I can’t remember when I first became galled at the amount of control medical insurance companies have over our lives. Certainly I’ve been disenchanted most of my adult life with physicians who don’t listen–citing their education while I am reminding them of my 60+ years experience in my body. For the latter I usually just change doctors until I find one who isn’t deaf or busy trying on crowns. But, for insurance companies, it’s a little more difficult; you don’t usually have the luxury of deciding who insures you.
Currently, I’m dealing with a doctor who claims to be working with my insurance company to get a particular medication approved for coverage. I say claims because despite testing that indicates a need for the medication and several attempts at alternative medications that are not working, she is not inclined to press the insurance company to approve the one medication I’ve taken that actually works. (I’ve taken this medication for years yet suddenly it is not on the formulary and no longer covered. The insurer now recommends three other options. I’ve tried all three and every other option available and am, in fact, taking two of three they suggest at the same time now despite the fact that my doctor tells me I can’t. They don’t work.)
My doctor’s current solution (and mind you, we’ve been at this song and dance for over six months) is that I give up all carbohydrates for the rest of my life. She is convinced this will work. This is a huge laundry list of foods, including some beans, pasta, dairy, nuts, seeds, whole grains, fruit, vegetables, and of course, sugar and who knows what else.
I asked her what she suggested I eat, reminding her that I am diabetic. She wasn’t amused. She told me I could eat all the eggs I wanted and all the meat I wanted. I said that my husband has heart issues (never mind that the number one killer of women is heart disease and that diabetics are more prone to heart disease) and that we like to eat together and that neither eggs nor meat would fit his diet in quantity.
She told me that wasn’t true, that whatever diet my husband’s cardiologist had given him was probably faulty because most cardiologists, while they mean well, are too busy to keep up with the current studies and literature and are, therefore, woefully behind the times. I told her she should go right upstairs to my husband’s cardiologist (they work in the same clinic) and explain things to him since she has read the latest literature and obviously has more time than he does and would be doing him a favor that he, no doubt, would appreciate to no end.
Despite my cheekiness (and no doubt wanting me out of the office) she wrote a one-month script for the medication I wanted so I could see how well it worked (duh) while she promised to contact my insurer to “see what she could do.” I picked it up the script yesterday and with no coverage had to pay $302. This will not be a regular occurrence. If my math does not fail me, that is $10 per pill.
I ask you, is this ridiculous? Is this not reason enough to want socialized medicine? And, isn’t the inability of a medical professional to prescribe a specific medication and a patient to then receive that medication without the interference of the medical insurer reason enough to question the amount of control medical insurers have over our lives? Why do physicians go to school if big business insurance providers can override their decisions?
This brings me back to the point I was making about how I’m sure this particular doctor is probably not working very hard to get my insurer to approve the medication I need. As is my usual solution here, I will be looking for a new gastroenterologist, one that believes in a more balanced diet and in standing up to insurance companies.
Would that I could look for a new insurer, too.
So, today, I broke down and paid $302 for one month’s supply of what I know works. Tomorrow I intend to try ordering online from Canada and just to be a bitch, I also plan to spend the day on the phone with the deaf doctor and belligerent insurer until I get what I want. Any suggestions, physician friends?