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Blue Cross Blue Shield plans sue CVS for overcharging them for generic drugs
- interestica 6y agoI thought that the grammar in this headline was all messed up. But it turns out "Blues plans" is a thing.
- woofyman 6y ago3rd person present: plans
- coronadisaster 6y agoThey also charge me more at the doctor when I have insurance... is it ok to say that you don't have insurance and make a claim later?
- _-david-_ 6y agoIt might be considered fraud but it would probably depend on your state / country.
- labster 6y agoMany doctors discount their care when providing it to people who don't have insurance to help them afford medical care. It's probably legal to make a claim later, but you're effectively lying to the doctor so you can receive a charitable contribution. It's ok to do it if you don't mind feeling like a welfare fraudster.
- toast0 6y agoThey may also discount their care if they get paid upfront and don't have to submit the claim and wait for reimbursement. But it might also violate their network agreement with the insurer to not do the submital?
- thebooktocome 6y agoIt's not a charitable contribution; the doctor in this situation is unethically applying differential pricing.
- deleted 6y ago[deleted]
- kinkrtyavimoodh 6y agoSo it's unethical to charge less to a person who might not be able to afford the higher price? I think we have different definitions of the word ethical.
- colejohnson66 6y agoIt’s viewed as unethical to some because when you flip the script, it’s: “charge rich people more simply cause they’re rich”. Which isn’t a good argument, but it’s what I’ve heard.
- kinkrtyavimoodh 6y agoBut rich people are not charged because they are rich. They are charged because they have insurance. And it is insurance that has led to this bizarre situation where the free market is completely broken and you can't confidently put a price number to a medical product or service. If almost everyone was paying for their medical care out of their own pocket we would not be in this situation. And there are plenty of other countries where this is the case. In India for example, individual doctors literally have a board with a list of what they charge for various services, and if you visit a hospital, someone at the reception would be happy to help you with these. You want a general ward? Here's the price. You want a private air-conditioned room with five-star catered meals, here is the price.
- franciscop 6y agoYou are paying more for your insurance because the doctors offer different prices to different people (since insurance prices follow cost). This likely locks some people out of insurance altogether.
- crazygringo 6y agoIt's totally legal to pay the cash price if it's lower. It's not against the law to have insurance and not use it. But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures (most likely), or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end. If you haven't reached your deductible and don't think you'll reach it, then it can make sense to pay in cash and just not report it to your insurance company at all. That's fine (though it doesn't count toward your deductible of course). But also note it's not a universal that insurance prices are higher than cash. At every doctor and dentist I've ever seen in New York City, insurance prices have always been lower than not having insurance. I ask every time, since I have a HDHP. One of the benefits of health insurance is often precisely that they negotiate lower rates with doctors, because (in theory) they bring in more patients to make up for it. Of course, if you're paying cash the doctor can give you a discount if they choose to, if you tell a sob story... which I've never heard of happening with insurance.
- FireBeyond 6y ago> But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures, or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end. Unless you're the provider, in which case there are many cases of providers billing insurance after taking a cash patient. Effectively "reverse balance billing", aka fraud. If you see instances where providers "accidentally" process your care through your insurer after paying cash, tell your insurer. While it may seem like a non-issue, and that the provider will claim accident, I assure you that for all their (many, many) faults, insurance companies dislike provider fraud too, and similar to credit card chargebacks, too many "accidental" billings will become problematic to the provider.
- deleted 6y ago[deleted]
- specialist 6y agoRepeating myself: I thought charging different customers different prices for the exact same thing was wrong. Somehow.
- cjhopman 6y agoWhy? Would it be wrong for a restaurant to provide meals for free to those in need?
- mattmcknight 6y agoProviding something for free is not exactly charging a price, but it is also not something they do. At least I seldom see a restaurant have people in need come into the restaurant and eat for free next to people that are paying. However, to bend your analogy to the current situation, you come into the restaurant, there is no menu, the chef decides what you need, you find out how much it cost weeks later, the price can vary 500% based on which "hunger insurance" plan you have selected. If the restaurant decides to give you the meal for free, they come up with the highest possible price for tax purposes.
- cjhopman 6y agoSure and an argument could be made that the specific things happening in this situation are wrong. That's not the argument that I replied to. I replied to a flippant argument that it is always wrong to charge different people different amounts. I just went to what I considered a clear counterexample, though it does have problems that it is rare (though local coffee shops and bakeries, for example, fairly regularly will provide things for free to those in need within the store exactly like they would for regular customers). Is it wrong for universities to provide financial aid to those in need? Would it be wrong for a city to provide subsidized public transportation? subsidized school lunches? You can come up with other harder to decide examples. A really good one would be whether it's wrong to charge tourists and locals different amounts. On the one side, this feels unfair to the tourists, why should they have to pay more? Generally, I lean to unfair things being wrong. But, the consequences of charging them the same are, to me, much worse, especially as the means of the two become further and further apart.
- SupriseAnxiety 6y agoI had to fail 4 medications WITH insurance and I had BCBS, to get my medication for free, thay was already free through the insurance, that just fucked me up even more mentally than I started.
- mattmcknight 6y agoPrice discrimination in healthcare is out of control. Simple addition to Medicare regulation that requires any provider (including Pharma resellers) to have a public price and not charge anyone more than they charge Medicare solves a lot of problems.
- Ididntdothis 6y agoPrice transparency and making extreme price discrimination illegal should be the first steps so people can discuss solutions based on hard data.
- jedberg 6y agoHah. When we did IVF, they had me sign up for that CVS plan. It was sold to me as an "insurance program" offered via CVS, and only good at CVS. It saved me many thousands of dollars, which I assume was charged to people who had insurance that covered IVF drugs (mine did not). I thought it was a pretty clever workaround on CVS's part.
- wronglebowski 6y agoDo you have any details on this? My wife and I are currently looking into IVF and the cost of the drugs alone is staggering.
- jedberg 6y agoI believe it was this: https://www.singlecare.com/prescription-discount-card/cvs https://www.singlecare.com/prescription-discount-card/cvs But it was literally the CVS pharmacist who had me sign up when I went in the first time. And yes, the cost of drugs are staggering. :( I was super jealous of my Canadian friends, who get one free baby with their national insurance. I was also jealous of my friend who works at Merck. They make a lot of the drugs, and provide them to their employees for free.
- vulcan01 6y ago> who get one free baby with their national insurance. I read that the wrong way the first time... ;)
- mattlondon 6y agoWhenever I visit the states and pop into CVS I am frequently amazed at the sticker prices on some of the dugs there. Things that literally cost pennies per tablet in the UK (generic hayfever tablets, pain killers etc) were absurd prices. 20USD for 7 hayfever tablets? 15 USD for 12 ibuprofen tablets? WTF?! Do not forget to get 12 hayfever tablets for £1.80 (~2USD) from a supermarket before your flight otherwise you'll need to spend 45USD (+tax) at the CVS a block from your hotel. Do you guys actually pay these prices for this stuff, or is it only forgetful travellers who fall for it and end up paying through the nose because they have no other choice? Surely you won't be claiming for pain killers for a headache etc on your health insurance? (...although at those prices maybe you should??!) It feels to me that is pretty criminal to charge those prices at retail - to inflate even more to insurers just seems pretty outrageous.
- jedberg 6y ago> Do you guys actually pay these prices for this stuff, or is it only forgetful travellers who fall for it and end up paying through the nose because they have no other choice? Usually you can get those cheaper in bulk, like at Costco, or at a pharmacy that your doctor works with, or you can get a discount by showing your insurance card. But yes, sometimes when desperate, we pay that much too. We also have these health savings plans where we get a debit card and can buy that stuff with pre-tax money, which is sort of like saving 10-40% depending on your tax bracket. But yes, it sucks. When I go to other countries I try to stock up. You have better prices and stuff that we can't get here.
- triceratops 6y ago> health savings plans where we get a debit card and can buy that stuff with pre-tax money, These are stupid, and I wish they'd die, for multiple reasons. First, the list of things that are allowed and not allowed is completely arbitrary and random. Feminine hygiene products are allowed, but baby formula isn't. Wtf why? And now someone's gotta maintain this list of items and enforce it (Wageworks et al), and process claims made manually. So now we've just added another actor in the whole system that can add their own profit margin on top. All so we can save a few bucks in paying taxes. Second, these aren't available to everyone (just like 401k plans, the other symbol of taxation inequality). It's a benefit that has to be offered by your employer, and there are plenty of shitty employers out there. The people who could most use a tax break on a $10 bottle of aspirin are the least likely to get it. Third, the use-it-or-lose-it nature of FSA money. And if you lose it, the money goes back to the employer. Again, wtf why? You're basically placing a wager against your expected healthcare expenses every year at open enrollment time. For really no clear benefit. Why can't the "debit card" work like a "credit card" instead, with payments made directly from your paycheck? There's no guessing involved, and no one ever over- or under-contributes.
- tosser0001 6y agoWhen I was between jobs I had about a 2 week period where I was technically without coverage, but the new company reimbursed me once I was on their plan. I went to fill a prescription for a very common generic drug that has been around for decades at the chain pharmacy I always use. I was expecting to pay the same price I generally did, about $3.00. I was shocked when they charged me $150.00. I can understand the pharmacy needing to charge a bit more to cover costs, but this seemed like highway robbery.
- Wowfunhappy 6y agoThe real question here isn't how much you generally pay, but how much insurance generally pays. It was almost certainly less than $150, but it isn't at all unusual for even generic drugs to cost insurance hundreds of dollars, even when you have only a small copay.
- deleted 6y ago[deleted]
- Animats 6y agoAs the number of pharmacy companies has declined, there's been a huge creep upwards in the price of generic drugs. Even for non-prescription drugs. Price is no longer even vaguely related to production cost. Look at the price of antacid tablets (which are chalk, calcium carbonate) and cranberry pills (a very cheap product.)
- creaghpatr 6y agoDevil's advocate on antacids, I knowingly and willingly pay a premium for Tums Extra Strength Smoothie Flavor.
- VMisTheWay 6y agoI've done price comparisons and CVS is hands down the worst price for anything. The only reason you go to CVS, is if you have 0 other options. While I blame the various medical cartels for making healthcare unaffordable by bribing (Lobbying) hundreds of millions of dollars to politicians- can the customer be blamed for negligence?
- tyingq 6y agoAs a former BCBS employer plan admin...the irony is thick.
- chrisjc 6y agoJust switched from CVS to Walgreens for this exact reason. They were charging the insurance (and us for the uncovered amount) full prices for generic versions. And let me just clarify, the prescription bottle had the generic version on the label, our receipt was for the non-generic! We complained to the CVS pharmacist about this and their response was brazen and they wouldn't budge even when we said we will escalate this to our insurance company. We did escalate it to our insurance company (not Blue Cross Blue Shield), but never heard anything more about it... perhaps more will sue in the weeks to come. Edit: This was in SoCal, not one of the states mentioned. Also, we weren't part of this plan that they talk about in the article.
- SeanDav 6y agoSeems like an obvious business model. Sell OTC drugs at fractions of current prices and still make a large profit... What is the catch?