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Tuesday, May 22, 2018

HEALTHCARE HORROR STORIES

Over the course of the last several years, I have had a rather sudden exposure to our Country's healthcare industry. I have met some great healthcare workers from nurses to doctors to technicians and everyone in between. I probably wouldn't be here without those people. After three strokes, a heart attack and a cancer scare  , I feel very fortunate every morning I wake up and put my feet on the floor. The people  I have met and the services I have received along the way for the most part have been exceptional, and I might even say amazing when you see life saving  technology in action,
but dealing with insurance issues have sometimes been a nightmare.

 The latest happened yesterday.

I have been under the care of an outstanding Opthamologist who in my opinion has been working miracles to save and restore my eyesight. Yesterday I had an appointment with him and he noticed my eyes were irritated and I told him I thought it was just allergies from all the spring pollen.

I guess it has been a tough spring for many with allergies and he offered to prescribe allergy drops for my eyes.

OK, so far so good. Relief , I thought, was in sight, No pun intended.

Before I reached the parking lot from the Doctors Office, I was already getting an automated text messge from the Doctor's Office, confirming that a prescription had been sent in to the Pharmacy I use and it included a link to a phone app, GOOD RX, to check pricing and other information on the prescribed drug.

Good Rx  is a great app and I look at it often to look up prescriptions as well as instructions and side effects. It is a great resource and the "GOOD RX" app is free.

So anyways, I was a little surprised when the Pharmacist called and said Insurance needed a "Prior Authorization" from the Doctor before they could fill the prescription.
I had already looked up pricing on GoodRx. so I said to the Pharmacist that I was a little surprised that they would require a "Prior Authorization " for a $63.00 prescription.

I was floored with her response. She said $63.00 was the price if I paid "out of pocket" , since it was going through Insurance, the price was actually $210.59. An almost 300% markup on eyedrops. ( And loansharking is illegal, this should be also) This should be criminal to gouge the Public like this and if it was any other business the Justice Department would be investigating and indictments would be forthcoming.

And this is just one of many examples I could give. I had one prescription that I had been paying out of pocket before my stroke, my cost was $28.00 and I gladly paid it After my stroke, my Insurance company refused to pay for the $28.00 drug because "It wasn't part of their protocols", whatever that means, I guess that might be Insurance speak for "we don't get kick backs from that company". But instead they were willing to pay for a comparable substitute at almost $1,000.00 a month. $28.00 or $1000.00. big Insurance opts for the $1000.00 alternative

And we wonder why the system is broke

Our Insurance system is broken and needs to be fixed






2 comments:

Anonymous said...

Welcome to the ongoing scam that is healthcare and pharmacy benefit managers that are allowed to call the shots and harass licensed MD's over their scripts. All illegal .Its totally illegal to change a prescriber's rx in any capacity be it quantity or med and its illegal to write an rx for patients without being licensed to prescribe and an examination yet these PBM's with no more than HS diploma's do just that under the guise of PA's and limits of meds or types of meds with impunity,no exams and no license to write an Rx in CT. Since it all went state side with obummercare there is no real regulating authorities in the state anymore..they all get kickbacks and the greedy corporations rob the people they call membership and harass us over our legal and valid prescriptions and deny access to scripts (and they call this the "free world")..Shame on the politicians who claim to rep the people yet have allowed them to get this far with this nonsense and double that shame for the CT regulators who get paid on tax payer dimes and do nothing about any of it for CT residents..

Anonymous said...

Kevin, that's why I use Yales pharmacy. They do a great job finding coupons and deals for me. I used to use CVS (690 Weathersfield Ave) to be exact. Nothing but issues, and over pricing on meds. Express Scripts is good too. You can save a lot by using their service vs your local pharmacy.