Usual and Customary

[sKiZo]

Skipped going to a doctor for around 10 years, and first time I go in, they give me blood pressure, cholesterol, and type two diabetes. One way to get even with having to miss that boat payment over the years, right? ;-]

New to the "subscription" vs prescription game and just now got around to reading the small print ... the reams and reams of small print, that come with the lil brown bottles. My pharmacy lists a "usual and customary" price as well as my co-pay.

Looked that up, and it's what the insurance usually covers in your area. That's not necessarily what your insurance actually pays, as there's apparently all sorts of back door agreements between them and pharmacies, which would explain why the corner druggist went the way of the dinosaur. Real eye opener though ... a month's supply lists a U&C of almost $500 ... and my copay is $10. All of a sudden, the monthly premium I pay blue cross is a whole lot less annoying. All of a sudden, I'm saving money instead of spending it! Sort of ...

Not venting ... more like a wOw moment, and a bit of muttering thrown in for texture.

 

[whoaru99]

Pretty much like any insurance. Big waste of money until you need it.

 

[exhippy]

My 95 year old mother has a stomach tumor. The medicine is called Gleevec, it's classified as an 'Inhibitor' it keeps it from growing and spreading to other areas of her body. So far, so good for a little over four years. Her cost for 90 days- $1,200. Insurance pays- about $15,000. Probably the only time I've ever said, Thank god for insurance!
.

 

[Scifi]

There's plenty of over the counter medicine. I take my blood pressure a couple times a week and use diet and exercise to control it. About 4-5 years ago, it was 180/110 at the dentist office and I decided I had to do something about it. A low saturated fat, low sodium and low sugar diet brought it way down and if I stay on my diet I can get it down to about 130/80. Going off my diet raises it. Most people know there's an obesity epidemic in this country yet I'm always amazed how so many people insist I eat health damaging foods when I'm around them. I try to keep a schedule for eating, too, which helps. I find a lot of people try to offer me something when I'm not on schedule for eating or drinking coffee and then I have explain my 180/110 blood pressure to them to get them stop so I don't get off my diet and let my food addiction take over like it did before. This is another example that proves the majority isn't always right. At least I don't have a $100,000 student loan which skyrockets over time if not paid off. I never got a student, BTW.

 

[sKiZo]

Funny you should mention a dentist ... that's what started all this. It'd been a while since I'd gone there as well, and I made the misteak of checking off the "high blood pressure" in the history box.

280/160

Little more than I could blame on "white coat syndrome". Got a lot of those OMG puppy eye looks from the staff there, and I'm sure they were looking high and low for a splash shield in case I decided to explode on them ...

Only way they'd fix my tooth was if I promised to see my doctor right away. Dentist actually called the doc and I was scheduled in same day, so I guess they all figured it was pretty serious, and I'd best pay attention.

And ya, self medicating and proper diet can make a world of difference. Last test, I was back down to "high borderline on the diabetes thing, and the BP was a good solid 130/80 ... certainly not the current definition of perfect, but a big improvement.

PS ... I still eat pretty much everything I like, but smaller portions. Little trick is to drink a glass of water before every meal, and you fill up faster. Check out this thread, and you'll see a lotta stuff that would set my dietician to gibbering and shaking her head ...

http://www.audiokarma.org/forums/in...-your-dinner-home-cooking-only-please.696992/

Oh. Went cold turkey on pop too. Haven't had one on a year now, and that was good for 10 pounds of weight loss, which certainly helps all the numbers ...

... and speaking of healthy foods ... I know a couple lifelong vegan fanatics, both of whose diabetes numbers are worse than mine. Go figure. I prescribed them a couple big ol' butt steaks, seared enough so they don't moo no more. Then again, just looking at one would probably send them into shock ... <G>

 

[Scifi]

Your blood pressure was 280/160? When the first number goes above 200 you're supposed to go to the hospital from what I heard. One problem with the western diet is that corporations selling food have to make money for their share holders and to stay in business they have to make food that is addicting which usually includes lots of fat, salt and sugar, but of course, addicts can't believe something they're addicted to is bad for them until they hit bottom. I found that when I'm on my diet a while I get used to it and don't feel I'm missing out on anything. I feel a lot better, too, which results in me hating to be on a gluttonous diet, although that seems to be hard for some people to believe.

 

[sKiZo]

Yup ... not a misprint ... the dentist was ready to dial 911, but I told him the stress of waiting for an ambulance would probably kill me. He still did the repair on the cracked tooth I'd gone in for, bless his lil heart.

To this day, they insist on using the cuff every time I go in for a cleaning. I apparently scared the crap out of them, or their lawyers.

 

[knockbill]

Welcome to old age!!! Glad you made it! You're gonna learn a whole new language dealing with the new, modern, predatory health and insurance experts around now.... I got my wake up call with Blue Xs famous "group of one"...

Question and confirm, is the phrase of the day,,,
Good luck...

 

[sKiZo]

I still think they got it all bass ackwards ... INCREASE the blood pressure to blast all that nasty plaque out of yer veins. <G>

And ya. I take it all with a grain (or sometimes a pound or two) of salt. Especially when it's obvious they're still making it up as they go along. Apparently, they've recently raised the acceptable BP levels, and they're THAT close to figuring out how aspirin works ...

 

[Scifi]

I don't buy any candy most of the time except just before Halloween and start eating it when I get it home. Usually I have to buy more later and then no one comes to the door and I end up eating it all. I was thinking of putting up a sign in my front yard at Halloween time explaining my problem with high blood and how I eat candy when its sitting around and say no candy is available. Maybe I'll give out potatoes or apples or something like that if anyone comes to the door. I'll try to encourage them not to eat candy, too, because refined sugar is bad for you. After Halloween my blood pressure is always higher because of the candy.

 

[soundboy]

My 95 year old mother has a stomach tumor. The medicine is called Gleevec, it's classified as an 'Inhibitor' it keeps it from growing and spreading to other areas of her body. So far, so good for a little over four years. Her cost for 90 days- $1,200. Insurance pays- about $15,000. Probably the only time I've ever said, Thank god for insurance!
.

Wow!!

My 74 year old mother has dementia and she was prescribed a medical patch called "Exelon". $1500 for 3 month but her co-pay was $350. She has Medicare and purchased the supplemental Medicare insurance, which for the last 2 years in her zip code where she resides cost her $0 per month. Unfortunately, my mom keep peeling the patch off despite me telling her not to do that. I asked her doctor whether there's pill form of the patch....and voila, a generic pill version of the medicine only cost $10 for 3 months. Again, thank God for insurance.

 

[sKiZo]

Get a refund from the doctor for the patches that cost her an extra $100 more per month than the pill?

I just went the opposite, but it was my call. Changed from Lipitor (generic) to Crestor (generic) at my request, because come to find out, the Lipitor doesn't work if you eat grapefruit - some enzyme in it neutralizes the Lipitor's effect and passes it right to the liver at much higher than normal amounts. First I'd heard of that. Doctor (PA) raised the dosage last time I went in when she didn't like the cholesterol numbers, and that would have just blown my liver out twice as fast if I hadn't caught on ...

You'd think they'd know to ask "do you eat grapefruit?" before upping the dosage. Crestor is a LOT more, but ... I like my morning grapefruit, there's no interaction, it's otherwise good for me, and my co-pay didn't go up much. The U&C is $250, so if I figure at an average of maybe 20 grapefruit a month, them juicy lil balls of tart goodness are costing the insurance $13 each. I'll try my darndest to feel guilty ... ;-}

 

[old_tv_nut]

...
You'd think they'd know to ask "do you eat grapefruit?" before upping the dosage.

I agree your doctor should have mentioned this, but...every prescription I've received for many years has an information sheet attached from the pharmacy, and it tells all these things your doctor may not mention. You owe it to yourself to read all the scary side effects, interactions with other meds, etc., and not just take the stuff without knowing. Especially important if you get prescriptions from more than one doctor.

 

[sKiZo]

Yup ... finally got around to it. That's where I came up with the whole U&C thang ...

 

[Scifi]

Here's something about the DASH diet. I try to avoid sweets as much as possible since as a sweetaholic, once I have one bite it can lead to a sweet binge which I don't want happening. I have enough of a problem with it around Halloween. I also keep saturated fat levels as low as possible. Just read the labels. Monounsaturated fats (olive oil, etc.) are considered to be good fats, ie. raises HDL and lowers LDL. Monounsaturated fats can be omega-6 (ie. olive oil) or omega-3 type fats (fish or flax seed oil).

http://www.marketwatch.com/story/this-is-americas-best-dietfor-the-7th-year-in-a-row-2017-01-04

I've been frustrated by the misinformation about sodium. The USRDA for sodium is 2.4 grams/day, ie. 6.1 grams of table salt per day (2.4 x 58.44/22.99 = 6.1). I've seen sea salt recommended as a substitute for table salt, but its also high in sodium. Some people have told me sodium has no effect on blood pressure, which is wrong according to a lot of research. Some articles I've seen say if you have 3 or more times of the USRDA of sodium in your diet, then it can significantly raise your blood pressure. Some recommend no more than 1.5 grams of sodium per day if you're over 40 or 50.

Na 22.990 g/mol
NaCl 58.44 g/mol


magnesium
http://naturalsociety.com/magnesium-and-blood-pressure-6392/

potassium
http://www.bloodpressureuk.org/microsites/salt/Home/Whypotassiumhelps

I have to remember the magnesium and potassium.

 

[luvvinvinyl]

Get a refund from the doctor for the patches that cost her an extra $100 more per month than the pill?

I just went the opposite, but it was my call. Changed from Lipitor (generic) to Crestor (generic) at my request, because come to find out, the Lipitor doesn't work if you eat grapefruit - some enzyme in it neutralizes the Lipitor's effect and passes it right to the liver at much higher than normal amounts. First I'd heard of that. Doctor (PA) raised the dosage last time I went in when she didn't like the cholesterol numbers, and that would have just blown my liver out twice as fast if I hadn't caught on ...

You'd think they'd know to ask "do you eat grapefruit?" before upping the dosage. Crestor is a LOT more, but ... I like my morning grapefruit, there's no interaction, it's otherwise good for me, and my co-pay didn't go up much. The U&C is $250, so if I figure at an average of maybe 20 grapefruit a month, them juicy lil balls of tart goodness are costing the insurance $13 each. I'll try my darndest to feel guilty ... ;-}

I just found out from my pharmacist that Crestor, or, in my case, the generic Rosuvastatin, is rendered ineffective if you consume dairy, within two hours either way, of your Crestor. Graperfruit? Have all you want, but stay away from the milk, she said. My doc doubled my statin, a few months ago, when she wasn't happy with my numbers. Nobody asked me about milk. I drink near to a couple of gallons per week (1%).

No more milk for me, with my evening meal.

 

[sKiZo]

Crap ... can't win for losing, can we?

Is cheese considered dairy in this case? A piece of that and some grapes is pretty normal here for a bedtime stack. Easy enough to fix I suppose ... just move the pill to the day box instead of the night box.

PS ... check with your doctor again ... only concern I saw about Crestor is with WHOLE milk ...

 

[Scifi]

How Does Cinnamon Reduce Blood Pressure?
http://www.livestrong.com/article/27611-cinnamon-reduce-blood-pressure/

 

[Rome]

Wow SKIZo, that BP was out of control. I had 220/170 one time & the nurse asked me what had I been doing? Well, I didn't tell her!

But, glad you got yourself checked out.

Rome

 

[toxcrusadr]

Pharmaceutical industry gets high on fat profits
http://www.bbc.com/news/business-28212223

This is a couple years old but the top 10 pharma companies made a collective $90B in profits in 2013. The highest profit margin was the 3d biggest company, at 42%.

And that's just the drugs. Add in the hospitals, doctors, technicians and nurses, consumable supplies, equipment, software...staggering amounts of money. Yet competition does not seem to bring the cost down like it does with so many other things we consume so much of.