I gave someone a ride to the pharmacy a couple days ago. After waiting a bit, the pharmacist informed my friend that one of her prescriptions was not covered.
After seeing what it was... an important drug for her health, I spoke up and ask the pharmacist, "How can an ins. company refuse when a dr perscribed it? They are not doctors."
He said, "Good question. Sorry." My friend then had to pay $140 for her 'necessary' prescription... btw, just an FYI, she has crones(spelling) disease.
Can anyone explain this?
2006-12-18 14:23:28 · 14 answers · asked by BeachBum 7 in Politics & Government ➔ Politics
For many years now I have been calling for universal health coverage, the profit that the insurance company's make at our expense would go to paying for a fair share of the expense of it, do away with insurance company's and you do away with most of the corruption in the health care system. How often do you hear that insurance company take your money but do not like to pay out claims. They really don't care if your friend lives or dies as long as she or he pays their premium. It is a scandal that 45 million people have to live in the richest country on earth without benefit to the healing arts.
2006-12-19 13:47:33 · answer #1 · answered by Anonymous · 0⤊ 0⤋
No
I have the same problem. I have something wrong with me that the doctors can not explain. I swell up in random places of my body for no apparent reason. I have gone to different doctors mulitiple times, and each gave me different medication, and only once it was covered by my insurance. Nothing worked so I have given up. Even though the swelling is painful, especially when it is at the bottom of my foot, it does keep my body warmer. Such as if my forearm is swollen, the rest of that arm is warmer. I guess it is almost an evolutionary advantage since I live in Michigan
2006-12-18 23:29:00 · answer #2 · answered by Anonymous · 0⤊ 0⤋
there is a difference between "won't pay for it" and "requires prior authoriztion". So are you sure of what you are saying?
Your pharmacist is an expert on drugs......how you pay for them is your problem.
There is one difference between doctors and insurance companies. Your doctor doesn't have to pay for your drugs, if they did you might see a huge difference in what is prescribed!
The insurance companies do have doctors that work for them, so your statement that they aren't doctors is untrue. They make recommendations on therapy when there are multiple drugs that do the same things, or when newer and more expensive drugs just don't work better. Of course some of these companies are weasels, just trying to get out of paying for something expensive. Have your friend contact the insurance for answers.
2006-12-19 10:54:10 · answer #3 · answered by jloertscher 5 · 0⤊ 0⤋
In many instances, she can call the doctor and get a different drug that is covered and can be effective, doctors don't always have time or information to know these things, all they know is what the drug companies tell them. The patient has to let the doctor know what is happening, he does not want an unhealthy or unhappy patient. It is vital to know the conditions of your insurance 'before' you get sick, many insurers now have websites that explain in plain terms what is covered and what alternatives they have.
2006-12-18 22:49:51 · answer #4 · answered by Anonymous · 1⤊ 0⤋
I also have had this happen to me. It is unfortunate, but I do understand some of their reasons.
They will refuse if:
1. There is a cheaper alternatived
2. It isn't a widely proven med, or it doesn't consistantly work for everyone
3. It is "controversial" (most don't cover birth control pills, and they aren't that expensive - I pay $33 a month for it)
4. It is a male aid (they don't cover the pill, but they cover Viagra)
5. They just deem the cost being too much
It is wrong, it is a crock, but it happens.
2006-12-18 22:46:26 · answer #5 · answered by volleyballchick (cowards block) 7 · 1⤊ 1⤋
The insurance companies frequently specify Generic only. But some drugs (under patents) have no cheap equivalent
Go big Red Go
2006-12-18 22:54:21 · answer #6 · answered by Anonymous · 0⤊ 0⤋
If you are referring to a "group plan", these are insurance plans that are purchased from an insurance carrier by an employer. Most contracts are very specific about what is and what is not covered. Others simply state what is covered and if something is not listed it is not covered. It sucks considering the amount of money the employer and employee spend, but it's their game and we are just playing along. By their rules of course.
2006-12-18 22:31:31 · answer #7 · answered by truth seeker 7 · 1⤊ 0⤋
This is one of things that has come with the Bush administration.
Big companies (pharmaceuticals) having more power than
the person (doctor) who went to school for 12 yrs. to know
what to prescribe. Scary, isn't it? Having the fate of your
health in the hands of someone who works for the insurance
company & not a doctor.
I say, someone should try to pass a bill requiring the insurance
companies to hire working doctors to their staff. And, pay them
a doctors salary.
Crones disease is very serious. This situation is quite disturbing.
2006-12-18 22:37:29 · answer #8 · answered by Calee 6 · 2⤊ 1⤋
Insurance companies cover only certain drugs. Which drugs are covered or not covered are in the policy.
Since Insurance companies are private businesses, they have the right what is available for coverage and what is not.
It sucks for us the consumer...but we have to face the truth: Healthcare is expensive for everyone in a capitalist society, even insurance companies.
2006-12-18 22:32:38 · answer #9 · answered by Kyle 3 · 0⤊ 2⤋
Dude it's easy to take advantage of the sick.
My friend works for the insurance man and she always tells me crazy stories about the man going bogus on poor people.
2006-12-18 22:28:26 · answer #10 · answered by ? 2 · 3⤊ 0⤋