4 ms·

Health insurance in the US sounds like such a scam. Is it not possible to pay for a psychiatrist directly or to renew prescriptions without seeing one?

wepple 2y ago
The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication
- olalonde 2y ago
  It's crazy that you can't get a prescription for under 379$. Something is seriously broken with that system. I'm pretty sure I could get one for 1/10 that price where I live, without insurance.
  - GuinansEyebrows 2y ago
    When I first moved to the Netherlands, I had to visit a pharmacy to purchase insulin. I was prepared to spend nearly half my paycheck on a months supply and deal with the headache of not having a prescription on file before I’d established insurance. I walked out the door with a box of Lantus pens having spent 80€. That would have cost me about $600 in the US at the time, if they’d even dispense to me without a prescription.
    - rafram 2y ago
      It only would’ve cost you $600 if you paid the list price, which no uninsured patient should ever have to do. GoodRx has a coupon that takes it down to $35 per 30-day supply - significantly cheaper than in the Netherlands - and any decent pharmacy should offer you their “store discount,” which will be about the same.
      - olalonde 2y ago
        Why is there a "list price" and an actual price? What's the point? Do pharmacies not compete with each other? Imagine if you went to a McDonald and the Big Mac was 300$ but it really was 10$ if you asked for a discount. So many questions...
        dghlsakjg 2y ago
        In the US, pharmacies absolutely compete, but the model is complex. They are delivering service to a party that is not always the one paying (Patient vs. Insurer). They can dispense the same drug from multiple suppliers with wildly different costs in some cases (Original vs. Generic). Most of their customers have some sort of coverage, so the coupons don't apply. The drug companies really hate when their are articles about people dying because they can't afford meds, so they have coupon programs for the uninsured, but keep the list price high since that is the starting point for negotiating with the insurers. Don't forget that doctors are completely disconnected with cost. They don't even know their own rates that will be charged to the patient in many cases, let alone what the cost of drugs are, and what portion of that the patient will end up paying. So on the patient side, the pharmacy will compete for patients with convenience, while the insurer will try to steer the patient to approved generic drugs and manufacturers with negotiated deals, while the drug companies are trying to steer the patient to the most expensive name brand drugs. Oh yeah, and then there are the unlucky minority that don't have insurance or have insurance that won't cover the drug they need, and they get a coupon. It is SUPER fucked. The answer is that there are at least four parties in any pharmacy transaction (Dr., Pharmacy, patient, drug maker, and sometimes insurer) that all have different incentives. Some that overlap, and some that are opposed.
        rafram 2y ago
        Four parties? Try five! Insurance means there’s a pharmacy benefit manager in the mix as well. Sometimes those are independent companies, but often they’re owned by either your insurer or your pharmacy (or some other big chain of pharmacies, e.g. CVS). That’s one more middleman and often one more conflict of interest in the mix.
NeuroCoder 2y ago
As far as psychiatric health goes, its highly variable. I have a friend that I talked to last night that is working with Medicaid to revamp how they bill this kind of stuff because a lot of it is rejected by insurance since it doesn't fit within a clearly covered area. Getting small areas or sustainable coverage established like this can sometimes be a path forward to broader adoption. But that's still pretty optimistic thinking
Trasmatta 2y ago
I'm paying $250 per week out of pocket for a therapist in NYC.
indrora 2y ago
on insurance, the number is $400/session. off insurance, the number is $1200/session. I can think of a lot better things to spend $14k a year on.
- olalonde 2y ago
  That is the equivalent of a multi million $ yearly income for the psychiatrist. That's insane. Why aren't there more people getting into this profession? In Turkey, you could have a private psychiatrist working for you full time for $14k...
  - reverius42 2y ago
    In the US, psychiatrists are medical doctors, the supply of which is (severely) limited by the number of spots in medical schools.

wepple 2y ago

The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication

olalonde 2y ago
It's crazy that you can't get a prescription for under 379$. Something is seriously broken with that system. I'm pretty sure I could get one for 1/10 that price where I live, without insurance.
- GuinansEyebrows 2y ago
  When I first moved to the Netherlands, I had to visit a pharmacy to purchase insulin. I was prepared to spend nearly half my paycheck on a months supply and deal with the headache of not having a prescription on file before I’d established insurance. I walked out the door with a box of Lantus pens having spent 80€. That would have cost me about $600 in the US at the time, if they’d even dispense to me without a prescription.
  - rafram 2y ago
    It only would’ve cost you $600 if you paid the list price, which no uninsured patient should ever have to do. GoodRx has a coupon that takes it down to $35 per 30-day supply - significantly cheaper than in the Netherlands - and any decent pharmacy should offer you their “store discount,” which will be about the same.
    - olalonde 2y ago
      Why is there a "list price" and an actual price? What's the point? Do pharmacies not compete with each other? Imagine if you went to a McDonald and the Big Mac was 300$ but it really was 10$ if you asked for a discount. So many questions...
      - dghlsakjg 2y ago
        In the US, pharmacies absolutely compete, but the model is complex. They are delivering service to a party that is not always the one paying (Patient vs. Insurer). They can dispense the same drug from multiple suppliers with wildly different costs in some cases (Original vs. Generic). Most of their customers have some sort of coverage, so the coupons don't apply. The drug companies really hate when their are articles about people dying because they can't afford meds, so they have coupon programs for the uninsured, but keep the list price high since that is the starting point for negotiating with the insurers. Don't forget that doctors are completely disconnected with cost. They don't even know their own rates that will be charged to the patient in many cases, let alone what the cost of drugs are, and what portion of that the patient will end up paying. So on the patient side, the pharmacy will compete for patients with convenience, while the insurer will try to steer the patient to approved generic drugs and manufacturers with negotiated deals, while the drug companies are trying to steer the patient to the most expensive name brand drugs. Oh yeah, and then there are the unlucky minority that don't have insurance or have insurance that won't cover the drug they need, and they get a coupon. It is SUPER fucked. The answer is that there are at least four parties in any pharmacy transaction (Dr., Pharmacy, patient, drug maker, and sometimes insurer) that all have different incentives. Some that overlap, and some that are opposed.
        rafram 2y ago
        Four parties? Try five! Insurance means there’s a pharmacy benefit manager in the mix as well. Sometimes those are independent companies, but often they’re owned by either your insurer or your pharmacy (or some other big chain of pharmacies, e.g. CVS). That’s one more middleman and often one more conflict of interest in the mix.

NeuroCoder 2y ago

As far as psychiatric health goes, its highly variable. I have a friend that I talked to last night that is working with Medicaid to revamp how they bill this kind of stuff because a lot of it is rejected by insurance since it doesn't fit within a clearly covered area. Getting small areas or sustainable coverage established like this can sometimes be a path forward to broader adoption. But that's still pretty optimistic thinking

Trasmatta 2y ago

I'm paying $250 per week out of pocket for a therapist in NYC.

indrora 2y ago

on insurance, the number is $400/session. off insurance, the number is $1200/session. I can think of a lot better things to spend $14k a year on.

olalonde 2y ago
That is the equivalent of a multi million $ yearly income for the psychiatrist. That's insane. Why aren't there more people getting into this profession? In Turkey, you could have a private psychiatrist working for you full time for $14k...
- reverius42 2y ago
  In the US, psychiatrists are medical doctors, the supply of which is (severely) limited by the number of spots in medical schools.