Question
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Drugs & Medications
Periodically, I get a notice from my insurance company informing me that the prescription my doctor wrote for me is not the best medication and will not be covered under my insurance plan. I also get a notice from time to time that a certain medication will no longer be covered by the insurance and I am given a list of choices to give my doctor so that she can change my prescription. I am a diabetic and blood sugar is something that reacts differently to different medications. Once you establish good control through medication, diet and exercise, it is something that should not be messed with. Why then does my insurance company feel qualified to second guess my doctor?
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Answered Undecided
Insurance Companies are businesses...and their concern is the bottom line. Their goal is to keep costs down and generate the most profit. Some of what they do is legit...otherwise doctors would be manipulating the system by sending people for needless expensive tests. But often the insurance companies' business sense butts up against a physician's expertise. Ironically, the least corrupt insurance company is Medicare, the government administered insurance for seniors. It is the private insurance companies that are the most restrictive and abusive. -
Answered No they would rather see me dead just to save a few bucks.
I've always considered this and insurance companies determining the necessity of certain tests and examinations as insurance companies practicing medicine without a license. Unfortunately, the insurance lobby's have bought most politicians in most states which is why the type of health insurance a person can purchase depends upon the state in which they live. The type and cost of health insurance currently on the market is due to governmental meddling on behalf of the insurance lobby. If you think health care coverage sucks now, just wait until the government takes over full control. Why haven't people ever thought to wonder why Clinton and Obama are Hell bent on requiring health insurance? HINT!...The Insurance Lobby is the largest individual contributor and fund raiser to Clinton's and Obama's election campaigns. -
Answered No but it is my responsibility as the consumer to do something about it.
No, it is the responsibility of the patient to consult with their doctor. Using the information from the insurance company to research and discuss with ones doctor is probably a good idea, not all doctors are right about all things.
Just gave me a thought of a government employee in the bowels of some building deciding whether my medication was right or not and actually having the power to control it. Yikes!! Makes insurance companies look good. -
I'm not defending the insurance companies by no means...but it is a little more complex than some employee in the bowels of some building making the decisions. Insurance companies have advisory boards that are made up of physicians that make the rules regarding what is covered and what's not. The employee just approves or denies the claim based on these guidelines. I know with Medicare, they might not cover an expensive new medication until it has been on the market long enough to determine that it is safe. Many times these medications are found to cause sever side effects or death. They also might not approve a complicated expensive surgical procedure when other less invasive procedures will result in an equal outcome. But regardless, it is a decision made by a group of physicians, not Mary Jane in the claims processing department.
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Answered No they would rather see me dead just to save a few bucks.
Insurance companies are not, repeat, are not, your friends. They just want you to send in the premiums and die before you file a claim. What your insurance company is doing to you is nothing short of criminal. You might try contacting your state's attorney general or whatever department oversees the insurance industry in your state and see if they are breaking one or more regulations. If the letter is from out of state, get the Feds involved. Unless the person signing the letter has a medical degree and is fully cognizant of your medical history they are putting your life at risk just to save a couple of bucks.
Answered No but it is my responsibility as the consumer to do something about it.
No, it is the responsibility of the patient to consult with their doctor. Using the information from the insurance company to research and discuss with ones doctor is probably a good idea, not all doctors are right about all things.Just gave me a thought of a government employee in the bowels of some building deciding whether my medication was right or not and actually having the power to control it. Yikes!! Makes insurance companies look good.