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Old 03-09-2014, 07:28 PM
pjohns pjohns is offline
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Default Re: Yes, there WILL be rationing

Originally Posted by saltwn View Post your insurance will not pay if your doctor would like say an extra MRI than what is recommended.
"[R]ecommended" by whom?

If that additional MRI is something that is widely accepted practice in the American medical community, my healthcare insurance does, indeed, pay toward it.

Originally Posted by saltwn View Post
Sometimes [the problem is] a drug that is not in their formulary. Your doc is probably pretty up on what he can prescribe and get paid for and what he cannot.
For the record, I should probably point out that my primary-care physician is a she. But that is a minor error. And certainly an understandable one.

There is, indeed, a formulary attendant to my healthcare insurance; it contains five tiers of prescription drugs.

But the doctor does not get paid for my purchase of any drug, from any of these tiers. It is the pharmacy with which I am dealing that gets paid. And it gets paid more if the drug is in one of the upper tiers.

Ultimately, the insurance will pay toward any drug that is not merely experimental. But it will pay much less toward some drugs than toward others.
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