Wednesday, May 6, 2009

Health Insurance Absurdity

The closer I come to turning 40, the more health conscious I become.  I try to eat organically grown produce. I rarely eat meat. I eat wild caught fish and try to stay away from the "bad" ones. I make healthy choices when it comes to snack foods skipping trans-fats and high fructose corn syrup. I rarely drink soda and if I do, I opt for one made with natural ingredients. 
After living this way for a few years, I decided I ought to make sure I'm as healthy as I think I am. So I scheduled an appointment for a physical. For those of you who know me well I'm sure this comes as a surprise. I haven't had a primary care doctor since my pediatrician. But, I made the appointment and went in for a checkup. The doctor thought I was in pretty good shape but wanted me to see a dermatologist for a skin check. I made the appointment and 6 months later, went in for my skin check (note to those who are looking to go into the medical profession - dermatology may be the way to go - these docs are seriously busy).
Immediately the doc noticed the large amount of sun damage on my face and arms. Fortunately she didn't see anything needing direct attention  in terms of biopsy but she did prescribe Retin-A for the brown patches on my face.
So, I took my prescription to my local CVS, dropped it off and came back to pick it up 2 hours later. It wasn't ready and the pharmacist seemed a little baffled but told me he'd call when it was ready. Well, before I arrived home he had already called. I called him back and he told me that the prescription was pending pre-authorization from the insurance company. It seems that the insurance company needed to talk to the doctor to be sure I really needed the Retin-A. Obviously a written prescription from the doctor for the cream was not enough proof that she wanted me to use it. They need to be super sure so they need to talk to her first. So CVS told me to call back in 48 hours and maybe everything would be taken care of by then. By then, hopefully, the doctor would have convinced the insurance company that, yes in fact she did want me to have it other wise, I can only assume she would not have written the script in the first place.
I wonder if this ever happens in the case of something a little more timely, say blood pressure medicine or asthma medication. Are there people out there being hospitalized while awaiting drugs requested for them? 
I also wonder if the doctor ever says, "Oh yeah, I forgot, I really didn't mean to prescribe that. Boy, it's a good thing you called, otherwise my patient would have taken something they didn't need."  I don't put all my faith in doctors of western medicine but I can't imagine a doctor is going to prescribe Retin-A unless she thinks the patient needs it. Strangely enough, I've been prescribed and received  Oxycodone a number of times with no further authorization. And that's a drug  I could sell on the street in a heart beat.  
I guess there is a reason for this delay and I'll probably never understand it. Hopefully this is not the kind of thing that happens in a more critical situation. And hopefully I can get my Retin-A soon and get rid of these brown patches so I can look as healthy as I feel. 

1 comment:

Reada said...

Bebe, the same thing happened to me when I was first diagnosed w bad allergies. My allergist prescribed me medicine and the pharmacy couldn't fill it because my ins company wanted to know why I couldn't use the OTC allergy drugs. Now really...if those had worked in the first place, I wouldn't have needed the stronger drugs. BTW, it was never approved and I've had to get by w the OTC drugsl.