Last week I went to the dermatologist for one of those full body scans for skin cancer. I was given a clean bill of health and a prescription for something to clear up a condition I’ve had for years but only bothers me occasionally. This also required a blood test that I took and passed. Wanting to be a good, knowledgeable patient I looked up the drug in the formulary my insurance company sent me and it said I needed pre-approval. I called them; they gave me an 800 number to give to the doctor to call. I called the Dr’s office this morning and was told I should go ahead and submit the prescription to the pharmacy where it would be denied, and then the doctor could go ahead and fight the insurance company. This could take two or three days and I should call the office again if I don’t hear from them in that time. I’m glad this isn’t an emergency, but what if it was?
This is the kind of thing that makes me wonder how our healthcare system functions, at all. My time making all those calls doesn’t count, after all, I’m retired. But what about the pharmacist, the doctor’s office, and the insurance company? Surely this cannot be cost effective. This is why doctors need such large support staffs. They aren’t there for you; they are there to deal with the nonsensical rules set up by the insurance companies.
This is a nasty game that puts your life in the control of an insurance clerk following rules set up by a high priced accountant.
I began working on this post on July 10, inspired by a post on Wintersong, written more beautifully and coherently than anything I produce. Today is July 16 and I haven’t heard from either the doctor or the pharmacy. I’m certainly glad my life doesn’t depend on this medication.
Critics of single-payer universal healthcare call it socialism and say it is not compatible with the capitalist system. I think the system we have in place now is a form of totalitarianism. I have no control over my healthcare, and worse yet, my doctor seems to have little or no control over my healthcare. Someone is certainly making money out of all of this, but I’m sure it’s not my doctor or any other health provider.
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Oh I getcha! (Thanks for the link to Wintersong!) Here’s my latest story: having switched to Medicare and part D with Secure Horizons as of May 1, last week was my first re-order of my routine Rx since the change. Got a call from the mail pharmacy telling me the folic acid required pre-authorization. Went through the same routine you were told to follow. Dr. called yesterday to say the request was denied because they viewed folic acid as a vitamin supplement. Actually in my case it is required at 1mm to counteract possible side effects (sores in mouth and throat) of the methetrexate (the cancer drug) that I take along with the Enbrel for my reumatoid arthritis. Dr. argued with them but to no avail. Btw, folic acid is available over the counter but at much smaller doses so that I’d have to buy numerous bottles and take numerous tablets each day rather than the one that the Rx strength gives me. My Rx at the local pharmacy will cost me $11.20 for 30 days–not a lot but it still galls me that Secure Horizons think they know better than the doctor. Grrrrrrrrrrrrr!
Oh and did you hear the stories that the costs to administer Medicare are 12% higher than if the government simply acted without the middleman? Double Grrrrrrrrrrrr! We all need to complain, Ruthe, and I’m so glad you wrote this post.
Good comments..and good follow up from where I left off when we stopped at the drug store.