I take quite a few medications to control several chronic and rather serious health conditions. I have been taking all of them for at least two years and they are “covered” by my health insurance, which is United Healthcare. If United isn’t the largest insurer in the country, it is among the largest and their website is filled with how much they care about my wellbeing.
Right.
Most of the medications are provided through a mail-in service where I obtain a 90-day supply at a time. The copay is quite reasonable and the service is excellent. Even a new prescription usually arrives in ten days or so, and when I have needed to call for some reason the person is always friendly and helpful.
Two of my medications, however, are provided through prescription which I must get filled at my local pharmacy, and that is where things become really ugly. Note that I have been taking these medications for two years and will continue to be taking them for the foreseeable future, they are not temporary medications.
Of the first medication I can get only a 30-day supply, not a single day more, and I can only get it refilled once every 30 days, not a single day earlier. That means that if I cannot get to the pharmacy where the prescription was originally filled on precisely the 31st day then I have to go without the medication until I can get to that pharmacy. Going on a trip? I need to schedule that trip not to conflict with my need to get that prescription filled on the appointed day, every 30 days precisely. Not approximately every 30 days, exactly every 30 days. Purely to satisfy the bureaucratic fetishism of United Healthcare.
For the second medication there are the same conditions as the first one and, unfortunately, the refill date is not the same. There is an additional problem. Because I have been taking it for a long time it is losing efficacy and on my last visit the doctor decided that I needed to take it in a slightly higher dosage. United Healthcare disagrees. At the dosage my doctor is now prescribing they will not pay for it at all.
My doctor sees me in person, examines me at length, discusses my symptoms with me in detail and prescribes medication. United Healthcare, who has never seen or spoken to me, determines that the original dosage is better and decides to overrule my doctor.
In an earlier post I said that healthcare in this country is increasingly a criminal conspiracy.
That’s how United Healthcare makes its profit. It accepts money in the form of premiums that we pay for my health insurance, and then profits by finding ways not to pay for proper medical treatment that I receive. If that is not a criminal conspiracy, I would like to know what constitutes criminal conspiracy.
Remember that name: United Healthcare.
Update: Sept 14, 2007
Okay, I should have called the insurance company about this issue before I worked myself into such a towering snit. Turns out they may be run by bureaucrats, but they aren't criminals.
It seems the pharmacy screwed up. United Healthcare is sending me a claim form and will reimburse me for the prescription I paid for. The refilling exactly every 30 days is an ongoing issue, though, so I'm not removing the post. It makes me look like something of an idiot, but if the shoe fits...
It's not the only one. Trust me. Here's an accolade for the VA - where I get my meds. I have had to go through some hoops for meds not on their formulary, but then they are reasonable. And I can get them all by mail - or at the local VA if I need them in a hurry. And the copay is very reasonable - much lower than the insurance I had when I was working.
ReplyDelete