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Medicare in America When Drug Prices Are out of Reac

游客2024-03-01  23
问题                        Medicare in America
    When Drug Prices Are out of Reach
    True Story. Elderly and uninsured Americans pay the highest prices in the world for prescription drugs. Ronald Jacobson found out what that means when he retired in 2002 and bid farewell to his workplace health insurance. Suddenly, he was responsible for his $30-a-month prescription for Prevacid, which he takes for heartburn,  What’s Up. Medicare does not cover prescriptions. Americans without health insurance also must pay full retail price for drugs. Even some insurance plans won’t cover certain drugs. In response, many Americans are now buying their drugs from Canada.
    Drug companies have a different view. The bulk of their profits come from drugs sold in the United States. if too many people bypass high U.S. prices, the industry might be less willing to make the risky investment to seek cures for plagues like cancer. Just last week, Pfizer threatened to restrict drug sales to Canadian pharmacies (药房；制药业) that sell to many U. S. citizens.
    Battle Plan. The legality of buying drugs online from abroad is a gray area. Several months ago, the House of Representatives voted in favor of it. in the meantime, nobody has convinced me we’re compromising people’s lives by getting drugs from Canada. The physicians agree the real threat to patients is their inability to pay for drugs they need.
    You don’t need to ask your doctor’s permission to order drugs online. But ordering a prescription drug without medical care and a prescription from a physician is foolish. A reputable site will ask you to mail or fax your prescription, and will not fill an order without it. The FDA warns that consumers should never buy certain drugs over the Internet because they have safety restrictions.
    A number of Web sites let Americans order from Canada, where prices are substantially lower because the government negotiates to keep a lid on medication prices. But pharmaceutical choices on the Internet are varied -- and confusing. A few reputable sites will, for a tee, sort out the array.
    In addition to evaluating Canadian pharmacies and comparing prices, list state and drug company programs offering discounts. The information costs $299 a year; libraries and senior citizen organizations often share the information with others.
    Bonus Tip. Often, Internet prices for lifestyle drugs are higher than drugstore prices. Perhaps because of embarrassment, some people pay higher prices to sites that supply the drags without a prescription -- a practice that is dangerous to consumers.
    Don’t get Killed By Bills
    True Story. Howard Omote has multiple myeloma (骨髓瘤), a form of cancer that affects his bone marrow (骨髓). When he checked into the hospital near his home, a few years ago because of internal bleeding, he was relieved to discover the problem wasn’t serious. The $30 000 bill for his three- week hospital stay, however, was sobering. Howard and his wife Aileen weren’t worried. They had plenty of insurance: through Howard’s old job under the federal law known as COBRA, through Aileen’s employer at the time, and through Medicare, because Howard is disabled. But the insurers couldn’t agree on who was responsible for paying that. Then the hospital collections department called. If the Omotes couldn’t get the insurance companies to pay up, they were told, they’d, have to get legal help. Aileen found out that attorney fees could reach $50 000. The couple decided to pay the hospital bill themselves and try to get reimbursed (赔偿) later.
    What’s Up. A confusing medical bill. Is there any other kind? Healthcare financial systems are set with medical providers and insurance companies in mind, not patients, says Scott Johnson, technical director for the Healthcare Financial Management Association, a professional organization. A Kaiser Family Foundation study in 2000 found 1 in 4 people who had health plan difficulties cited billing and payment problems as the snag. The problem may be worsening: More physicians are refusing to file insurance claims for patients.
    Battle Plan. The Patient Advocate Foundathm will help sort out your bills free if you’ve got a chronic, life-threatening disease. In January 2002, the Omotes sent copies of their bills to the group, which worked with the insurers to figure out who owed what. In August, the couple was reimbursed for the $30 000. Many states have a healthcare ombudsman (巡视官) office that will do the same. Another option: For $55 to $85 an hour, a private claims advocate will review your bills and figure out what you owe.
    Bonus Tip. "Many people just pay their medical bills, and they don’t owe the money," says Diane Meyer, an individual claims manager with Medical Business Associates. Before you do, review explanation of benefits (EOB) from your insurer that tells how much the insurer is paying on the claim. The EOB should arrive within 30 days of service. If there are discrepancies, investigate first, and pay later.
    Who’ll Pay for the Doc You Want?
    True Story. To Nancy Weiss, things looked bad: "Something had to be done, and fast, or my daughter would be dead." The teenager was potentially suicidal and getting into drugs, and had been to a dozen specialists in Maryland, where the two lived, Weiss is a single mom and education consultant. She had health insurance and a specialist’s strong recommendation that her daughter get away -- friends were linked to many of her problems -- and be treated at a specialized residential facility in Utah. "So I called my insurance company, and they said no dice: They would only pay for something local. And staying local was part of the whole problem." Weiss began paying $6,120 a month for out-of-state treatment  What’s Up. Health insurance companies frequently refuse to pay for you to see the doctor you want to see. A woman with cancer in both breasts was told she could not see a specialist outside her HMO (Health Maintenance Organization) even though the HMO surgeon had missed a tumor. A car accident victim was told she didn’t have coverage for the specialists and emergency personnel who cared for her. And when companies say no, most patients give up.
    Battle Plan. Yet the Rand study also found that 42 percent of appeals for additional services are decided in favor of the patient. You can tilt the balance further in your favor. Get past the insurer’s customer service reps (推销员) at the 1-800 phone lines. They aren’t healthcare professionals. Most companies have "case managers" who are nurses: Ask to be assigned to one, saying you have a complicated illness that needs to be carefully managed. Write letters citing a serious threat to your health. The case manager may be more understanding of your medical needs. If not, ask for a review by the company’s medical director. Your employer may also be willing to switch you to a more flexible insurance option "for cause". As for Weiss, she hired Stull. After a bit of back and forth, the insurer decided the Utah treatment was covered and is reimbursing some past expenses as well.
    Bonus Tip. Proper language helps your appeal. Patients Are Powerful, a nonprofit based in Penryn, Calif, has crafted strongly worded model letters requesting payment for a specialist or second option. The letters use phrases like "imminent and serious threat to my health" and insist on a decision within five years. [br] When Health insurance companies say they don’t pay for the specialists outside the patient’s HMO, most patients ______.
选项
答案 give up
解析 此句的答案可从第十四段的最后一句“And when companies say no，most patients give up．”中得出。
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