4 ms·
If the doctor prescribed it, it shouldn’t be the insurance company’s decision to deny it. That’s how it works in most countries. Too bad it’s expensive, but th
by maronato 2y ago
If the doctor prescribed it, it shouldn’t be the insurance company’s decision to deny it. That’s how it works in most countries.
Too bad it’s expensive, but that’s why people pay a lot more than $60/yr for insurance.
- mgraczyk 2y agoNo, that's not how it works. Which countries work that way? Where can a doctor prescribe untested drugs and have it paid for?
- maronato 2y agoI’m not sure about any countries that allow untested drugs or treatments for conditions not covered by the insurance company. I’m saying that in many countries, like Brazil, an insurance company can’t deny a treatment for a covered condition because it’s too expensive. So, for example, if the insurance covers prostate cancer, the doctor can prescribe any medically proven prostate cancer treatment and the insurance company can’t say they’ll only pay for a cheaper treatment.
- mgraczyk 2y agoRight but that's not what happened in this case. In this case it wasn't "medically proven" in the right sense. I'm not an expert on Brazil but from what I just read these specific drugs would not be covered
- alp1n3_eth 2y agoThe US, Canada, England, and most of Europe are beginning to embrace the use of dual biologics in Crohns disease. The FDA approved levels of a singular biological may have issues reigning in out-of-control cases of severe Crohns, and there have been tons of trials run in multiple university hospitals over the last 10 years showing that the dual biological combo can help in those instances. That's exactly why his doctor wanted to do it, because it had worked in the past. This wasn't some insane lab experiment done by a fresh grad gastro doctor.
- peitho_pls 2y agoI'm genuinely curious, what countries work this way? I've never heard of it, every system has some form of rationing as far as I know.
- maronato 2y agoIn Brazil, where I’m from, insurance companies can’t just deny medically proven treatments to covered conditions because they are expensive. For example, my father in-law had prostate cancer. His health insurance covers prostate cancer, so the doctor was able to prescribe any medically proven treatment he had access to. The first treatment they tried was the one with highest percentage of success, and then changed it to other treatments depending on how the cancer responded. Cost was never brought up, and they never heard complaints from the insurance company. Lots of insurances accessible to middle class families also cover in-testing treatments that have shown success in other countries, if the patient matches conditions for the trial and other approved treatments didn’t work.