THANK GOD for PRIVATE HEALTH INSURANCE

[True Federalist (진정한 연방 주의자)]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

What BC/BS obviously tried to do was keep me on the cheaper Proventil, despite it being ineffective, just because it was cheaper.

Let's see here.  The entity actually paying the bill wants proof the doctor had determined that a much cheaper medication was ineffective instead of simply being swayed by a pretty ex-cheerleader salesrep to start prescribing it with no idea of the cost.  Sadly, far too many doctors are clueless about prescription costs.  I don't see the problem, especially at a difference of $244/month. ($2,928/year)  Frankly, that's the sort of hoop an insurance program, whether private or public, should make doctors go through.

If you don't want a third party having any say concerning the medical decisions of you and your doctor, pay the damn medical bills yourself!

Plus there is the fact that you changed from one class of asthma drugs to another.  You went from using a β₂-agonist to a combination β₂-agonist / glucocorticoid, so it wasn't as simple as simply trying a different medication to produce the same effects.

[True Federalist (진정한 연방 주의자)]

Please, for the love of god, stop pretending to be an independent.

Let's see:  In the past decade I've voted for Republicans, Democrats, Libertarians, and a Socialist.  So which party is it I'm a member of?  (And don't invoke love of god in trying to force me into a party.  There's no way I'd ever vote for the Constitution Party.)

BTW, as far as health insurance is concerned, I'm in favor of something like the system the Dutch have.

[True Federalist (진정한 연방 주의자)]

My point with the second sentence is that I don't think the government insurance would give a damn about whether or not my asthma med cost $289 or $45.  They'd pay for whatever the doctor prescribed me.

What BC/BS obviously tried to do was keep me on the cheaper Proventil, despite it being ineffective, just because it was cheaper.

Plus there is the fact that you changed from one class of asthma drugs to another.  You went from using a β₂-agonist to a combination β₂-agonist / glucocorticoid, so it wasn't as simple as simply trying a different medication to produce the same effects.

But it was producing the same effects. The budesonide (glucocorticoid) reduces inflammation which helps alleviate the symptoms of asthma and it works in conjunction with the sympathomimetic formoterol, which is a bronchiodilator. This combination of drugs has the same effect as albuterol (proventil) so I don't see anything wrong with the doctor prescribing it. It's not as if he was being switched to a BP drug or anything like that. The doctor was just seeing if reducing inflammation in conjunction with stimulating the SNS would produce a more desired effect than the sympathomimetic alone.

Similar effects, but not the same effects.  Keep in mind that in medical billing they go to some seemingly absurd lengths at times to specify conditions.  There are some 14 different diagnosis codes that apply to asthma under ICD-9, which is the system most U.S. doctors and insurers use to communicate with each other.

I don't know the specifics, but it is entirely possible that for him that the insurance company had in their files on him a prior diagnosis code from the doctor for which a combination medicine is not indicated as bring more effective than a bronchodilator alone and thus were refusing to pay for the combination product.  Since his medicine had been working, but was ceasing to work as desired, it is possible that his diagnosis code changed to one for which a combination inhaler was appropriate, but the doctor's office failed to get that code to the insurance company in a timely fashion.

I'm not disputing that he suffered from a bureaucratic failure, but in this case I don't see a problem with the bureaucratic system he was dealing with per se, just its implementation.  His reaction would be as if in light of FEMA's failures during Katrina, the proposed solution was to eliminate FEMA.