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Insurance Companies Rule the World … or Want to
First, it was the prescriptions:
A few years ago it seems that insurance companies decided that they will determine when you can get your prescriptions filled. I would go to the pharmacy and ask for a prescription to be refilled and they would inform me that I cannot have it filled for so many days. Why not? My health insurance company says so. Really? My doctor and I cannot decide?
Now I might understand it if my insurance covered prescriptions and paid for them, but they do not. Nevertheless, they do give me discounts on them so they tell me how often I can fill them. It can be very frustrating though. I thought maybe if I went to my doctor and got all new prescriptions and let the old ones expire I could get them all filled at once. No dice. I still have to wait. They have to base when I get them on my old prescription. Now since I pay out of pocket I should be able to get them when I want. (I am not talking about any narcotics.) There is no reason that I should not be able to do so. What if I was going out of the country for a while and needed extra to take with me?
What has happened to me as a result of all this is somehow my prescriptions are filled at different times. So, instead of being able to fill all four at once, I have to go at different times for different ones. I am not even sure how that has happened. I can’t seem to get to the point where I get them all at once because I am always going to run out of some if I wait for the time the others can be filled.
I guess the good news is that my pharmacist texts me when I can fill one of them, and they will even call the doctor’s office if I have run out of refills. But it still is not in my control. It is out of my hands.
Now it is my regular doctor visits:
I am not going to say that my insurance company is deciding when I can go to the doctor, but they are trying. I got a phone call a few weeks ago from my insurer. Some nice lady on the phone told me that they want to set up an appointment for me to see a doctor for a checkup. (I had an appointment this last summer and I have another one scheduled for this winter already.) I asked her what she was talking about. She said that they have a Case Manager assigned to me who will handle my health care appointments.
Can you believe it? A Case Manager. I do not need a Case Manager because I am an adult who can handle his own health care needs – including doctor visits, tests, or anything else. I explained this very carefully. I also explained that I take medical advice from my doctor and not my insurance company. If I have an insurance question, I will talk to my insurance company or agent. I am not interested in taking medical advice or help from my insurance company. They are experts at insurance, not health care. Likewise, I do not take insurance advice from my doctor.
This incident reminded me of the time when I was doing taxes in a CPA office. Some of our clients would come in with some strange ideas about taxes. One said that she did not need to pay taxes because she was 80 years old, and once you reach that age, you do not have to pay income taxes anymore. Where did she get this idea? From Hardees. What I mean is that she would go to Hardees and talk to her friends and they are the ones who told her this. I said that she should get her hamburgers from Hardees, but tax advice from her accountant.
I have as much confidence in an insurance company handling my health care as I do the local Hardees giving me tax advice. I do not care that my insurance company hires medical people to help them with this. They want to take complete control of my health care. That is not what insurance companies are for. I am not letting them “handle” my health. Their agenda is to save money. My doctor’s agenda is to keep me healthy by personally knowing me and interacting with me regarding my medical condition. Her advice is based on that. That is the way it has been, and it needs to stay that way. I do not want some case manager who follows a script and perhaps reads a medical chart, but who has never examined a patient in his or her life, telling me what I ought to do.
Insurance companies want to control the whole healthcare system. I understand their incentive. They want to control costs. And I am glad that they are doing that. But that does not mean that they should tell me when to go to the doctor. And they should not waste money assigning “Case Managers” to anyone. If an adult is not capable of making medical decisions, that responsibility can be legally delegated to someone who knows them and their needs.
If I want medical advice from unqualified people, I will go to Hardees.
Published in Healthcare
Because of insurance issues on some prescriptions, we have found that paying directly instead of using insurance means a lower out-of-pocket cost. Amazing.
I can’t imagine being a medical professional now. When I see my Doctor, sometimes she feels like a particular test is needed. She then spends more time looking up a code and justification which will be accepted by the insurance company. In general, she spends more time on the terminal than directly with me.
I started on a Medicare Advantage plan 18 months ago when I turned 65. Every few months a “health care management” outfit that I think was hired by the insurance company running the Medicare Advantage plan telephones. I’ve only talked to them once, as I learned during that conversation that they were trying to get me to sign up for all sorts of “benefits” to which I was entitled under my plan, but which would provide them with a very high level of control over my care. In their defense, a lot of their Medicare Advantage customers are probably much older than I am and may have trouble keeping track of their care. But at my current age and in my current state of health I did not want to cede that much control over my medical care.
For most of my adult life, I have paid for my prescriptions out of pocket, with no insurance involvement. I discussed this with the pharmacy at Costco, where I get all my prescriptions filled, and they agreed to never bill my insurance. All of the medicines I take are generic, and while I was working I could more than afford to pay for them. My doctor would write in multiples of 100, which makes it easier for the pharmacy to fill, since most pills come in 100-tablet bottles.
A couple of years ago, my maintenance arthritis medicine more than doubled in price. This also coincided with my forced retirement, and my going on Medicare. So my income went way down, and out-of-pocket payments skyrocketed. Reluctantly, I have been using my Medicare drug plan since then. I am not able any longer to have my doctor write for larger quantities, and the PBM who my insurance uses, dictates when I can have my refills. This has also coincided with shortages of my medicine, which has me anxious about running out, like never before. I hate this state of affairs, but there’s next to nothing I can do about it now.
I got a letter from my insurance company this past week that said I can no longer buy my prescriptions at the chain two blocks from my house but can from chains completely inconvenient to me. They are trying to force me to use an online service. I don’t mind that so much, but I have the same problem you mention of never being able to stay in synch. I only use the local pharmacy to buffer my supply. Why want they just change the reimbursement amount instead of banning me?
I’m only allowed something like a 20 minute appointment with my doctor. I ask if I can just make two appointments back to back, but of course, that’s not allowed. I have to come back another day which is another huge waste of time. I’m sick of the rules that make me waste my time which don’t even make sense. They’re just trying to squeeze blood out of a turnip because the system is dying.
@DougWatt wrote a post recently where he mentioned that which police officers a department hires is in part determined by insurance too. If it costs too much to have a particular cop driving a patrol car then I guess we’re going to go with the next candidate on the list.
I heard another example on a podcast of insurance ruling the world (or aspiring to) but I don’t recall the example or the podcasts so that doesn’t do me (or you) all that much good, now does it?
Most doctors today, in general practice, operate as dictated by government and insurance companies. Not much better than the person you place your order with at Hardees. Just following instructions. You don’t like that, huh?
What we saw during the Covid Pandemic was an eye-opener.
Ever since these companies started paying for routine visits and day-to-day care, they haven’t been insurance companies. They became healthcare companies, and this behavior of theirs is entirely predictable and natural. If you don’t like it, lobby to get rid of direct payments from “insurers” to providers. Pay your own bills, and settle up with your insurer yourself.
I ran into a similar problem today. Express Scripts wants to penalize me for filling at my local CVS instead of using the mail order pharmacy and getting a 90 day supply.
Do you not have the option of paying for your prescription yourself?
Does she not have the option of refusing all insurance?
When I went off of insurance I asked Express Scripts if they’d let me pay for the pills myself. Nope; they wouldn’t sell them without an insurance company involved in the mix somewhere. When I went back on insurance they suggested I deal with Express Scripts. Yeah, learned my lesson on that one.
Pharmacy Benefit Management companies like ExpressScripts work solely with insurance companies. The patient is not their customer, the insurance companies are.
See, if they had explained that to me at the outset I wouldn’t have had the illusion that I was their customer, and neither would they.
My current “medical provider” is part of a large company which bought out my old (literally) doctor before his retirement. I think she is constrained by what “large company” policies are and it seems that – at least with Covid – their policies were set by CDC/ Fauci. I don’t seem to be very involved.
We get calls every few weeks trying to get us to allow a nurse employed by the Medicare Advantage plan to do a “house call”. A little research revealed that the purpose of the house call is to find some elevated risk (real or imagined, I would assume) so that they can re-categorize us into a more profitable Medicare class.
So we never reply to those voicemails.
Yep, Express Scripts. Can’t go to Fred Meyer (Kroger), but can still go to Rite-Aid and Walgreens for some reason.
I have blocked their number after telling them repeatedly we don’t need nor are interested in having such a “benefit”.