What is wrong with US Insurance Companies?


#1

I got a prescription from my endo for 7 tests a day (I asked for it, it didn’t come naturally, I must clarify). I had the pharmacy (I go through Liberty Medical) put the order and the insurance company (United Healthcare) said they could not process more than 4 strips per day for orders served through regular pharmacies -what is wrong with this picture?

I mean, isn’t it in their best interest to have me test as often as I can, so as to maintain better control? Why on earth would it make sense for them to NOT process 7, 10, 20 strips per day if needed? Unless… of course, their main interest lies not in their customers being healthier but rather sicker, so that they can get more … business?? I don’t know: I just can’t figure it out.

I have to get on the phone with them today to try to get an explanation. I will share back again when I’ve heard the “official version”. Right now, I am quite simply outraged.


#2

I’d be outraged too! My sons is written for 10x a day


#3

That is why I test when I can afford and dont currently see a Dr at all. Insurance companies and Dr’s all want money not the health of people. sigh… It’s just like the public school system. The kids go to school to become teachers because they love to teach children and see them learn and grow. Then, they graduate and get caught up in red tape that wont let them teach. ( unless it is prescribed by the Govt.)
Some Dr’s want to heal… they get stuck with red tape too.
It is a crappy circle of greed. vs people and unfortunately people are not winning.
MeadowLark… currently in a venting mode:( So if I offend… well we all have those days. try to forgive my mess.)


#4

There are rational explanations for it. The most notable is the fact that insurance companies typically save much more money when a patient orders a larger quantity by not using third-party providers (whether its Walgreen’s or Liberty Medical), but uses a mail-order supplier they have contracted with. Typically, this is done through large suppliers like Caremark or Medco Health, but sometimes they operate their own mail order pharmacy operations.

As for the question about whether it’s in their best interest to have you test as often as you can so you can maintain better control, the answer isn’t quite that simple. Although better control does reduce costs for insurers as far as the big picture is concerned, it costs them significantly more in up-front costs (they still must pay for the patient to get the tests, supplies, meds, doctor’s care, education, etc.). Think about the company’s perspective on this. You want to maximize your return to shareholders, and while getting patients with diabetes to better care for themselves does prevent long-term complications, only a portion of those will actually develop complications on their dime. A significant number will change jobs and therefore change insurers, or will go on Medicare and the Government will end up paying for it. Their goal, therefore, is to minimize their expenditures on care to the maximum extent possible. Its an actuarial equation for the insurer, nothing more. Its about minimizing risk and maximizing revenues. They really could care less about the patient.


#5

I had an issue with Liberty too - called them up prepared to scream that they thought 4xday was enough when my endo wrote a script for 10x. As soon as I got on the phone, they said, “Oh, wait, you’re type one? No problem.” It did have to be mail-order though - which was OK by my because I’d rather get them 3 months at a time…


#6

I’m sorry you are dealing with this, Manny. I feel blessed that we never have dealt with these issues in the past 5 years. We get our scripts through the local pharmacy after trying mail order and having it fail miserably. The people in the pharmacy know me by my first name and have been very helpful. We never pay any out-of-pocket costs for Ted’s supplies. I wish it could be this way for eveyone who has a chronic condition. Good luck today and let us know who you fare with the insurance people.


#7

I see your point, Scott. I understand they are running a business.

My problem is that I don’t think healthcare should be treated like a business… but that’s a whole other discussion! :slight_smile:


#8

I will have to agree with Manny, I sell insurance for one of the bigger companies around. I feel so discouraged at times, one would feel like a leper when you disclose u r a diabetic, when in reality we probably take better care of ourselves than those who do not have this. Wth group insurance, its not so ban…but just try to become self insured and thats when the nightmare begins. Some good nes thouge, I began using the inhailable insulin, and I love it. Comments welcome.

Andy


#9

Excuse the spelling, thoughts come faster than correct spelling.