Here’s an interesting experience I just went through. It’s sort of a shaggy dog story (where does that expression come from???) so I will try to keep it brief.
I’ve been on a certain medicine for over a year. I take it daily. My doctor decided I may do better with the same medicine, but in what is called an “extended release” (ER) version. This keeps the medicine flowing at a supposedly even rate through the 24 hour period.
I started on this “ER” version of the medicine over a month ago. The doctor ordered two refills on the prescription. It seemed to be working better for me compared to the older version. When I went to refill it, my insurance company balked. They ultimately determined that the medicine is too costly and that I should try something else. They also criticized that since I was not officially diagnosed with the primary ailment the medicine is customarily prescribed for, I do not qualify to get it even though I had similar symptoms. This came after they allowed the first month’s supply, but then decided to stop it once I renewed it for the second month which the doctor had approved. To make a long story short, arguments went on for over a week and a half involving me, my doctor and the insurance company.
I asked the insurance company how they could overrule a doctor who went through all the training and education for his specialty and then added years of practicing experience. I was told the decision was made by the insurance company’s review board which is also made up of doctors. I reminded them that their doctors are working for and looking out for the insurance company. My doctor is working for and looking out for ME—the person with the problem who doesn’t have the medicine he needs.
What is despicable, I think, is the fact that I ran out of the medicine and had no choice but to suddenly stop taking it, something the manufacturer warns against. What saved me, somewhat, was that I still had some of the old version of the medicine left over when I switched to the ER version. I was willing to pay the hefty co-pay for the ER medicine since it was working better.…but that makes no difference to my insurance company who, I assume, has now taken over my medical care. I sure hope they have decent magazines in their waiting room.
After I calmed down a little, which took a few days, I got to thinking. If I walked into a gun store today and filled out the papers and underwent a background check, I could pick up a brand new AK-47 assault rifle and a few magazines of ammunition, probably in 2-3 days. No one could stop me. But if I walk into a pharmacy and attempt to fill a legitimate prescription a doctor has given me to help relieve a condition I have….well, you get the point. It’s sad.
Books by Marc Kuhn: THE POPE’S STONE, an historical novel that follows two descendants of a Virginia family who, despite living a century apart, share uncanny similarities in their lives; NEVER GOOSE A MOOSE, a collection of whimsical verse featuring thought-provoking “never-do’s” that children should beware of; and ABOUT A FARM, a children’s book about challenges we all face every day, regardless of where we live. All three books are available at amazon.com and each has its own .com website under its title.
Intimate details about Marc Kuhn and other exhilarating stuff at marckuhn.com
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