured post op patient whose insurance wanted to deny his Eliquis after a DVT.
Ended up calling the hospital to get the Epi-pen changed to a weird generic brand that had a savings card that only works at CVS, then transferring the prescription. Meanwhile the patient was fresh out of the ER and too exhausted to be doing this.
I called the inhaler guy's doctor and got the inhalers switched to our $24 brand, then talked the doctor through signing him up for the patient assistance mail order service.
Eliquis guy's insurance refused an emergency supply, and neither the hospital he was in nor his GP had any samples. I called every hospital I could find until I found one that had samples of Eliquis to last the guy until his PA went through. He had to drive 45 minutes to get them.
Then I called in for the next two days because of a torn ligament in my knee that no one will fix because I don't have insurance either! What is going to happen to our patients if the pharmacy is too busy due to staffing issues to go the extra mile?
Thank you for the tireless work you do.
Prayers for all the pharmacy techs & Pharmacists that really care about the patients 🙏.
Do prescriptions have brand names written on the meds and not generic? (eg: “Prozac is written but you must prescribe Prozac and not generic Sertraline?”)
You are an angel to people like me. I often have issues getting my essential daily meds that I would end up in the ED for if I stop taking them for even a day or 2. I wish I had someone that cared even a fraction the amount you do at my pharmacy.
No way you get paid enough for all that.
Oh god I'm so sorry.
That’s not even the worst of it… in our oncology clinic we have literally had to watch people die of treatable and potentially curable diseases because the insurance company wouldn’t cover immunotherapy. Some of these are supposedly “good insurances” who won’t pay for literally life saving/preserving treatment. Our nephrologist has had the same thing happen with progressive glomerular disease.
When we can treat diseases but the insurance won’t approve treatment it’s a new low. Even worse is that it’s perfectly legal. Right now only we as providers are liable. You cannot sue the insurance company or hold them responsible when there is a poor outcome when they don’t approve treatment. If we change one law that needs to be it
I'd love for there to be data collected on how often insurance essentially decides to let a patient die. I know it happens, I just don't know how often it happens.
Scribing in peds heme-onc and watched insurance slate our kiddo for brain CTs over MRI for his entire treatment because 🤑
I mean, doesn't it hurt their bottom line to let patients die? Dead people can't pay insurance premiums...
@@mr.heymister2918
If they stall until people die, they keep their money.
Edit: they can always get more customers.
It's all about population control. Make your tin foil hat jokes, go ahead, but deep down inside you are afraid I am right. In the words of George Carlin...
"Its a great big club and you aint in it!"
Having worked in health insurance, the fact that Americans aren’t rioting in the streets over this racket of a health insurance system we currently have boggles my mind.
There have been many different psychological studies into this (the study was of colonoscopies); humans are generally willing to endure discomfort as long as the spikes in pain are as low as possible. The study was also extended to how people decided to pay off credit cards or use payment plans for things; that people would mainly just be happier with the monthly minimum payment as opposed to the whole amount being paid.
As long as these companies can keep the appearance of low month-to-month prices to consumers with payment plans, they can basically charge whatever they want.
I see it more as an insurance industry problem...and not just health insurance, but ALL insurance. Insurance companies are ruth by psychopaths and their underlings are sociopaths that enjoy destroying people's lives.
Now, that might sound like hyperbole...but if you understand that psychopaths are driven almost entirely by greed...and sleep just fine at night if they kill millions to get all the toys they like to have to help them alleviate their pervasive boredom...and you know that sociopaths are incapable of experiencing joy, so the closest thing to delight they can experience is watching someone else's life be destroyed, then you understand this is fact...not hyperbole at all.
We can't. You know how much it is to go to the hospital after a cop destroys your face with a baton? It's not like the cops aren't militarized in this country or anything like that.
They write the laws....
Like he wasn't joking these companies buy our politicians and pay them to do stuff in their favor.
@@Metzgeweiser You haven't spent much time around cops in other countries have you? Probably haven't spent much time outside the US.
Getting bonked by a cop is pretty common the world over. Not exactly a sign of a "militarized police".
Now, when beat cops start carrying machine guns on their person on patrol, then you can try and cry militarized police. Would note that, that is so common I'd say more than half of countries have their cops carrying assault rifles and machine guns. Not in their cars like American cops, but at the low ready.
Go to Paris and look for the folks in blue uniforms carrying sub machine guns. The Gendarme.
Also they have soldiers patrolling the streets.
Travel outside of the US... the grass ain't greener, just a different shade of piss.
This was my debate topic in health economics. Gotta love a good pbm, especially when they strongarm patients into getting mail order even if they live somewhere their mail will get stolen/ left out in weather that can ruin the medications. Its great, who needs insulin that isn't expired anyway?
Expired insulin? Just throw it in the freezer. It’ll be good as new 😈
Good way to send someone to the ER while seizing in an ambulance experiencing acute benzodiazepine withdrawal. Do they not factor in the cost of that ER visit that they'll have to pay into their almighty spreadsheet of sorrow?
This is EXACTLY what I go through. It drives me crazy.
@@Celastrous The PBM isn't always the insurer as well like the situation in this video. There are fewer PBMs than insurance companies, and there's less turnover than with insurance because different insurers can use the same PBM. Since they're not the ones that ultimately pay for the care, they don't actually care. The insurance company doesn't care about the increased cost either because they're betting that there's enough turnover in insurance that they won't be footing the bill later.
@@MeredithDomzalski Ah true.
Let me get this straight … we pay insurance premiums, pay for prescriptions, medical co pays and we still need authorization from the insurance company as to who qualifies for a surgery? 🤦♂️. If this is happening to me I can only imagine what happens to those who do not have healthcare!!!!
We struggle and hope as hard as we can that we don't get sick or break a bone.
As they artificially inflate the prices so high that they'll believe you'll be begging for insurance in a pleading tone.
Fun fact, sometimes your care is better without insurance. Once I went to urgent care because I hurt my foot AND my thumb. When I got to the exam room they asked about my foot so I told them. Then I started talking about my thumb and they stopped me “insurance won’t let us bill for both, you’ll need to book another appointment for your thumb.”
I told them I didn’t have insurance and they were like “oh, never mind, let’s X-ray both of those then since we don’t have to go through insurance.”
Incredible.
We take advantage of the fact hospitals have to treat you and then never pay the bill.
@@davidjohnson9186 that's literally what things are like in countries with universal healthcare. Working in a hospital os hard enough as it is, I couldn't imagine having to navigate a convoluted system of insurance just to treat someone.
I'm in a bunch of healthcare finance classes right now and we talk a lot about examples of provider corruption, over-billing, ordering unnecessary tests, etc. In my time working in healthcare I've never seen corruption from providers but we all get robbed by insurance companies every day.
check out IHC of utah, overbilling is standard and they keep getting sued for it but its still more profitable to keep doing it
Just had a baby and the provider charged both my wife and the baby for room and board for 2 days when we were in the same room for 26 hours. We wanted to leave right at 24 hours but conveniently the pedestrian couldn't get our baby's final check up in before leaving in time. When I called about the double charge for room and board, they told me that they couldn't help because they took our baby to the nursery to do the hearing test and state required blood testing, I think she wasn't even in the nursery for an hour.
I have absolutely experienced provider corruption.
Went to ER for chest pain. 6 hours of pointless unnecessary tests, more than $6k in bills AFTER insurance, and they conclude by telling me "We don't know what it is, go see a GP."
I go to a GP and they take 5 minutes + $10 to tell me that it's a muscle sprain.
The only reason unnecessary tests are ordered is because of Malpractice Attorneys. Who sue physicians for millions of dollars. In states with good tort reform and caps on lawsuits, fewer unnecessary tests.
Physicians don’t get any benefits from ordering tests. They don’t want to order unnecessary tests because that’s just more unneeded work.
A lot if not most of the it's admin not the providers in and of themselves. That said as a chronically ill/disabled person many providers happy to bill hundreds of dollars for a 30 minute consultation that you waited weeks for.
Work at UHC, can confirm. Not like you needed me to confirm, you understand completely. I am unapologetically loud about how disturbing our treatment of doctors/patients is and I will continue to be so. Your videos give me the strength (and laughter) to keep on pushing forward with the goal of change from within no matter how much they try and tell us that UHC is some sort of saint of healthcare, protector of patients. Thanks for making these and spreading awareness while also adding in a dose of funny!
Mad respect to you for fighting this issue within the company itself. Cheering you on ✊
Let me guess. Your name is Jimothy, right?
Cardiologist here. Whenever I have to do a peer to peer with someone from UHC, it’s easier to help the patient change their code status to ‘No Code’ than to get him anything approved.
Worked at UHC for 3 years in Provider Services. One of the most frustrating experiences of my life, telling healthcare providers who had perfectly legitimate complaints that nothing would be done to help them or change the outcome. Having to listen to fed up people ranting all day was no picnic, even while I knew it was the company they were angry with and not me. Pushed for change as best I could at my level, which was of course futile. Left the job, but I'm still embarrassed to tell people I used to work there.
I worked for Pacificare befoir became UHC had to back to acute care to fight for my patient’s rights. Now they use Navihealth for all prior authorizations which are denied automatically and require a peer to peer even for stroke patients requiring acute inpatient rehab…leave before your soul is sucked dry!
“When you make enough money, you get to write the laws.” And you get to spread disinformation through mass media so half the populace believes they’re getting the best value for money possible too, and will argue on the insurance companies behalf
The news on your TV is not in the business of spreading the truth. They are in the business of making corporations want to spend money on ad space. The commercial breaks are not just what they're selling but the equivalent of the company logos on Nascar jourseys letting you know who really signs their checks and who they treat as "always right".
Honest coverage of the healthcare system in the US and the alternatives would lead to a lot of insurance companies (aka "for profit death panels") and pharmaceutical companies not spending money there because those corporations expect a political return on their investment as much as they do when they "donate" (aka: legally bribe) politicians.
Half the populace doesn't think that lol. 1/3 wants the system ripped apart so an actual free market can exist and not a government sponsored monopoly, while the opposite 1/3 think somehow socialized healthcare would fix this without concern for the problems of just creating *another* government sponsored monopoly.
The other 1/3 are just clueless and don't know better.
Yep. Because "socialism"is bad
"Many Americans love their health insurance" - evil bastards who gank it to the thought of poor people starving or dying of preventable causes.
Let's talk about pay medical influencers to post misinformation so common people doesn't take absolutely any preventive measure to avoid an infectious disease that is going to cause them sequelae and dependance from medical care and pharmacological treatment in the next months or years in 10-30% of cases at least.🤦🏼
As a pharmacist working in independent community pharmacy, I was pain-laughing the whole way through this video.
I weep for all the lost independent pharmacies destroyed by UHC, CVS, and other evil ilk. Bless you for still being here, I adore my independent pharmacy and pray they’re able to weather the PBM bs storm.
@@christinajackson2662 I use an Indy pharmacy too. Cheaper, no lines of 100 people waiting, an explanation of each drug if you need it, and a smile!
Among the reasons we decided to sell.
Retail pharmacies and independants get squeezed so hard its hard to make a profit sometimes with adequate staffing...
Thank you for everything you do! My parents would be in serious trouble if it weren't for their local pharmacy that delivers and is always so kind and helpful with questions. Well worth paying a little more for not using a "preferred" big box pharmacy.
“You don’t make 200 billion dollars a year with oversight” made me laugh so hard 😂
My husband has severe asthma, he’s been seeing his pulmonologist for about 12 years now. The doctor gave him some new trail inhalers and it was helping. He would only use his rescue inhaler maybe once a week. Of course the insurance company refused to take pay for it. Thank God his doctor is still giving the trails until we can figure something else out. This has been going on for about 3 months now. Insurance companies are literally evil.
Any luck with Stinging Nettle/Cow Itch tea? It's best raw (idk if only from Jamaica) as some boxes sold now here in the States are really blends :(
You can try sending in a request to the manufacturer for the inhalers. All pharmaceutical companies give out their meds for free if you meet financial requirements. Back when I was going to the free clinic, the pharmacy made me fill out these forms every 3 months. I got a free EpiPen, a year's supply of albuterol inhalers, and a year's supply of my steroid inhalers. Unfortunately I have insurance now so I actually have to pay for everything myself. But GoodRx covers you nationwide regardless of insurance status.
That's just crazy! I'm a pulmonologist coming from Greece, working in Sweden. I'm guessing your husband is using some kind of Salbutamol inhaler as a reliever. A 200dose 100mcg ventolin inhaler (called Aerolin in Greece), costs about 2,5$ without insurance and you can buy it from any farmacy without a doctor's receipt. The usual daily inhalers (symbicort, Relvar etc) are more expensive at about 45$ without insurance. I REALLY DON'T UNDERSTAND what is happening in US.
@@kostasvlachos2294 what is happening is that pharmaceutical companies pay lobbyists to encourage congress to vote in their favor and influence the fda. Most of the people in congress have their campaign funded by one or more major pharmaceutical companies.
@@kostasvlachos2294
An Albuterol inhaler retails here at $130. An ipatropium bromide inhaler at $220. An Advair inhaler (long-acting bronchial dilator + inhaled steroid) retails at around $650.
...All these medications have been on the market for at least 20 years.
Fabulous timing, Dr Glauc! Just 3 hours ago I was speaking to the Office of the Insurance Commissioner of WA state, asking how to file a complaint about OptumRX and United "Healthcare." Specifically (this week) their chronic habit of (a) refilling my medications automatically WITHOUT MY CONSENT (auto-refills are turned *off* for ALL my medications for good reason, plus there's that whole "I DIDN'T ORDER THESE" thing... 2 years and counting) (b) auto-filling said meds TOO EARLY (so they can hurry up and profit quicker) and (c) literally trying to take the place of MY DOCTOR by ordering tests and sending me test kits in the mail (DIY tests!) without even talking to my doc. (That doesn't include the f**king "checklist" they send me every year TELLING ME what tests and actions I'm going to dictate to my doctor.)
I could continue listing shady shit that UHC & Optum/OptumRx pull *ad nauseam.* But I'm saving the rest for the official complaint.
Omg they send the refills over a month early! I thought it was a mistake but then I quickly realized it wasn't. My auto refills are turned off also. This is my first refill for my household. So hopefully I will be able to get this straightened out. But I'm not going to hold my breath. They told me I was saving money by using them. Damn lie!
Also who did you find out to file a complaint about UHC? I'm so mad at them. They did me so wrong with my infusion/chemo medication. Very long story. But basically I was denied my medication for almost 7 months!
CVS refills too early! (except opiates, etc) Constant texts& reminders to fill fill fill!
@@flyingartgirls1 do they send your opiates on time for you at least. I'm worried mine won't come on time for my refill date. So I stayed with a local pharmacy since my town doesn't have a CVS or another pharmacy they consider
@@amber13000 In my state - Washington (not DC)- it's the Office of the Insurance Commissioner. There should be a similarly named office in every state. If you're having trouble finding where to file a complaint, ask your state's Attorney General office. UHC & Optum are out of f**king control.
So I needed knee surgery a few years back, and I'm uninsured so had to rely on public healthcare. Between the gp consult, the MRI, the surgical consults, surgury, post op recovery and my two week painkiller supply I had to pay the outrageous sum of $7.80.
Turns out the opioids were the only part not covered.
I'm in Australia.
Australia seems to have a healthcare system that covers almost everyone and works reasonably well for almost everyone. It would be adaptable to the US but those that "write the laws" will never let that reform happen.
$7.80? OUTRAGEOUS! Pretty sure my mum got everything for free...specialist consults, surgeries, radiation, meds - so many meds - pt, scans, bespoke compression stockings, silver pad bandages...but then again it was skin cancer in NZ, so
@@luciesimpson6437 I believe the issue is this was an elective surgery, they gave me a script for the oxy when they were ready to punt me out that I had to take to a chemist.
We knew you weren't American when you said the words "public healthcare"
In America the consultation alone would have a copay of $78.
As someone who is currently researching PBMs, this is 1000% spot on. Thank you for the great content and for shinning a light on these shadowy middlemen!
Oooof as a pharmacy technician who gets to call insurance companies and hear roundabout logic like this, and then to have to be the one to tell someone their medicine is over $200 or just not covered at all. Let's just say I wish the insurance companies had to talk with people in person to explain why something isn't covered.
And hear the patient or family etc. Crying because it's to much money etc.
Oh, they’ll just be like the insurance guy in “The Incredibles”.
Burst out laughing on the flow chart.
And then I wanna cry...
Love this! I’d share it, but I literally might lose my job if I did that. Also, the PBMs have gotten so big, they don’t even MANAGE their own stuff. They pay companies to use their employees. PBMs can basically have way less employees on paper, since most of their employees don’t TECHNICALLY work for them. Crazy right?
I've worked at Walgreens as a pharmacy tech for 4 years and as a pharmacy intern over the last year, so I'm all but too familiar with everyone's least favorite pharmacy conglomerate CVS/Caremark. To clarify, CVS/Caremark has its retail pharmacies, mail order, owns its own PBM, and is a large portion of the health insurance market from commercial to employer to Medicare and Medicaid.
Now, Texas law HB 1919, effective 9/1/21, prohibits PBMs from directing, steering, or requiring a patient to use a related pharmacy for their prescriptions.
Despite this seemingly straightforward law, I have yet to see a reduction in insurance rejections from CVS/Caremark-owned prescription plans that are in network with Walgreens but state that the patient must call CVS to either override the rejection and fill outside of CVS or get told they have no choice whatsoever but to transfer to CVS or their mail order.
I have pleaded with the respective patients to research this law and inform CVS that they are blatantly disregarding Texas law so that eventually they might be held accountable, but it looks like these corporations are all too aware no one will ever call them out and take appropriate action.
As a fellow Texan, I'm thinking that this is a plea that might be better directed, or rather, also directed, at state representatives. Maybe at candidates taking questions at campaign stops? OK, the one candidate who famously takes questions at campaign stops. There's cameras and reporters at them, so it might help publicize the problem.
Or a protofitering lawyer who will spend time and effort getting a class action together... seems America is good at one thing, being litigious.
I am in Florida and I LOATHE that the ONLY pharmacy my insurance will allow me to use is Walgreens. It is ridiculous because they treat you horribly. They never have heart or seizure medications when the it is time to refill it...and I refill it every 3 months! How hard is it to have it in stock when it only gets refilled every 3 months? You can complain about CVS all you want, but Walgreens over here is horrible! If the staff were nice it may be different, but they aren't. It is like they know you can't go anywhere else. It is a shame! My insurance is through BCBS.
Ugh we need that law here in Illinois. When i looked into it 2 years ago we had something similar but it only applied to insurance policies that were NOT from your employer. So basically the law is useless to pretty much all of us. Also the info wasn't made easily accessible to the public so those who might benefit won't know anyway.
@@Persephone-t5b That's awful. My local Walgreens is good about having my meds when I need them. They let me know 2 weeks ahead of when it's time to refill, and I haven't had trouble as long as I respond to the reminder within a couple of days. And the staff is really super helpful at the closest one to me. But just because they are reliable for me doesn't mean that's true for everyone, which is why no one should be forced to use only one pharmacy. If they can take your business for granted, they will!
My wife almost applied to a job for United healthcare yesterday, I made sure to show her these videos and she quickly changed her mind. Thanks for the content!
A wise man. You saved your wife's life and soul.
If she gets the job, she could potentially make things better for people depending on her position.
I nearly took a job with UHG, but I missed out on it.
Honestly, I had been unemployed for months and was running out of money. I would've taken it despite moral qualms.
@@gamemeister27 Centene one of United's competitors and they will be posting jobs starting August 8th
@@Orochigin Oh thank you, but I found a job!
These learning about healthcare shorts are both the most painfully accurate, and painfully on the nose, shorts I've ever seen. I get depressed and lose a little faith in humanity each time because they're so true. Yet, oddly, I love them anyway. Maybe, someday, if enough people realize all this then we might actually get change...
*United Healthcare laughs at me in billionaire*
Incredibly accurate. Racketeering. Same deal with getting MRIs approved and strong arming for “preferred providers” at another facility
Yep.
MRI? You need to go to Texaco Mike.
Truth. I can go to a specific place for MRIs and have no out of pocket expense, and they never compare my current MRI results with previous MRI results. It I can go literally across the street to a hospital for an MRI, where they put comparisons in the results & the notes are more comprehensive, but I have to pay hundreds out of pocket. Same thing when I have to get a colonoscopy (every 2 years because I have Crohn’s disease). And I’m overweight. The no copay place has a small MRI machine so I kind of have to squeeze in; the hospital has the larger machine. 🤦🏻♀️
Aetna/CVS is just as evil or worse. In addition to having the vertical integration of insurance (Aetna)-> PBM (CVS Caremark)-> mail order , they also have retail locations. Isn’t it shocking that the only “preferred” pharmacies happen to have CVS in their name? They will charge higher copays elsewhere, yet pay those pharmacies less per script than they pay themselves, thus ensuring high profits.
Spot on! I was prescribed a high potency topical steroid, Aetna did not cover. CVS wanted to charge me $180 - called local independent pharmacy - $40 same medication. I now pay out of pocket for all my medications. Oh, and you need a PA for post-op pain medications. NOPE! I will pay cash. Efffff CVS.
Every skit I watch about Jimothy makes me more and more glad to live in Europe. Oh sure, our Health Service is criminally underpaid and the government pockets most of the money they are supposedly spending on hospitals, but at least I can be sure my doctor is not being paid to send me to specific pharmacy and if they try setting murderous prices on their drugs I can just go somewhere else. Oh and some of our drugs are partially refunded by the state, lowering the costs. And I won't be charged 500$ for an ambulance ride to the hospital if I get hit by a car.
Lmao....$500. I live about 5 minutes from the hospital (at the posted speed limits) gonna be about $1500-$2,000 and that's if they don't give me any meds or start an IV,etc.
I'm pretty sure a $500 ambulance ride is on the cheaper side... Gotta love America and our superior healthcare system!
You won't get charged 40% of your paycheck for insurance, or get charged $6,000 for getting a SPLINTER.
Depends on what insurance you have. I got a GoodRX card and lowered my son's prescription cost from $200/month to $39/month. If I do my prescriptions through mail order, I get them for free. And ambulance rides are free. So don't think everyone pays what you have seen. They just don't research their insurance properly.
@@retired5218 wait until you need an airlift to a hospital, nearly no insurance covers it, you cant say no because your unconscious and its usually around $50,000. Also most people get their insurance through their job so they don't have much of a choice.
OMG!!! There is so much truth packed in this brief video. This is a 2-minute primer on exactly how insured healthcare is handled in the USA. It is an indictment of the healthcare insurance industry that could be understood by anyone of any political stripe.
Having practiced in a semi-rural area of Maryland for almost 40 years (including residency) I saw our healthcare system evolve into exactly what is summarized here in this video. The video is simultaneously hilarious and horrifying. Once again an amazing effort by our beloved hero Dr. Glaucomflecken.
A company that may or may not have been mentioned in the video released a booklet of "providers" that was given to employers to give out to their employees. It "rated" each "provider" with a star system with 5 stars being the highest rating. I found I had 4 stars. I called to inquire as to why I had 4 stars as I considered myself a caring, dedicated, and excellent doctor. I was told someone would call me back. Two weeks or so later someone from the insurance company called to tell me that for 3 or more out of my 200 or so patients with the company I had ordered too many tests or specialty consults. The specialists then ordered too many tests. If I wanted to appeal my "star" rating, I could review all 200 patients in my panel and send a detailed letter describing my thought processes and the necessities of my ordering habits. I told the person all that information was already in the medical record for anyone who knows how medicine is practiced to read and understand. Obviously, they didn't care as to why I did what I did. They only cared about their bottom line. Needless to say, I bagged that effort.
After I reluctantly, but to keep practicing had to join our local healthcare organization, I attended a mandatory meeting of doctors, nurse practitioners, and physician assistants employed by our organization given by one of the large healthcare insurance companies. The meeting was to introduce the concept of "care management". If implementing "care management" saved money, it would be split 65/35 or something to that effect between the insurance company and our healthcare organization. You know who got the 65%, right? If "care management" is used to prevent duplication of services, wasteful and unnecessary procedures, testing, and to better coordinate care; I was and am always all for it. We all wanted to learn how to practice more efficiently, cost-effectively, and reduce waste. That type of practice is actually better for patients and their health. The meeting started with a PowerPoint projection on a huge screen of the 30 highest-cost patients to this company. Their actual names and diagnoses were used and highlighted in bright red. Since we were all contractually beholden to the company and our employer there was no HIPPA violation. The first name on the list costing the most money (over 3 million dollars) was none other than one of my patients whom I had diagnosed at the age of 12 years with acute leukemia. She was at the time of the meeting 17 and had spent many, many months in and out of one of the nearby children's hospitals during the preceding 5 years. The suited man in charge began using a laser pointer and inquired "For example, what could be done to reduce this from 3 million down to 2.5 or even 2 million dollars?" I felt tears coming up into my eyes as I recalled the years of suffering, stress, and heartache incurred by the patient and her family. Thankfully by the time of the meeting she was in remission and doing relatively well although she needed ongoing specialty follow-up and psychological counseling. My tears turned to rage as he inquired "Anybody? There's nobody here who can add anything to this situation?" I stood up and said, "Why don't we just let her f*****g die and that would save way more than 2 million f*****g dollars." You could have heard a pin drop. I was later reprimanded by one of my superiors for using foul language. I apologized.
I am retired now and wonder how I kept my sanity and "boy scout" attitude all those years of my career. I guess a boy scout wouldn't have used the f-word. But it sure felt good!
Horrifying... They gaslit you. They pretended that you did something wrong for cursing, but really, it was because you called them out for being greedy, heartless scoundrels. They were egregiously wrong, but pretended YOU were wrong for cursing. They gaslit you & deflected blame to anyone who dares to speak out. Typical narcissistic response. You are clearly a good person & you said exactly what should have been said. Bravo, sir 👏🏻
Thank you Doctor fir your many years of compassionate care of your patients.
Satan being the leader supreme of insurance companies is so true I can’t even..
Let's not insult Satan now. This one was all human evil.
And yet, I bet the CEO's of these companies all claim they go to church on Sundays. I don't think Satan had anything to do with this evil. This is all man made corruption.
Have you ever wondered what CVS stands for? It stands for Come Visit Satan
😂
So true, it’s sad. Yet physicians cannot send blood work to specialized labs for a discount price without being slapped with a Stark Law violation, cannot own hospitals, and in my state cannot own pharmacies or dispense medicine. Anyone else see something wrong here?
Uh, no? All of those things sound like a mix betweem conflict of interest and malpractice
@@Celastrous I think what Donna is getting at is that if the laws are so strict on what physicians can and cannot own in order to reduce conflict of interest, it should be the same with insurance companies, labs, and pharmacies.
@@sarahb7626 Pretty sure they mean that not only is all this middle-man nonsense going on, but the laws are set up to dissuade competition in the pharmaceutical industry, meaning all these people bending you over the barrel with these prices are also making sure you cannot be able to go to anywhere else.
Like blackmail, only the ransom is your health and ability to survive longer.
Well doctors can own hospitals, but they might have a lot more red tape, but the issue there is, owning or starting, or buying a hospital is expensive, doctors are rich, but even they wont make enough to generally buy out a hospital.
@@Celastrous yes that's what she meant. She meant if physician's can't do any of this because a conflict of interest, then why can insurance companies get away with it!
I work with a non profit independent pharmacy which makes medications affordable for those who do not have insurance.
We also serve those who do have health insurance and I can't thank you enough for shedding a light on this issue. Independent pharmacies all over are put out of business thanks to companies like these who make the patient move their medications from their local pharmacy to a giant mail order one like the one you mentioned.
Please share the name of such a pharmacy!
Thank you for being a part of the correct path when it comes to the medical field.
Name drop, my man.
Do you import or reimport medicines? This is what independent suppliers in Germany often do. I see a German inhaler with a printed laber, original label in Greek
DIdn't even know they had independent pharmacies. I'll have to look into these in my area. THank you!
Doctor! You need to partner with Mark Cuban cost plus drugs company! Literally focusing on this exact issue
Wait, Mark Cuban is doing something good?
Meh, he is pretending to be revolutionary: ruclips.net/video/HR5RvurbJmQ/видео.html&ab_channel=MartinShkreli
I've been following Cubans company. It will be fascinating to see how it plays out.
I'd seriously consider using it if he adds the expensive migraine meds i need to his inventory.
America actually spends more on healthcare than most countries. The system is just broken.
Not just most countries, USA spends more on healthcare than ANY other country. All so we can have the insurance company middle-men interfere with the provision of medicine and worsen patient outcomes, all for profit. It's past time to change this, but it really is this bad right now.
"America" as a country or "Americans" as citizens?
Honest question.
@@Siriathion Both.
@@voicingsomeopinions7006 yup, both out government spending and private spending are larger than the entire public+private spending of many other nations...who get better outcomes for less than half the price. It's just an extortion racket.
@@dynamicworlds1 With legalized corruption, it makes it a rat's nest to unravel.
Remember the Golden Rule: The one with the gold makes the rules.
🎶I follow the golden rule
How can a man resist
When the gold in his hand
Lets him rule the land
With an iron fist🎶
Sorry I couldn’t resist a good Starkid reference
ive been saying this for years. my family owns a small town pharmacy. and weve dealt with PBMs for as long as theyve been a thing. Insurance being able to negotiate prices separate from what uninsured patients have to pay is the very reason American healthcare is so expensive despite not giving any noticeably better care than other first world nations.
I work as an account manager for a mid sized specialty pharmacy. DIR fees and clawbacks are devastating to independent SPs. It’s very difficult to project how many millions of dollars will get clawed back every year. PBMs and insurance companies are ruthless and evil. Vertical integration of these entities should be outlawed for reasons of conflict of interests. It’s bad for patient care.
I did call center customer service for a PBM twenty years ago. It was hair-raising, what we did to people. It scalded my soul.
I'm sorry you had to deal with that.
I think we need a few examples. Or at least i do. I'm not mad enough again lol.
2:06 - 2:08 Yeah Jimmothy, how else do ya think monsters are able to get away with such heinous acts?
Jesus, 9 times out of 10 you make me laugh, and the other one time you convince me that we need to dig a hole big enough to fit every single last employee of the healthcare industry and fill that hole with every single last employee of the healthcare industry.
Well that would be dumb to throw EVERYONE in there. Who would help you then when you break your femur? Or have a stroke? Get a splinter in your eye? Or are about to go septic from a UTI?
Throw everyone in a pit and pretty soon you'll be joining us in there with your mortal wound or preventable/fatal condition.
Hey now, don't put doctors, nurses, pharmacy workers, and other actual people in there with the soulless suits, the ACTUAL problem with the U.S healthcare system, who don't even understand how to medicine and only care for lining them and their associates pockets.
Just a heads up, Cost Plus Drugs exists now.
Basically, Mark Cuban started this company with the sole purpose of selling all drugs with just a 15% markup plus the shipping cost. From what I've been told, they have a decent list of drugs rn and they will continue to add to that list over time.
They're not spending any money on advertising so it's existence is mostly being spread through word-of-mouth (plus the couple of times he's been on podcasts to promote it).
Cost Plus works well in some instances, but not in others. Beyond that, their customer service and delivery scheduling is glitchy and inconsistent, especially since they don’t currently have live CSRs. It’s all electronic. Mark Cuban himself even said that patients might have to make some sacrifices initially for better pricing. I think getting more backing within the industry will be beneficial, especially with some PBMs genuinely wanting to get involved to reduce patient costs. This is based on articles I’ve read, so take all of this with a grain of salt.
Oops, one guy missing: United Health owns PBM Unum...and Unum owns medical practices. They just bought Atrius Health, largest (formerly non-profit) doctors' practice in MA. So the middlemen own the doctors. You'll need a beard for that character.
Makes sense about Satan…one of my prescriptions was reclassified as a tier three drug and if I didn’t have a savings card, would cost close to $1000 for a refill. This video couldn’t have been more timely. My Primary care doctor actually tried to file a tier exception for me with my insurance company but was denied in a hot minute; now I see why.😈
Dafuq is a savings card?
Savings cards for drugs?
…that’s not even legal up here in Canada last I checked.
@@liesdamnlies3372 savings card like Good RX. They find the cheapest place to get medications and then they help with a discount if your insurance doesn't cover the medication or if you just flat out done have insurance.
@@liesdamnlies3372 The only ones I’ve seen in Canada are drug-specific, provided by the manufacturer & billed to a private insurance company, but they’re pretty rare. I’ve yet to see anything about a “GoodRx” type discount card here.
@@GoBlueGirl78 Yeah pretty sure it's illegal. There's a reason Shoppers won't let you use their discount card for the pharmacy, for example. It'd leave the field wide-open for massive chain pharmacies to out-compete anyone else and then we'd be in the same boat as Americans.
@@liesdamnlies3372 That's a loyalty card, which is different than what we're talking about.
The govt sets rules about loyalty cards, which is why you can't use it to get points on or redeem for lottery, tobacco, Rxs, etc.
Me, a Canadian, who's been in pharmacy for decades, wondering WTF a "pharmacy benefit manager" is...
Be grateful that you don't need to know.
In an ideal world, they negotiate with drug companies for better prices. That might be through scale (we have 20 million customers so give us a volume discount), it might be through preferential coverage (we'll only cover your drug in the relevant class if you give us a much better price), or whatever. The idea was that PBMs would have negotiating power and would then sell their services for a small commission, much like an investment advisor might. With luck, the PBM would be able to crowbar out more savings from the drug companies than they charge the insured. However, with changes (including but not limited to the ACA) there's much less of an incentive to cut costs and so now they are mostly overhead.
They are unadulterated trash! A bunch of idiots that literally don't know how anything works, but try to force you to take medications they want you to take when they want you to take them. I spent the last two weeks fighting Optum RX while sick over two separate medication denials. The idiot liars literally got on the phone with my doctor claiming my medication was already covered, but when he read to them THEIR OWN LETTER THEY SENT TO ME telling me how they were no longer covering my prescribed medication starting July, their story changed.
@@garrettkajmowicz It's funny Trump tried to pass something that'd cut out the middle men, and let people negotiate this for themselves, which would've reduced costs for everyone. But then it got memory holed.
@@xShadowChrisx Do you really believe that individuals can negotiate prices with corporate America and its greed ? Especially when there is such seriously big money at stake ? Gift for Corporation.
Some of the individuals are too sick and enfeebled to do Activities of Daily Living --- let alone negotiate with Satan. What do you believe is practical and realistic ?
When will Jimothy lead the uprising? Jimothy, you can be the hero we need right now.
He's kinda trying. Education is the first step!
✊
As a doctor watching this is an eye opener. No health care system is perfect but I’m so thankful for our NHS in the UK
This is hilarious. But as a retired RN in Canada…it makes me ill to think about the cost of drugs for American patients.
that last line hit like a sack of wet mice, absolutely terrifying
And this is why I’m moving back to Canada.
- your friendly neighborhood ICU nurse who can’t afford medications for her child
This is the best skit so far. The healthcare industry of this country is so broken, and people literally die as a result. I hope it changes, and soon, but the prognosis is not good.
While these videos are funny, they are in the, I am laughing to keep from crying, kind of funny. These insights into the American healthcare system are so depressing, and I'm a Canadian that doesn't have to deal with it personally! Over the last 2 years, I've had 5 CTs, 3 MRIs, a lumbar puncture, an electrocardiogram, an echocardiogram, and more blood tests than I can count. I've seen 2 neurologists, 1 neurosurgeon, 2 rheumatologists, and a hematologist. All of this, and I have never seen a single bill.
The first and second line of prescription treatments didn't seem to be working well enough, so I just started a biologic treatment today. I had a case manager contact me directly, and she sorted out government coverage and approval for the treatment, and set up payment of what wasn't covered by the government as a subsidized payment by the drug company? Maybe? I'm not sure. She just said she would take care of it. She then sent the prescription to a pharmacy of my choice, and sorted out payment. I just had to go pick it up. I paid nothing on pickup, but did see that the total cost for this one month's worth of medication (a single shot) was $1672.
I can't even imagine if I had to pay out of pocket for any of that, or even having to navigate the insurance system in the US. Having gone through unexpected medical issues these last 2 years, I really feel for my neighbours to the south.
This is particularly helpful to those of us who don't live in US..... Reminds me of a Michael Moore documentary about healthcare and insurance odyssey issues US citizens must endure...
There was a part in that movie where a woman who worked for an insurance company told about a 60's-ish couple who had been denied health coverage numerous times. They'd jumped through multiple hoops for this latest application's requirements.
The employee said that when the wife turned the paperwork in to her, she heard them say "everything's going to be alright soon, we're going to have insurance. "
She said she quickly looked at their application and knew right away it would be denied.
Heart.Breaking.😢 I don't remember much else from that movie but I've never forgotten that part and how just tragic was. Shame on "the system" that it puts human beings in a position like that. Basically playing lottery with their health, having them run like mice in a maze, except the maze has no exit.
Yes “sicko” iirc
So glad to work in the UK where we at least have a set price for prescriptions... Even if our generics companies artificially reduce production to inflate prices to the NHS 😤
Glad that you are actually able to admit that your country has flaws too
In-general, generic medications cost less in the US than in most of the developed world. On-patent medications are much more expensive, though.
the truth is so absurd that it's both hilarious and disturbing
You are just confirming to me yet again that I made the smart move to Costa Rica, where all drugs are way cheaper. That $1,200 Lyrica prescription a month runs roughly forty bucks here. The US system is so so broken!
Oh my god I really can relate to this video. I used to work at Optum as Pharmacy Help Desk and I know how hard it is to explain to the customers that United Health Care and Optum are just one. 🤣
Don’t even get me started on PBMs. The one for my insurance denied my Emgality for a straight 2 years because the ICD-10 code submitted with the prior authorization wasn’t specific enough.
They didn’t bother to explain this to my doctor. The ICD-10 code section for migraine is also a complete mess because they expect doctors to be hyper specific on where the migraines are episodic or chronic, if an aura is present or not, if migraines last for at least 72 hours, and if they are manageable or not. The hyper specificity of migraine codes makes it really easy for PBMs to deny prior authorizations.
My poor neuro is a headache specialist and we have to fight to get my ajovy and whatever abortive filled. Its always a battle of phone calls, prior auths, then me getting solicitation letters/threatening letters that i have to use express scripts or they won't pay. I hate it so damned much.
Excuse me, I came here to laugh, not cry
This vertical integration thing, controlling every aspect of the supply chain, is exactly what made Pablo Escobar so rich. But it also made him vulnerable because there were multiple areas the law could target him. Unfortunately, this aspect of American Healthcare is perfectly legal so gl
The more I watch your videos the more I think that the US is a dystopian nightmare
God, I got onto UHC through my engineering job last year and the whole UHC-Optum-OptumRx thing is sickening. I get better prices through goodRx compared to my $10/$15 copay on my essential meds.
Quality content again doc! Thank you!
I refused to be on UHC's panel for behavioral health. They go out of their way to deny mental health benefits, and the way they abuse their own gatekeepers is shocking.
I will never understand the US health care systems. Heath care shouldn't be a privilege but a universal right.
Vote for the people who want to get money out of our health care system. If we don't come together as a nation to finally say "enough is enough", we'll continue to see our quality of care & life expectancies plummet. Health care is a right!
But but but that's socialism! Holding the health of average Americans for billions in ransom is a god given right!
That was also the moustache of the second Jonathan in the Interview portions and I nearly died when I saw the thumbnail at the sheer thought of a Jonathan involved in United Healthcare 😂
You are a true GOAT, educating us future doctors on things our medical schools will never cover. I hope one day we can a fully change/revamp the US Healthcare system BY physicians, for our patients before its inevitable collapse.
First I laughed, then I raged. Thanks for writing, performing and posting this. We have to change our laws and ban this mass extortion of people seeking wellness. You spell out the travesty so brilliantly and succinctly. I hope with increased awareness, we catalyze action. #SinglePayerNow