The bold one is correct.
2 Likes
âIâm confused as to why anyone would think I WOULD know?? I believe what my Insurance and my medical team tells me until I figure out that I canât trust them to look out for our well being. I think the best of everything, and everyone, until such time that I figure out I shouldnâtâŚthis is case in point. Lesson learned now.â
Because you are already using Humalog and Lantus. Why the change in price with the switch to a pump? Or had you not noticed? Just trying to figure out the sudden price change. It doesnât make sense.
I go online with every rx I need and find out what my cost will be. Then deal with finding an alternative - the preferred isnât always the cheapest. I pay full price for everything until I hit my high deductible so Humalog - the only fast acting insulin they will cover at all - is well over $400 per box. I stock up when I travel out of the country.
It never occurred to me that my doctor or med team should keep my rx costs down. They canât possibly know every different plan under every different ins co. I was the first person they ever had in their office who didnât have a co pay of some sort for a dr visit. I pay in full.
1 Like
Yes, the exact same thing happens to me. My doctorâs office constantly writes my insulin prescription for 30 day refillsâŚwhy would you ever write a long term diabetic 30 day refills for insulin. CVS then jacks up the price because because itâs a 30 day refill. Just reminds me that most people in the medical field are complete idiotâs.
Many prescription plans only cover 30 day supplies of medication. If you want a 90 day supply and your insurance covers that-- you just need to inform your doctors office to write 90 day prescriptions. They are likely just looking at the last prescriptions in your chart and seeing that theyâre all 30 day and continuing the pattern. Or if you have an insurer that is known to them and only covers 30 day supplies they may just me going on that knowledge.
If your plan does cover 90 day supplies, at a lower cost overall to you, and your doc keeps writing 30 day scripts-- you just need to let them know. Doctors offices have staff that deal with these exact things all day long. Itâs not their role to just intuitively assume the fine print of your prescription coverage-- just give them a call⌠If youâre the one continuously overpaying for your insulin Iâm not sure how that means âmost people in the medical field are complete idiotâs [sic]â
With my caremark plan I have to do mail order to be assured of the lower cost⌠Otherwise itâs hit or miss, sometimes I could pick up at a cvs (if one was nearby) for same costâ other times itâs way more unless I use mail order.
1 Like
We would have continued using Humolog for our sons pump had my wife filled that prescription and not began asking questions we didnât know we needed to ask.
If you donât know, you just donât knowâŚwhether you should know, or not.
I agree. As in anything we purchase, itâs incumbent upon us as consumers to be fully informed of our options.
2 Likes
THIS!
Add to this fact that what your health insurer covers and when they cover it can change multiple times at the drop of a hat. It is simply not realistic to expect your physician or D-team to know and keep up with this information. To do so would require more than one additional staff member working full-time.
Figuring out what your health insurer covers is your responsibility. I fight my daughterâs health insurer on a nearly monthly basis in order to get the same damned insulin and supplies. Welcome to the world of effed up medical care due to the astonishing greed of health insurers. They are robbing us dead.
1 Like
Unfortunately many doctors are ignorant or actually donât care what the costs are to the patient. It falls to us as patients to know all that and make sure the doctor makes a decision that is in our best interest. And we have to be on the lookout for scams. You have to watch that a doctor doesnât order a test that is not covered or a medication that is not preferred or not covered and the worst scam of all, out of network providers. And the worst culprit with out of network providers, hospitals. You can go and demand that they write on your chart âNO OUT OF NETWORK PROVIDERS,â but they seem to ignore that and just use whoever is around and we as patients are left holding the inflated bill.
Health care costs are not transparent and we as patients (and society) suffer.
1 Like
Can you stop with the doctor-bashing for just one single day, Brian?
You truly have no idea how many âunbillable hoursâ doctors and their staff spend fighting health insurers tooth and nail to get the best medical care possible for our patients. When I first hung out my shingle, this unreimbursed task took approximately 5% of my work time. This has steadily increased and now consumes (I exaggerate not) over 65% of the 50 to 70 hours I live in my office each week. I swore Iâd quit and start selling Avon products door-to-door well before I spent over 25% of my time as a physician on hold for the privilege of trying to convince some asshat without an MD after their name why my patients need a particular test or medication or more follow up appointments per year. But here I am, still beating my head against this brick wall until it bleeds, only to repeatedly read comments like yours that call physicians ignorant and uncaring.
Just please give it a rest every once in a while. You have no idea how much your comments tear me to pieces while I continue struggling to care for my patients at a personal cost that is higher than you can likely imagineâŚ
1 Like
Sorry, this has been my experience. And it has been repeated over and over again. But you are right, it isnât just doctors. And doctors do generally try to do the right thing. But they often canât or donât want the extra work. How is a doctor supposed to know what is or is not covered as in or out of network and each patientâs different formulary? But I have had doctors knowingly order services that were out of network and uncovered without informing me. I had my sleep doctor fall out of network and not bother informing me. Iâve had hospital visits with my orders for only in network services be ignored. Doctors in general have no idea what a patient will pay for a prescription. And now I have my doctors ordering my prescription electronically, I canât even review them before they are filled. Iâve probably spent thousands of dollars due to being prescribed a medication only to find it isnât in the formulary or non-preferred. I just have to suffer the consequences. The entire healthcare and insurance industry seems designed to make sure the patient cannot know the cost of their care before they are billed.
And donât even get me started on balance billing.
1 Like
I just feel that the telephone call I jokingly stated aboveâŚthe conversations I listed, could have honestly very easily been done between medical staff and my insurance and it would have lasted 30 seconds. I know I am probably living in la-la land and this isnât reality and NOW I realize, that, in addition to ensuring doctors are âin networkâ, I also need to make sure Iâm being prescribed the correct medicines, in the right doses, etc., etc., All things that I honestly would think the patient would have NOTHING to do withâŚsince, as you mentioned, they donât have MDâs after their names. I hadnât ever heard of Humolog or Novolog before T1, but Iâm sure my Endo hasâŚI just think everyone putting responsibility on the patient is all good and well, but I donât think that resolves the communication problem that I think exists between medical establishments and insurance to LOOK OUT FOR THEIR PATIENTS FINANCIAL WELL BEINGâŚas well as their physical and mental well-being.
ButâŚas has been pointed out here repeatedlyâŚitâs something I guess I just should have knownâŚthat 100% of everything pretty much falls on our heads.
If âDoctors in general have no idea what a patient will pay for a prescription.â, believe me, it ainât for lack of trying!
Please remember that, even as physicians, we are patients, too (and are PWDs and mothers and fathers of children with diabetes and other horrible diseases). So we actually do know, intimately and all too well, the financial and emotional costs of dealing with health insurers. I beg you to please remember that your doctors are firmly part of the âWEâ in the âWE V. THEMâ battle for adequate health care.
You are right, it is unreasonable to expect a provider to be all knowing. But you also need to see things from the patient view. I realize this places a burden on you and you spend a lot of time dealing with insurance to get reimbursement. But doctors have some level of duty to help their patients navigate the system. A patient hit with a huge bill for a medication is just going to stop taking the medication. This is just part of the landscape. I expect doctors to be transparent. They should tell me if they are in or out of network. They should not have the freedom to just order services or medications without my ability to know their costs. We are dealing with a system that seems to use active deception to keep prices opaque and cause us greater expense. I personally am not happy out this. But you are right, doctors are just a cog in the system and I am sure they are represented by some of the whack jobs I have encountered.
The âcommunication problem thatâ you âthink exists between medical establishments and insuranceâ consists of the fact that health insurers simply wonât listen no matter how slowly we physicians speak, no matter how clearly we annunciate, no matter how many Progress Notes and Medication Flowsheets and peer-reviewed meta-analyses we submit to prove our patients need this particular medication or diagnostic test or surgery. Health insurers are deafened by the fact that it will cut into their profit margin. They donât care. But we physicians do. I simply cannot believe that I am the only physician or that I am a member of a minority of physicians that do care.
2 Likes
This is easy to explain. This is called the âprinciple agent problemâ. It is a term used when someone is spending someone elseâs money (yours or the insurance company). This is why our healthcare system is broken. This is why big government doesnât run as effectively. There just isnât an incentive to find the best value for your money.
1 Like
Goshdarnit, Brian, I do see things from the patientsâ point of view several times each and every month when I fill my prescriptions and my daughterâs prescriptions. Iâm sure that every physician who takes a prescription medication or has a family member who takes a prescription medication (which I believe encompasses a majority of physicians) does.
I am becoming close to done with trying to explain this. If you or anyone else wants to believe that doctors are stupid, lazy, uncaring, wealthy SOBs who spend their Wednesdays golfing followed by laughing on their way to the bank, then nothing I can possibly say will convince you otherwise.
1 Like
Iâm not a physician but I tend to assume that expecting my PCP or endo to stay current with the ever-shifting formularies among the dozens of insurers their patients come in with is kind of unrealistic. Judging by the number of shocked and outraged threads devoted to formulary changes around here, itâs a topic not altogether unfamiliar to us as patients and weâre only dealing with our own plans.
1 Like
Itâs not easy for anyone.
Daughters insurance stayed the same when we abandoned our grandfathered plan this year for ACA.
She got a new number. Same benefits. Just a new number.
A provider she has been seeing for six years started to charge her nearly double for quarterly office visits.
It took two hours on a three-way phone call between the provider, insurer and myself to come up with a solution.
Part of our problem is the fact that so many claims are now processed electronically --without human eyes or hands.
Another part is the poor service the provider receives when calling the insurer.
Let alone our wait time on hold to get thru to someone in insurance who actually can track down the info!
I respect all doctors. If not for them, we would have much smaller life spans. I get a feeling that you are a very special doctor, and person. Your care and concern, from all that Iâve observed in my short time here, go above and beyond what I see most doctors exhibiting. This may be partly due to your living daily with this disease, or this could be just who you are. But I do think there are a LOT of doctors out there that do just what youâve stated above. 
JUST NOT YOU! 
3 Likes
GeeâŚnever thought of that.