I am, perhaps, the last to know, but just in case, I thought I’d pass along the following information. It seems that a patient can have the same prescription automatically refilled every three months for more than a year and still suddenly have the refill unexpectedly blocked by the same insurance company that’s been paying for it all along. Well, not blocked exactly. But delayed while they go through the motions of authorizing it. Again.
I spent two days going back and forth between the pharmacy and the doctor’s office, trying to get my glaucoma eye drops prescription refilled. First, the pharmacy told me they’d been denied by the doctor’s office. Then the doctor’s office said they’d take care of it. Then the pharmacy said they still hadn’t heard from the doctor. Finally someone at the doctor’s office said they were waiting for authorization from the insurance company! Authorization originally issued more than a year before.
I’d run out of drops two days ago but had been expecting the automatic refill. Fortunately, before I resigned myself to the inevitable frustration of calling the insurance company for an explanation, I asked Google. And voilà, there appeared an article from an American Medical Association series titled “What doctors wish patients knew about prior authorization.” You might find it enlightening.
Or perhaps I really was the last to know.
Of course I DON’T “like” it – no-one could.
My beloved soulmate used to say “Insurance ? – oh, that’s when the company says ‘You pay us your money and we’ll keep it!'”.
He was right, as always.
Medical insurance has changed horribly since I entered adulthood. Back then its only job was to pay — after the fact — 80% of whatever medical bill you incurred. There was no prior authorization of anything, no dictating, no restricting, no stepping between you and your doctor. Ain’t “progress” great?
Such a horrible system
It is. It’s bad enough that insurance companies get to dictate our medical care, but re-approval after the original pre-approval is just ridiculous. Too many third-party fingers in our medical care!
It’s all about the money of course. I imagine there is something to be said for encouraging the use of generics rather that the latest meds to be patented since the changes that justify new, more=expensive versions are often of minor efficacy. That has been my experience. I certainly agree about the inefficiently of the bureaucracy.
Yep. I read somewhere that those meds you see advertised on tv are there precisely because they aren’t selling very well (because they aren’t particularly effective?). Big Pharma doesn’t need to advertise the drugs that are already very popular.
The reauthorization delay on my generic refill accomplished nothing (see the linked article); it was already the cheapest drug in its category and it’s not like my glaucoma was going to disappear. I guess some bureaucrat just wanted to flex some muscle (and justify a paycheck).
I went through something similar with one of my meds. I finally had to stay on the phone with a nurse (the only one who knew how to do it) at my doctor’s office as she worked her way through the reauthorization process wirh one of my meds. It took over a week in all to get it done.
Glad mine didn’t take that long. I was getting a bit frantic not knowing what would happen to my eyes, or how fast, without my med.