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When he was diagnosed with two autoimmune diseases, Joel Hechler knew he’d be in for a battle. He didn’t realize maybe his toughest one would be with his insurance company.“I think they put the dollars ahead of a patient’s health,” Hechler said. “I don’t think they fully understand the impact the medicine will have on my long-term health and well-being."Hechler suffers from Crohn’s disease and ulcerative colitis, diseases that attack the lining of his digestive tract. Autoimmune conditions like his can’t be cured but, with the right medication, the symptoms can be controlled. Finding the right medicine can be hard for those suffering from autoimmune diseases. Even if there are scores of drugs on the market, some patients might only respond to one. In Joel’s case, his doctor thought he’d have a better chance trying a drug called Remicade.“I received a letter from my insurance company that denied the Remicade on the basis that I have to try a different drug before I can get to Remicade," Hechler said.Hechler's insurance company, Premera Blue Cross, wouldn’t approve the drug his doctor prescribed because they wanted him to try a cheaper one first.It’s part of a program that health insurers nationwide use called step therapy, requiring that patients try less-costly drugs before “stepping up” to more expensive ones — even if doctors believes the cheaper drug won’t work.Dr. Larry Adler is president of Huron Gastro in Ypsilanti, Michigan and says he spends virtually every day battling insurance companies over step therapy drugs.“They have to fail this medicine first before they get the new drug,” Adler said. “That doesn’t make any sense.”Adler says it's common for patients to get sicker while waiting for step therapy to run its course.In Hechler's case, it took six weeks of fighting with his insurer to convince them that the cheaper drug wouldn’t be effective. As he was waiting, he was getting worse.“It got to the point where I had to be admitted to the hospital,” Hechler said. "I was very, very sick.”Step therapies are used by insurers to try to control skyrocketing prescription medicine costs, says Glen Perry, Director of Pharmacy Contracting and Sales for Blue Cross Blue Shield of Michigan.“These drugs can cost up to 0,000 per year. These are not cheap medications,” Perry said.“It seems like you’re telling patients that, in many cases, your insurer knows what’s best for you, rather than your doctor,” Jones said.“We are trying to provide the most cost effective and safe medication use,” Perry said, adding that when a doctor and insurer disagree over a drug, they can usually resolve the case within a few days without putting a patient at serious risk.“A delay of one or two days I don’t think is really going to make that much of a difference for the medical outcome of the patient," he said.But for many patients, like Phyllis Toole, the delay is longer than a few days.Phyllis suffers from rheumatoid arthritis, a condition where her body attacks her joints. When her doctor wanted to put her on Orencia, her insurance company HAP said she needed to first try a less expensive drug, Humira.But Phyllis’ doctor was worried about possible side effects and thought Humira could be risky.After battling for months, Phyllis says the whole thing made her feel more like a number than a patient. With her doctor and insurer in a standoff, she was forced to rely on samples of the drug she got from her doctor. HAP never approved her prescription.“They’re playing doctor, is what it feels like,” Toole said. “They’re saying this is what you can have for the symptoms you have. It may make you sicker, but this is what you can have.”HAP issued the following statement to Scripps station WXYZ in Detroit: 3800
While travel advice abounds for the best times to buy the most affordable holiday plane tickets, flying during some of the year's busiest travel periods generally isn't cheap.In this era of packed airplanes, smaller seats and fees for extra leg room, what airline is going to offer inexpensive fares around Thanksgiving, Hanukkah, Christmas and New Year's? Common business sense dictates that high prices will follow high demand.What are procrastinating travelers to do besides drive or take the train to get to their destinations? CNN checked with airfare experts for some general advice and ways to dull the price pain: 644

When professional team sports resume later this month, a number of MLB and NBA players have decided not to return to action.Over the weekend, pitchers Felix Hernandez and David Price became the latest MLB players top opt out for this year’s baseball season, which is slated to begin within three weeks.Hernandez said,” Never before has an entire MLB season depended so much on everyone in the league’s involvement. Let’s be responsible and keep each other safe. It’s not just for us, but for the game and our own families.”Price also cited concerns about his family on why he opted to sit out the 2020 season.“After considerable thought and discussion with my family and the Dodgers, I have decided it is in the best interest of my health and my family’s health for me to not play this season,” he said.Other professional athletes have expressed concern over the return to sports. Angels star Mike Trout has been seen wearing a mask during on-field workouts.MLS goalkeeper Matt Lampson said athletes aren’t as invincible to the coronavirus as it appears.“For everyone in the ‘These are pro athletes. There is no risk. Nothing happens to them if they get the virus camp - I am high risk,” Lampon tweeted. “And I know for a fact there are multiple others at MLS is Back that are as well - including other players on their way here. This is serious.”Other MLB players confirmed to not participate in the upcoming season include Ian Desmond, Ryan Zimmerman, Joe Ross and Nick Markakis.NBA players who have opted out include Victor Oladipo and DeAndre Jordan. With the MLB, NHL and NBA all scheduled to begin within the next four weeks, the leagues will be heavily relying on frequent COVID-19 testing in order to prevent spreading the virus to other players. 1762
When Dr. Harold Bornstein described in hyperbolic prose then-candidate Donald Trump's health in 2015, the language he used was eerily similar to the style preferred by his patient.It turns out the patient himself wrote it, according to Bornstein."He dictated that whole letter. I didn't write that letter," Bornstein told CNN on Tuesday. "I just made it up as I went along." 382
White House looking at stricter travel banThe Trump administration is considering a new travel ban to replace its original executive order, which has had its legality questioned and is up for a Supreme Court hearing next month, White House national security adviser H.R. McMaster said Sunday.READ MORE 315
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