Your patient recently had an extensive work-up (as an inpatient, no less) for her migraines. I wasn't involved in it, but it looks like she was in the hospital for 5 days, and had several MRI's, a spinal tap, and a bunch of other tests. I'm sure her bill was pretty damn high.
She came to see me yesterday for her headaches. She doesn't want any more tests, and doesn't want to go to ER, either. So it sounds like she's trying to save you guys some dough, too, at this point.
So it was really a surprise to find that you bozos refused to authorize my prescription for a CHEAP FUCKING GENERIC drug (which according to drugstore.com is priced at 11 cents a pill) to help her feel better, and stay out of the ER. Instead, you told me it was "experimental" (although it's been a standard treatment for over 20 years) and faxed me 5 pages of forms overnight to get it authorized.
You guys can eat my shorts. I prescribed a drug that's $1.25/pill, now, and you bozos actually cleared it. Way to save some money there.
Wait'll your CEO finds out how this is gonna impact his bonus this year. He won't be happy.
not surprised.
ReplyDeleteIs this why my insurance costs so much? :(
ReplyDeleteThis brings up an important point that I haven't seen discussed. The relationship between MDs and insurance companies has become so poisonous and hostile that many docs have NO interest in saving money for the insurers.
ReplyDeleteI used to open my office on the day after Thanksgiving. Everyone else was closed and I usually saw at least 20 patients. I asked each insurance company I contract with to include a weekend/holiday surchage in my payments (an established CPT code) to help cover the added expenses on bringing in staff. They ALL refused; now I send everyone who calls that day to the ER, where they get a thousand dollar work-up for something I could treat for $75.
I tried to save them money in this case. They didn't want me to.
ReplyDeleteThat is because the refusal was done by a computer program run by a non-physician. An appeal would work but that is a pain in the ass. Honestly, a little "public option" competition might get these backwards companies on track with being efficient and up to date.
ReplyDeletewhy did she need an inpatient admission for migraine in the first place, why did she need several MRIs, let alone 1 MRI, and why a tap? Was there anything in her history or physical that justified that boondoggle?
ReplyDeleteverification word: trepti, remarkably close to triptan.
Anon- good question. But I wasn't the doc on the scene.
ReplyDeleteThis sort of happened to me this year on a generic drug I'd been taking... for 3 years.
ReplyDeleteThe pharmacist said I could have it for full price. I said no and that I'd call the insurance company to get it straightened out. Then I grabbed a bottle of wine and came back to the pick up window to pay for it. They said I could pay for alcohol at the pharmacy to which I replied, "Yeah, but this an over-the-counter drug to hold me over till I could get my real meds."
But, we are going to cut health-care costs--sure we are. And, my kids just cleaned the house and did the laundry because they wanted to.
ReplyDeleteDid the patient refuse to pay 11 cents/pill out of pocket?
ReplyDeleteCK - I love your comment on the alcohol! If someone said that to me, they'd be my new favorite customer.
ReplyDeleteI hate insurance companies...and the comment about the CEO's bonus is right on...why doesnt somebody look into that when fighting over what is best for health care options for this Country?
ReplyDeleteI think Insurance companies should be not for profit agencies!!!
What's the drug? let me look it up and see what the restriction is.
ReplyDeleteAt my pharmacy the other day had a patient's insurance refuse to pay for meloxicam but would pay for Celebrex. Didn't make any sense at all. I just cashed out the meloxicam (under $5 for the 20 tabs or so) and called it good enough. One problem is that insurance companies make money by kickbacks from Brand Name manufacturers....I'm of the opinion that health care reform needs to start with the insurance companies and PBMs. Don't ask me how to fix it but I'd start looking there.
ReplyDeleteI've come to appreciate my doctor more than ever in the past few years as we've had to fight for drug coverage past the limits of all reason. Losers.
ReplyDeleteMy insurance company, in their ultimate wisdom and vast medical experience have decided that my GERD is cured. They refuse to pay anything on the med that has kept it under control for the last several years. Now I take three OTC meds and suffer with mild symptoms. I'm sure they will cover esophageal cancer treatments though.
ReplyDeleteMy neurosurgeon ordered a MRI of my lumbar spine in anticipation that he would perform surgery on my spine for stenosis. Unfortunately I had to cancel the MRI with the intention of rescheduling at a later date. Last week I received a letter from my insurance company which gave me permission to have the MRI (although I had never asked them for permission), but stated that they weren't sure whether they would pay for it or not. Well, what good is that? If I have to pay for the damn test why would I care whether they approved of it or not? And why would I ever agree to have surgery if my surgeon didn't know what he was going to find in there prior to the first incision?
ReplyDeleteWe definitely need insurance reform. (By the way, my approval word is fingr, which is what I'd like to give my insurance company!)
Classof65
i must know... was it fioricet? If so, that's not the insurance company that's MEDICARE at work. CMS (Center for Medicare) doesn't cover fioricet --but get this -- they do cover fioricet with codeine. Ahhh.. federal health care in action.
ReplyDeleteWas it fioricet?
ReplyDeleteIt was a tricyclic.
ReplyDeleteGahhhhhhhhhhh!!! They won't cover a tricyclic because it's experimental?
ReplyDeleteMy hair's on fire! My hair's on fire!
Gahhhhhhhhhhhh!!!!
Fine. Then give her Lyrica. See how they like the cost of that.
You know, until the generic drug companies file for a new indication with the FDA.
What? Generic drugs don't get new indications from the FDA?
Wh-whaaaaaa?
STUPID, STUPID, STUPID!
Bozos.
maybe they don't want to pay for the tricyclic because it can cause weight gain for the patient...then they could become obese and suffer from high blood pressure, high cholesterol, and diabetes...which would cost them more than $1.25 a pill in the long run.
ReplyDeleteyeah...right...
hmm... my guess was wrong..it wasnt fioricet.. i can't think of a logical reason the insurance company would have rejected the claim. I can see why you were irritated.
ReplyDelete