Who’s the Doctor?

Those of you who follow my blog know I fight migraines.   I have participated in several studies  over the years and my management is 100% better than before.  I understand my triggers and what options that I can use to get the most control and prevention.  It isn’t a perfect system but I lose very few whole days to migraines.  I use a combination of holistic health practices, over the counter and prescription drugs to achieve this.

I recently  went to the pharmacy to pick up a prescription only to find my insurance company had put my medicine on hold until they got a form   back  that they wanted completed from my primary care provider justifying a refill.    This enraged me as my medicine is not something that one becomes addicted to or gets a high from.  My prescription was for 30 doses and it had been 90 days since my last refill.  I still had two refills left for the next four months.

People argue that the private healthcare is more efficient.  I am questioning this.  These actions are being  done in the name of cost containment, and are very common according to the pharmacist.  Simple math would tell you that I am not over medicating or sell my medicine since it took me 90 days to use 30 doses of medicine that instructions said use as needed.  The insurance company has created extra work for my healthcare provider in a part of the country who is already underserved with medical and healthcare providers.

Who knows me, my the health care provider I have seen for nearly ten years  or some employee at Blue Cross Blue Shield?   I called the BCBS office and asked about this process and was refered to a case review specialists.   I got a little put out when I asked my case specialists about her skills, training and background.   She had never worked in a clinic or hospital; she was not a nurse, pharmacy tech, or allied medical professional.   She did have training provided by BCBS including  medical terminology.  WOW was I impressed-not.    I asked who she thought had a better skill set to make recommendations about my health care people who wrote MD, or NP after their name or her with her medical terminology and some rules from BCBS.

I was eventually approved and got a letter from BCBS , but it reminding me to hold and be prepared to provide this letter to them in the future.   I was advised I may need to include it when I file future claims for this drug.  Now they generate this bogus piece of paper, but can’t keep track of it.   None of this makes me impressed by the services provided by BCBS

My monthly  health care premium is six times more expensive than my prescription, so I am not digging into to BCBS’s record profits. I see this whole process costing more than it would have been to have just given me the prescription.

I am not sure what the answer is in the rising health care costs, but there is no common sense at the insurance companies. I don’t believe that they care about providing the coverages stated in  the contract when they accepted my premium payments.  It is to take the money and pay as little as possible.     It is all about the fat cats, just like it is in congress and Wall Street.   I am just the person at the bottom of the system who pays with no power.

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2 comments on “Who’s the Doctor?

  1. Insurance is such a complete racket. You are exactly right, they want the most in premiums so they can pay out the least. They fight you tooth and nail to pay for anything. I just found out my insurance premiums are taking another hike in two months. I have a high deductible plan ($6500) which I had to go to in order to keep premiums reasonable. I am in deep doo if something happens to me because I do not have this amount saved up. At least you have federal insurance, which I hear is the best out there. After your post, this isn’t saying much is it?

    • Just when you think you have heard it all. I got a letter today asking if my frost bite was the result of an auto accident. Can/will I be filing a claim against my auto or homeowner’s insurance? Am I suing someone or is someone else responsible for my frost bite. Cheap bastards!!

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