One of the standard conservatarian responses to anyone suggesting government-funded universal health care is to start talking about how universal health care will inevitably lead to faceless, heartless bureaucrats denying or delaying treatment for stupid reasons. My response to these stories is “Who’s supplying your health insurance? And how do I get on that plan?”
Through my employer, I have a pretty generous health plan, administered by one of the most highly-regarded health insurance companies in the region. And this week, for the second time in two weeks, they refused to cover my prescription for heartburn medication.
(Details below the fold.)
I’ve been taking Nexium for a while now, since my regular doctor prescribed it back in February, and when I was still having problems, the gastroenterologist gave me a bag full of sample bottles, and told me to start taking it twice a day. At the follow-up visit after my endoscopy, I was told to continue that for the foreseeable future, and given a new prescription for a month’s supply of pills, with instructions to take two a day.
A little over a week ago, I took the prescription to my local chain pharmacy, and they said it wouldn’t go through. My insurance company refused to pay for the pills, because it was too soon for a refill of my prescription. I pointed out that this was not, in fact, a refill, but rather a new prescription, and that made no difference. The computer said they wouldn’t pay, and I couldn’t get it filled until this past Friday.
I forgot to call them on Friday, so I stopped by Saturday morning, and asked them to run the prescription through. Again, it was denied. Their computer says it’s a once-a-day drug, and they won’t pay for two pills a day. I pointed out, again, that this was a new prescription that clearly (well, as clearly as you’ll find on a prescription pad– do they teach lousy handwriting in med school?) stated that I was to take two pills a day. Again, it made no difference. They wouldn’t cover it without explicit authorization from a doctor.
Which means, I have to call my doctor, and have him call my insurance company to authorize the prescription, and then I have to go back to the pharmacy, and ask them to run the prescription one more time. Probably more than one, because I’m sure they’ll take a day or two to process the approval, and God knows, they won’t call me to tell me when it’s done.
Now, I don’t actually object that much to the idea of the insurance company keeping track of prescriptions to prevent people stockpiling medication on their dime, or buying lots of cut-rate Nexium to distill into… whatever you can make out of Nexium. That’s a perfectly sensible cost-control measure.
What I object to is the fact that they’re making me do their job for them. It’s perfectly sensible for them to screen prescriptions to avoid frivolous expenses, but they’ve got phones, and computers, and employees whose whole job is processing health care claims. My doctor’s phone number is right there on the prescription pad, and I’m sure it’s in the pharmacy computer– the insurance company ought to be able to call the doctor themselves, and confirm that it’s a legitimate prescription, and approve the payment that way.
But that’s not what they do. Instead, they make me call the doctor, which is always a multi-step process of leaving messages on voice mail systems, and sitting around waiting for them to call back. And then, the doctor has to call the insurance company (more sitting around waiting on voice mail), and then I have to call or go to the pharmacy again. This is all time taken out of my day, and none of this is part of my job. It ought to be part of the insurance company’s job, but they’ve got me over a barrel, because I need those pills, so even though it’s a pain in the ass, I’ll make the calls, and waste a bunch of time sitting around my office playing phone tag. (Luckily, I have a job that has enough flexibility in the schedule to let me play phone tag during business hours– lots of other people don’t have that luxury. Which, of course, is probably another source of savings, as some of them will end up going without the medication…)
(While we’re noting ways I’m lucky, this isn’t life-threatening, and if it were, I could afford to buy the pills and get reimbursed later. And I’ve still got a sack of sample bottles, so I haven’t missed a dose yet. It’s the principle of the thing.)
Keep in mind, this is one of the best insurance plans in the area. I hate to think what the lousy companies do to their customers.
So, if you say to me that universal health care will involve faceless bureaucrats delaying or denying necessary treatment, my reply to you is, “Welcome to my world.”