If you, like me, have struggled with a chronic, diabolical medical condition that’s robbed you of the most precious things of your life, requiring you to look for new meaning, new reasons to go on, you, like me, probably thought the medical field was in your corner.
For the most part you wouldn’t be wrong. Yes, there’s a smear of shit to wade through with doctors, medical staff, specialists and all, but the biggest hemorrhoid in the mix are the health insurance companies.
Yes, I hear the laughter of recognition as you read that last sentence. I know, I’m not saying anything particularly new or creative when speaking of the mother fuckers who own, operate and get fabulously wealthy on the backs of people like us who have to rely on them, but let me, just for a few moments rant about the latest experience I’ve had with these nitwits, and I’m sure the crescendo of recognition and laughter will follow.
To be clear, the experience I’m going to describe has happened repeatedly to me and to others. This isn’t a one-off experience.
But first, let me put this into a familiar frame. Everyone who is in this position along with me knows the drill. You’ve gotten the prescription from your doc, taken it to your local pharmacy, dropped it off, answered all the questions and are then given a date and time to return to pick up said medicines.
After long and bitter experience you know right away that you have a 50-50 chance of getting that much-needed medicine when you return at the promised time. In other words, 50% of the time you’re fucked. The pitfalls: your doc failed to date the prescription; s/he failed to sign the script or enter his/her DEA number. Or, your told that the medicine isn’t in stock and unavailable until early next week, the reasons are legion: but the most maddening is the “Prior Authorization.” Oh, yes, the stab in the back from the insurance industry.
I was just informed by my pharmacist that a medicine I require to stay upright was denied due to the fact that my lovely insurance carrier has changed its formulary. Even though for months they approved my medicine to taken twice daily. Sometime since my last refill they have changed their policy on this particular med to the effect that they will only cover the cost at one dose daily, not two. Did they bother to notify me in a timely manner?
Is this a considered medical call based on the evidence that this med is best effective at one dose daily, instead of the two doses that, by my experience, work best for me? I’m waiting for your laughter to die down. No, no, no. It’s simply a way to put heat on my doc and me to cut back the effective dose so these ass hats can make more money than they would if I take the med twice daily.
Their possible solution? The tried and true hoop for me and my doc to hop through? Yes, that’s right, children, the PRIOR AUTHORIZATION (PA). This dreaded phrase is the bane of existence to those of us suffering with daily, grinding pain.
PAs don’t just appear over night. No. First the pharmacy has to inform me that the insurance company wants the PA, the pharmacist informs my doc, then I call the doc’s office to make sure the request for the PA is being handled, the doc has to justify in writing why I’m taking the med twice daily. S/he sends the PA request back to the insurance company and some benighted douche bag either denies the request or approves it.
This is harassment. Why you might ask? The answer lies in the fact that I have never, not once had an application for a PA denied. I wonder if anyone has. It is simply an obstacle thrown down in our paths time and again to get us to give up and not take the drug, take it less, take a cheaper less effective med, or, most egregiously, stop taking the medicine altogether.
Hang on, there’s more. The only way you’re notified that your insurance carrier wants you to jump through this hoop is at the point of refill. Yes, there you are, if your like me and take skads of meds daily, you can’t always get your scripts refilled in advance because there are so many to track and we’ve all experienced the keepers of insurance smacking down a refill request if we are even so much as a day early. In reality there is only a small window of opportunity.
So there you are at home after calling into your pharmacy’s automatic phone refill for the meds you are out of or nearly out of when you get the automated call back from your pharmacy later that there is a delay in filling the request as the pharmacy has to contact my insurance carrier for clarification. Your heart sinks as it’s late Friday afternoon and there will be no communication on the needed refill until the following Monday. This is often a disaster.
Here, besides the reprehensible greed of insurance companies, is a small point. With all the high-tech communication at their finger tips, why can’t they install a program that tracks the users of particular meds and send out an email blast to those affected patients: a PA is required at the very next point that the patient is low on, or out of the medicine. Why create such a cluster-fuck when we are at, or nearly or near the point of running out of the medicine? Why create such anxiety or panic among vulnerable patients?
The answer is, I’m afraid is as apparent as my salty language in this rant–moola, yes, money, always the holy grail. This is nothing more than harassment to keep us from utilizing our insurance thus filling the coffers of the managers and stock holders.
Come the revolution, with Madame DeFarge looking serenely on, the first in the tumbrels headed for the blade and basket will be the insurance executives.
May I pull the lever?