• Best in the world? Hah!

    OK.  I spent two weeks being civil and fair.  Not today.  Today I’m pissed off.

    Readers of my old blog may remember the trouble I’ve had getting medications in the past.  But for those of you new to the issue, here’s a recap:

    I have a chronic illness.  I do not have this illness because of anything I did.  There is no way I could have prevented it.  I eat right and I exercise.  I don’t smoke, I don’t do drugs, and I don’t abuse alcohol.

    I work hard; I have health insurance.  I pay for the premiums.  I pay all the co-pays.  I follow the rules.

    For my illness, I take medication.  This medication is serious, with bad potential side effects, and it is not something you would want to take.  But, since I want to be well, I take it.

    The last time I lost my mind about this was because my insurance company, in their infinite wisdom, changed my pharmacy to a specialty one (which they own) and didn’t tell me.  That meant that when I called in to refill my meds, it became a massive clusterf*** when it was Friday of a holiday weekend and they needed to talk to my doctor and OH MY GOD, please don’t make me relive it.  Just go read this.

    *Deep breath*

    A week ago, I called my new pharmacy (which has changed names AGAIN) and ordered a refill.  I had my labs drawn so there would be no problems with my doctor authorizing it.  They asked how much medication I had left, and I told them up until today.  They said they would schedule delivery for Nov 1.

    I remarked that would be cutting it close, but they said they don’t like to deliver early and that it would be here today.

    About 30 minutes ago, I received an email from my wife.  It appears there is a message on the home voice mail saying that there is a problem with the prescription.  I should call them.

    Did they leave any details?  No.

    Did they leave me a number to call them?  No.  They said I should just call the number on the medication bottle.

    Do I have the bottle with me?  NO.  I don’t carry my once a day medication on me at all times.  I leave it in the medicine cabinet.

    So what am I supposed to do?  If I wait until I get home to see the number, they will be closed.  And, of course, I have no more medication.

    Luckily I managed to get a hold of my wife and she gave me the number.  And I called them.

    You ready for this?  They didn’t ship the medication.  Why?  It’s on back-order.

    So explain this to me, awesome insurance system.  You will only allow me to get my medication from one pharmacy, which is not local, and which you own and run.  And you won’t send the medication early, which would provide a safe buffer.  And then you run out of the medication.  And then you don’t tell me until the day I run out.  And then you don’t really tell me, you leave me a cryptic message on my voice mail that I would usually not be able to get until I arrive home and you are closed.

    Will you allow me to go to another pharmacy?  Sure.  But you won’t cover it.  Will you have the medication soon?  Yeah, you hope to have it tomorrow.

    I don’t believe you.

    Do you have any concern – whatsoever – that I am without my medication for a period of time?  That it’s entirely your fault?

    I’m a model patient.  I pay all my bills.  I go to the doctor.  I get the labs done.  I refill the meds on time with a weeks’ advance.  I follow the rules.  And you screw me.

    I understand the health care system better than almost anyone I know.  And this happens to me.  What do you imagine happens to everyone else?

    Best in the world my ass.  What am I paying for again?

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    • I am a pediatrician and spend my lunch hour and free time inbetween patients (and my nurses spend a lot of time during their day as well) trying to get insurance companies to #1 pay for medications that I Rx, #2 getting them to cover PT/ST/OT and #3 pay for procedures that I’ve ordered or subspecialists I have referred my patients to (and I have a full time person in each office who does this #3)….the people making the decisions on this, are usually high school graduates (and if i’m lucky a nurse who hasn’t nursed in several years)…after I or my staff has spent 15min in a phone cue to get to a live person…very very frustrating and a giant waste of my time. I feel your pain and hope you eventually get your meds :-p

    • Ouch. Your anger is well-founded. I hope you can find a way to work things out (and by work things out, I mean “get your meds on time and sue the insurance company for $15 jillion”.

    • I’d tell the insurance company you’re going to go get it at your old pharmacy; or any damn pharmacy you want; and they’re either paying or reimbursing.

      In fact, I would tell them that you aren’t going to even go through the trouble of locating it. Have them call around and find a pharmacy that has it. Set up the auth, call you back, and tell you where to pick it up.

      Advise them you’ll take your complaint to the state attorney general’s office if not. the AG’s office tends to get more respect and can get more done than going through the HMO’s grievance/complaint process.

    • This probably sounds like bragging but it isn’t meant to be…The Canadian version of the above:

      I take medication for high blood pressure (which I’ve recently started to bring under control primarily through diet) and medication for roseacea. The costs are about $300 for a 100 day supply. I go to whatever pharmacy happens to be convenient, which is usually the 24 hour store a few blocks from home. The prescriptions allow 1 refill. Therefore each prescription lasts 6 or 7 months.

      While the government health care coverage does NOT cover the drug costs, my employer based “extended health care” covers 100%. For beneficial tax liability reasons, my employer’s contribution is 0%/$0.00 and my contribution is 100%/$15.10 every 2 weeks. (Because I pay the premiums there is no tax liability on the benefits. If the employer pays some or all of the premium, the benefits may be considered taxable.)

      A couple of months ago I phoned my doctor’s office for an appointment to get my 6 month check-up, which primarily consists of checking my blood pressure and a pep-talk on my weight (also down about 9kg/20lbs in the last 7 weeks!:) However she had just left for vacation for a couple of weeks. And by the time she would be back, *I* would be on vacation (and out of the country) for a week. So I just went to my regular pharmacist/pharmacy and explained the situation. The pharmist issued her own prescription for a 20-day “emergency supply.”

      And then I went home.

    • You live in Indiana and your insurance company owns the specialty pharmacy? I’m afraid I have the same insurance. That’s just one more reason for me to hope I never develop a chronic condition.

    • Ouch! Hope you get this straightened out. I think you illustrate very well the powerlessness we,, even doctors, have when it comes time to deal with insurance companies. That MLR of just 75% is needed so you can get better service? Ha!

      One area that academics tend to just touch upon is the huge amount of time US citizens spend in dealing with the hassles of our system. We pay a huge cost in time, on top of that 17% of GDP. Libertarian Matt Welch alluded to this in an article on why he preferred French Health care. I think that if we ever decide to more drastically redo our system, I hope, it could succeed if it was marketed as saving time and no more having to deal with insurance companies.

      Steve

    • Would I be correct in assuming your carrier is Anthem?

    • Aaron,

      The comprehensive picture is even more problematic than you suggest. Health care needs a social revolution on the order of the one that freed the slaves or granted women the right to vote. This revolution will make it unacceptable for the health care system to treat people [patients] as second-class citizens whose intelligence, values, priorities, and needs can be safely ignored.

      Today, an observer might conclude that the purpose of health care is “to deliver tests and treatments.” That focus needs to change so that the purpose of health care becomes “to enable people to lead the lives they want.”

      That shift would change everything — from research to care delivery.

      The writer is President & CEO of Pario Health Institute and the author of Killer Cure: Why health care is the second leading cause of death in America and how to ensure that it’s not yours.

    • It’s a “free market” and the only way that work is if the consumer has information. If you are pissed name the insurance company and yell as loud as you can (e.g. blog, facebook, and anywhere else you can think of) not to mention your HR department. The only language these companies hear is $$$ and they may listen if your HR department speaks.