Monday, May 08, 2006

Insurance Doesn't Mean Assurance

I spent over 30 minutes today, arguing on the phone with a patient’s insurance company, then his pharmacy.

The patient has a cough; he is also allergic to codeine. The only effective cough suppressant that doesn’t contain codeine is excluded by Medicare as “a drug we don’t feel like paying for.” Imagine, they paid for Viagra, but cough meds? Those are insignificant, right?

Anyway, I had to call Medicare Part D’s subcontractor (insert long impassioned rant against automated phone answering systems, on hold music, the lack of on hold music, automated reassurances that my call is very important which is ironic since if it were very important I wouldn’t BE ON HOLD!!!!!!), and get them to tell me it was excluded. Then I have to call the pharmacy back and get them to apply for a TAR (I actually have no idea what that stands for. What it means is “we’ll get Medi-Cal to pay”) for the medication. The pharmacy-boy gives me static at this point.

Boy: “Why can’t she just have Robitussin?”
Me: “That’s not a prescription drug.”
Boy: “No, but Medicare pays for it.”
I count to ten, twice, slowly, in French.
Me: “Put in a TAR for the Rx, please, now.”
Boy: “Okay, but…”
Me: “Now.”
Boy: “Okay.”
Me: “Thank you.”

Set phone down with exaggerated care. Pound head against desk until floaty red stars obscure vision. Pick up next chart, repeat.

Actually, the next chart is someone who got the wrong prescription filled, and will now run out twice as fast. The insurance companies dole pills out per day, now, and if your scrip is wrong, you just might end up paying out of pocket, because your insurance company will not cover any deviation from what’s written on the paper. Even if you write them a new prescription, they won’t give the person enough pills to make up the difference for this month.

This isn’t a big deal if your med is cheap. If it’s not, I hope you have a savings account.

Incidentally, on NPR the other morning, I heard the head of some health agency in Seattle say, “In case of natural disaster, everyone should have 90 days of their medications stockpiled.”

Oh, really? So…you’re going to use your position to fight the insurance companies/Medicare who won’t cover “stockpile overrides”? Or are you saying only rich people should be able to have medications during a natural disaster? We should expect a blanket declaration of same to emerge from your office, when? You will lean on your colleagues in other states to enact such policies as well?

This will at some point devolve upon me, of course, because I will have to fill out the inevitable paperwork to apply for the overrides, track them, and solve potential override problems.

It’s like being nibbled to death by worms. Every month, there’s one more piece of paperwork for one more thing, multiplied by X hundred patients. Track this, document that, write this stuff down, keep record of that. Yes, each phone call is less than five minutes. We have over 800 Medicare patients. If I make one five minute call for each of them, that’s 66 hours. Did I mention Medicare doesn’t pay us for phone calls?

I know, everyone’s job sucks. But damn, there are so many enjoyable parts to my job that it makes me sad I don’t enjoy them as much because they are so often overshadowed by Medicare/insurance company shenanigans.

I spent 30 minutes on the phone with an insurance company today…I hope you didn’t.


Anonymous WordyGrrl said...

My sweetie in Florida is on SSI and Medicaid. Yep, that's pretty much the situation she's in and it's horrible. They dispense whatever medication they feel like giving to her -- despite what she knows works for her and what doesn't. She's only allowed 30 days worth, so if she runs out on Friday and the clinic takes a 4-day weekend, she's out of meds for a week.

No stockpiling for her, obviously. Despite the heart condition, rheumatoid arthritis and chronic pain she's been diagnosed with years ago. Oh well. Maybe she can find a faith-based pharmacy to hook her up, right?

9:45 AM  
Anonymous Anonymous said...

Only 30 minutes?? Try hours every day...

3:00 PM  

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