Wednesday, May 31, 2006
Fighting for your medical benefits is not an act for the sickly
I'm tuckered out from celebrating my bride's 46th birthday so this will be short. It's just incredibly stupid to me how medical insurance carriers operate. 
Previously I mentioned submitting a prescription on Friday, and with the weekend and holidays I expected it'd be Tuesday before they were around to react. Sometime on Tuesday the insurance company called to say they weren't going to grant payment for my prescription until the doctor faxed them some documentation showing that I have a need for the drugs. Like the prescription itself wasn't enough of a demonstration. They used some word like "pre-authorization", which to me means the doctor had to agree that you needed this before he'd even met with you. Doctors may be wise but they aren't psychic. Anyhow, I hashed this out with my doctor's insurance juggler, whom wasn't surprised in the least, and she said that after she jumped through their hoops and got some response she'd let the pharmacy know they could fill the prescription. I've been sitting on my rotten toes for a few years so a couple more days of inaction isn't going to hurt me, but as my wife asked (she too is having a joust with her insurance company over them also asking for proof from her doctor, which they do every two months to her chagrin and her meds are a bit more life-affecting) do they do this same delay-and-annoy tactic to insulin for diabetics or inhalers for asthmatics? (Answer, my doctor's right hand person said, is "yes, but usually it's yearly".) Digger the Dermataphite gets to chill out for a little longer.
A public thank-you here to Jamie Dawn for pimping my Icicle Lights in the Offseason Flickr group. It didn't escape my notice that despite all the people on her blog who said nice things about the group, or the topic anyway, very few people actually went there... some pictures still have 0 views. Fine, it's the effort that counts. :) I have other sets that I am trying to forward in related groups, such as Ghost Writing on old buildings and Flora & Fauna. I will soon be adding a Scenery set for landscapes an' stuff.
Previously I mentioned submitting a prescription on Friday, and with the weekend and holidays I expected it'd be Tuesday before they were around to react. Sometime on Tuesday the insurance company called to say they weren't going to grant payment for my prescription until the doctor faxed them some documentation showing that I have a need for the drugs. Like the prescription itself wasn't enough of a demonstration. They used some word like "pre-authorization", which to me means the doctor had to agree that you needed this before he'd even met with you. Doctors may be wise but they aren't psychic. Anyhow, I hashed this out with my doctor's insurance juggler, whom wasn't surprised in the least, and she said that after she jumped through their hoops and got some response she'd let the pharmacy know they could fill the prescription. I've been sitting on my rotten toes for a few years so a couple more days of inaction isn't going to hurt me, but as my wife asked (she too is having a joust with her insurance company over them also asking for proof from her doctor, which they do every two months to her chagrin and her meds are a bit more life-affecting) do they do this same delay-and-annoy tactic to insulin for diabetics or inhalers for asthmatics? (Answer, my doctor's right hand person said, is "yes, but usually it's yearly".) Digger the Dermataphite gets to chill out for a little longer.A public thank-you here to Jamie Dawn for pimping my Icicle Lights in the Offseason Flickr group. It didn't escape my notice that despite all the people on her blog who said nice things about the group, or the topic anyway, very few people actually went there... some pictures still have 0 views. Fine, it's the effort that counts. :) I have other sets that I am trying to forward in related groups, such as Ghost Writing on old buildings and Flora & Fauna. I will soon be adding a Scenery set for landscapes an' stuff.
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Karen, on my blogroll, is a big nature buff. She has something like 2,000 photos on her flickr account. She lives in Utah and has some great mountain scenery.
I think people may take pics when they see icicle lights in their area and remember the club. It may take time for them to get it together. Most people are more talk than action. It's the way of the world.
I saw another icicle lights offender today. They were on a business and not an attractive addition to it at all.
Happy b-day to your wife!!
My hubby just turned 46 while Courtney and I were in Canada. He is not at all happy to be over the 45 hump and heading towards 50. Luckily, I can still say I am in my LOWER forties. My brother had a b-day while we were in Canada too.
I think people may take pics when they see icicle lights in their area and remember the club. It may take time for them to get it together. Most people are more talk than action. It's the way of the world.
I saw another icicle lights offender today. They were on a business and not an attractive addition to it at all.
Happy b-day to your wife!!
My hubby just turned 46 while Courtney and I were in Canada. He is not at all happy to be over the 45 hump and heading towards 50. Luckily, I can still say I am in my LOWER forties. My brother had a b-day while we were in Canada too.
Hey, this is sounding like Germany. But here the doctors deal directly with the insurance companies, and the insurance companies have been starting to second guess and deny the doctor's requests. There've been several doctors strikes about this, but nothing has changed. I do believe that universal health care is agood thing to have, but in Germany it's starting to fall apart.
I just got another hospital notice in the mail today.
I still owe $900 from my last surgery.
They are RELENTLESS!! We have insurance, but it does not cover 100%, and when we have to cover 25% of these surgeries, it adds up BIG time.
Gripe, grump, snarl!!!
I still owe $900 from my last surgery.
They are RELENTLESS!! We have insurance, but it does not cover 100%, and when we have to cover 25% of these surgeries, it adds up BIG time.
Gripe, grump, snarl!!!
I was the the pharamacy today to drop off a different prescription, and asked about the last one since I still don't have my Lamisil. The woman said she hadn't heard anything from the insurance company and had resubmitted the order earlier today. Sigh, again, looks like it'll be after the weekend -- what will this be, ten days? -- after the original submission that anything happens. IF anything happens. She had no doubt that this other prescription (two tablets, common medication) would not meet any resistance.
Odd how laymen (insurance) has the power to second guess professionals (doctors) on what patients need.
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Odd how laymen (insurance) has the power to second guess professionals (doctors) on what patients need.
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