Monday, June 18, 2012

Pain Meds - Let's Pass the Blame

I have watched the healthcare system go downhill for quite a number of years.  While there is no shortage of reasons for this, one of the larger ones is insurance.  I say this because we have still managed to get a certain level of care - it's just that insurance makes it so much more difficult.

When the HMOs started, all we heard was how efficient and inexpensive they were.  They promised us the moon: they delivered some sort of irradiated space rock.  They promised to lower overall healthcare costs: instead they climb like a Saturn 5 rocket.  First I suggest we hold the people who made the promises responsible.  Let them pay anything above reasonable from the date of the start of their HMO.

Next up is the prescription pain medication debacle.  My mother-in-law has been denied medication simply because the insurer refuses to pay for it.  Apparently this is perfectly ok.  My wife suffers chronic pain and used to take Oxycontin.  She had a lot of trouble getting it because people would abuse it and the pharmacies would look at her like a criminal and say they refuse to carry Oxycontin.  I say there's no problem: let the junkies kill themselves on it but allow the people who need it for pain management to have it.  This is not so much an insurance problem as a federal issue.

Fortunately for her, my wife no longer takes opioid-based medicine.  However, the insurance companies manage to screw this up anyway in terms of approvals.  Certain medicines require approval, as if the word of your prescribing doctor isn't enough.  Doctors have to jump through hoops to get the correct meds for some of their patients (pain and otherwise).  This requires additional staff in some practices.  Guess what this does to the cost of medicine in general?

As if this weren't enough fun by itself, the insurer reserves the right to review whether they will cover the prescription every year or so.  And of course, that time came upon us last week.  The time when the insurer has to decide if they'll cover the pain prescription that has been in-place for two years.  It would seem fairly obvious, but there we are.

The determination tends to come as a surprise.  The prescription is called into the pharmacy and my wife has to call the pharmacy to see if it's in yet.  This time it wasn't, because a review was required.  Now she has to contact the doctor to make sure he is on the ball, answering the review questions.  Once this is done, it can be up to forty eight hours before the determination is made.  That's forty eight hours without pain medication.  Since this debacle began close to Friday, we have to allow another forty eight hours because the prescription company doesn't work on weekends (although people have pain on weekends).

But wait - it gets better.  The prescription was dropped at the pharmacy early in the week.  When the prescription company was called, at first they said it was in process.  Then they said it wasn't.  Then they said it only got called in on Friday from the pharmacy.  That's certainly a lot of different answers.

The pharmacy was sorry.  Yes, sorry.  No pain meds for the weekend, but they're sorry.

Monday morning the prescription company says the doctor never called them back.  But the doctor wasn't supposed to call them back.  The prescription company screwed up and thought the meds were given for a different reason.  They're sorry too.

A few hours later, the pharmacy company said the doctor sent the wrong form and was going to have to send another one.  It would be another forty eight hours.  When my wife explained that this was not acceptable, they said they'd mark it urgent so it would only take twenty four hours.

Day Five with no pain meds.

I should mention at this point that if the doctor had put in a new prescription, the insurer would approve a small amount of pills until the review was completed.  Because this is an existing prescription, nothing doing.

I went to my company's benefit folks and told them to DO SOMETHING, please.

If I were less civilized, mayhem would ensue.  It may still.

Now tell me insurance isn't a problem.
When the bean counters are allowed to dictate coverage (HMO anyone), this is what happens.  The ObamaChrist is not our friend.

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