Now I do understand that Simon Says isn’t exactly the correct metaphor to use here, but it makes for catchy reading. I went to see one of my (currently 5) doctors as “we” fight “my” cancer. After stuffing a camera up my nose and down my throat (I’m pretty sure he went far enough to check out my colon for goodness sake) he finds a Granulanoma in my voice box and prescribes for me some kind of generic Prilosec, 40mg, 2xday.
I rushed right over to my local pharmacist (well, 2 days later) and proudly hand her my prescription form (which was actually hand written, haven’t seen that in a long time). Cue the dramatic interlude music….my insurance company won’t approve that drug. How about this other one instead? “Sure” I say. Well another drug means I have to call the doctor’s office back and he has to re-prescribe it.
An hour later the pharmacy calls me and says my insurance company won’t approve the prescription because it’s written for 2xday and they only want me to take it 1xday…. who the heck are these people! Do they even know WHY I’m taking the drug? How can they know I’m only supposed to take it 1xday?
Because I’m a big $$ patient I have nurse case manager with my insurance company. I call her (and I’m in a pissy mood now cause they are screwing with me again) and when she calls me back and I explain to her what’s going on she tells me I need to get the prescription PRE-APPROVED by the insurance company because my DOCTOR wants me to take it 2xday which more than the normal dosage….
Here is the kicker, PREAPPROVALS have to be submitted by my Primary Care Doctor, and he is NOT the doctor (remember I have 5 now) that prescribed the drug in the first place. So I have to call his office and explain what going on to one of the admin people there. They submit a request to my insurance company and 2 (business) days later (today, 4 days after I submitted the request to my doctor’s office, now 7 days after I got the prescription) they say Yes, I can get the medicine I was prescribed.
Now my Primary Care Doctor NEVER SAW ME, he doesn’t know WHY I need the pills 2xday, he probably doesn’t even know I was prescribed the pills because his office people took care of it. I don’t understand why I had to ASK the insurance company before I could submit the prescription, you would think the mere act of the pharmacist submitting it would be enough of an ask. It’s just another hoop, another level of paper work, another thing adding to the cost of health care. Remember the insurance company never got any more information for the PREAPPROVAL then for the initial request from the pharmacy…
Simon Says you may NOW get your prescription filled…
What a load of crap.