Tuesday, December 05, 2006

Insurance Nonsense

After a month of taking Concerta (this first month of which was free, and therefore no insurance involved), my psychiatrist and I agreed that the dose I was at seemed to work better than other treatments (Straterra and Adderall).

My doctor wrote me a prescription and I dropped it off, hoping to pick it up later in the day.

Easy enough, right?

I guess not, because about an hour later the pharmacy called me, indicating that Concerta was denied by my insurance, needing "prior authorization" in order to be filled.

Okay... No problem. I'll just contact the doctor and have him phone in this authorization, right?


I called and left a message for the doctor. Also, the pharmacy faxed a form that he needed to fill out. Later in the day the doctor contacted my insurance company and the proceeded to ask him a number of questions.

Now, let's me clear: I side with the doctor on this. He has explained to me what insurance companies often do. A company doesn't want to fill a prescription because it costs money, so they put restrictions on it, trying to make it difficult to get. Then, when the doctor calls to authorize the prescription (the fact that HE wrote the prescription is not enough), they ask him harassing questions, assuming that he, a psychiatrist, is making a poor diagnosis.

That said, I'm not surprised by what happened: My doctor, feeling harassed, lost his temper. At question 8 of 10 he yelled, "This questions are outrageous. I'm going to report your to the board."

I don't know what the questions are and I don't know anything about this "board." All I know is this:

1. I pay high insurance premiums to Caremark.
2. I paid for the visits to my psychiatrist.
3. Neither my psychiatrist nor my insurance company seem to be acting in a manner that is beneficial to me, the patient.

So with my insurance company making unreasonable demands and my doctor angry with my insruance company, I am in an odd position, and uncertain of how to proceed. It's no wonder so many Americans are cynical about the state of health care in America. This is downright absurd.

What would you do?


David said...

matt, i guess I got off easy, a trip to the Dr. Office, a short discussion with a PA ( physiciams assistant) and he wrote me a scrip for Wellbutrin SR
300 mg a day and I am good to go
Dr visit $40.00 cash
Pharmacy $ 86.00 Cash
being sane - - Priceless!

Snaggle Tooth said...

The only eyedrops that stopped my allergy reacting eyes from burning (free Sample) weren't Insurance approved or covered rx either, $250 0.2 oz. The one they allowed, $125, only had a minimal, not curing effect. Now I do OTC. Better than none... I guess!

I have a co-worker who has to pay 90 bux + Insurance premiums + co-pay for 2 months of needed meds to stave off his major aggrivations. Usually, he doesn't get the meds cause he doesn't have the cash!

Me, I just wish I had insurance n the bux to go back to the Doc, it's been 3 years...

Really, that's alot of med bux, all around!!