Posted on 05/10/2011 10:47:05 AM PDT by Gum Shoe
I'm very happy to see the spring weather finally arrive. It seems Old Man Winter just wouldn't go to bed this year. With changes in the weather, comes my spring chest cold. There isn't anything I can do about it except head to the doctor and ask him to treat the symptoms until it clears. That's the routine. However, I discovered the routine isn't so routine anymore. After entering the exam room, I saw a new computer had been set up in the exam room. Nice LCD monitor, sleek key board on a telescoping arm. I asked the nurse about it as she checked my vital signs. She said it was installed in January, and was part of their office upgrades to allow integration into the new national heath care system - something to do with reporting data, and "stuff like that", to insurance providers. She said some things about the system were irksome, but she thought it was "a good thing". My only thought, at the time was, "Huh." You'd think something more profound would have occurred to me, but hey, I was sick after all.
Ultimately, the doctor showed up, gave me a going over, and decided I needed some meds. Instead of writing it all out on a paper scrip, he did it all on the computer. Pretty nifty. He fired off the prescription to the local drug store, via email I suppose, and told me it would be ready in about fifteen minutes. I thought that was kind of cool.
This is where it gets interesting. I drove to the drug store, allowing for the fifteen minutes suggested by my doctor. I walked up to the pick-up window, and found a woman in a fairly heated discussion with the pharmacist. I tried to be polite, tuned out the conversation best as I could, and occupied myself with a really nice, near-by massage chair. After saying something about making a call to her doctor, the woman turned from the window and stalked off. Seizing the opportunity, I jumped up and asked the pharmacist if he had filled the prescription emailed by my doctor. He said "not yet" and asked me to take a seat. So, I went back to the chair. The woman returned a few minutes later, and took the seat next to mine.
After waiting a good twenty minutes, and a series of ignorant expressions offered by the pharmacy crew (blank looks when I made eye contact with them to remind them I was still waiting), I finally broke and went to the window for a status report. The pharmacist said, "Oh. Your prescription was denied." That surprised me. I've never had that happen to me before in my entire life. I asked, "It was only for an antibiotic. What's so difficult about that?" He said,"Your insurance company disagreed with your doctor, and denied the prescription." Again, my thought was "Huh." But this "Huh" was immediately followed by a "That was pretty cheeky of them." In the desire to learn more about this situation I asked, "So, insurance companies can now over-ride my doctor's recommendations, without knowing or examining me?" The response was, "Yes." The pharmacist told me he was in the process of contacting my doctor to have him submit a prescription for a different drug, with different dosages. He again asked me to, "Take a seat."
I returned to the massage chair. The woman, from the earlier conversation at the pick-up window, still occupied the adjacent seat. She said, "They did the same thing to me." She went on to say her insurance company was denying her mother's prescriptions. Apparently, the woman's poor mother was dieing of stomach cancer, and in the final stages. According to her, their insurance company simply "Didn't want to pay for medication for a woman who was dieing anyway." After concluding the brief conversation with the woman, the remaining contents of which I'll keep private, I finally received my updated prescription and left the store. I hoped the circumstances surrounding the woman's mother weren't as dire as she explained them. Since she was still waiting at the pharmacy as I left, the pharmacist was likely working on some sort of resolution for her prescription problem.
I don't know at what stage the implementation of Obamacare is currently. I don't know if the federal government now dictates policy to private insurance providers in this country as part of that process. From this experience, I suspect the implementation of Obamacare is much further advanced than previously thought, despite bold claims to the contrary by Boehner and his ilk. What I do know with a certainty, is our liberal socialists will claim similar incidents are the reason America needs Obamacare. We need government to fend off the mean, uncaring insurance companies - to make them do what's right. I couldn't disagree more. I believe those incidents were caused by the prevailing liberal socialist theory that has spread like cancer through the United States of America. If we don't stop the federal government from taking over private health care, I fear the worst is yet to come.
“Find out before writing an article. How else could you blame this on Obamacare?”
If that’s the only thought you had after reading this article, so be it.
I don’t beleive the author blames the incidents described in the article to Obamacare, per se. In fact, the use of the question mark in article’s title supports that conclusion. It seems to me, the author is attempting to provoke a deeper internal dialogue. I’m certain he would like to know if Obamacare is the cause, a concern he believes any reader may share.
Nonsense. Insurance companies have used "formularies" for a long time.
This is the kind of paranoid, useless, ignorant crap that gives FR a bad name.
Try reading it again.
From this experience, I suspect the implementation of Obamacare is much further advanced than previously thought,
I had an insurance company question a doctor's prescription at least a decade ago. And insurance companies balking at expensive treatments for the terminally ill isn't something that Obama invented.
Do not rely on Medicare for prescriptions. I’m glad that my mom didn’t have to.
And don’t trust articles that spell ‘dying’, ‘d-i-e-i-n-g’.
Well, since it is the foundation of the author's claim, I figured it was enough, for now.
“I had an insurance company question a doctor’s prescription at least a decade ago. And insurance companies balking at expensive treatments for the terminally ill isn’t something that Obama invented.”
Fair enough. Are you concerned the federal government’s intrusion into the health insurance business may result in much worse?
“And don’t trust articles that spell ‘dying’, ‘d-i-e-i-n-g’.”
That’s funny! RSZ is just a newbie blogger I started following, not a pro. I’ll send him an email about his spelling.
Nothing stops you from buying that particular anti-biotic with YOUR OWN MONEY.
Sure. But this type of hysterical, ignorant “article” doesn’t help with anything. Saying something is one’s “first dose of Obamacare” when it hasn’t even been implemented yet is just stupid.
The article was written by a zombie.
“The insurance companies often refuse to approve payment for certain drugs when they believe a generic or different drug will do.”
What’s described in this article is different, though, seems to have started around the first of the year. They don’t suggest you use the generic, they just deny the prescription. My sister had this happen to her on January 1. Something she had been taking regularly. Called in her prescription, when she went to pick it up she was told it was denied by the insurance company. After several calls to the insurance company and considerable runaround, they finally indicated they wouldn’t pay for it (apparently, if she had called it in the before they would have.) She could have the prescription if she would pay for it herself, which she did because it was something she needed before her next doctor visit.
Fortunately, we have also invested in a medical savings account but many people are not able to get one (thanks to Ted Kennedy and the rest of those worthless liberals and RINOs in Congress, White House.)
I've informed my insurance co. that I do not appreciate them "practicing medicine" without a license and as I pay their premium, I'll get what my doc deems best (rec'd generic med that didn't work once too often.)
I also do NOT go to national brand "drug stores," but an individually owned pharmacy where I get personal attention that we all are paying through the nose for.
Unfortunately, the general public have put most mom & pop stores out of business by insisting on the cheapest prices possible (the Walmart-ing of America.)
Naturally, it's not the fault of Walmart, KMart, Sam's Club but the buying public that demand lowest possible price and get no personal service in the deal.
I buy American whenever and wherever possible and also trade with mom & pop stores as when they are all gone, this is the kind of treatment we'll get on everything!
Sad but true, as Rush says, "the public will get what they want - by demanding it (oh and refusing to pay for anything less)!!!
“The article was written by a zombie.”
ARGH! ARGH!
YUP!
Insurance companies denying to pay for prescriptions is nothing new. It first happened to me 7 years ago. Since then, it happens every year or so. My options are to pay for it out of pocket, ask the physician to substitute something else, or ask him to go to bat for me. I’ve done some of each depending on how badly I need the medication and its cost.
I’d guess your physician prescribed a newer drug that is costly and that’s why the insurance company balked. I have a condition that is best treated with an off-label drug (which also happens to be expensive) and my insurance won’t pay for it. New drugs are expensive. Friends in the pharmaceutical industry say it’s to do with patent length and the cost of new drug development. But that opens a new can of worms.
Nationalized health care is like public schools. Parents think they are great until they have a child who does not fit into the medium.
National health care will take great care of the healthy and abuse the hell out of the sick and handicapped.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.