Yesterday, I went to the doctor, and he prescribed medication for reflux disease. When I went to pick up my prescription, the cashier told me the pharmacy could not fill it until they received authorization from the doctor. I asked whether the doctor's prescription was not authorization. It turns out, according to the pharmacist, that the insurance company will not pay for the medication without a written justification from the doctor.
Rather than needing doctor's authorization, the insurance company was rejecting his authorization. So, I get no treatment for my reflux, which hardly seems fair, but the situation is exasperatingly complicated.
It could be that my doctor, under the influence of pharmaceutical reps, prescribed an expensive medication that is no more effective than cheaper alternatives. If so, it may be in the best interest of everyone, except the doctor and pharmaceutical company, to reject payment for an expensive medication that offers no additional benefits over other medications. Praise to the insurance company for holding the line on costs.
It may be that the doctor knows that the new and expensive medication is more effective and has fewer side effects than alternatives. He may have prescribed what he feels will promote my health and healing better than any other treatment available. In this case, all thanks go to my doctor, and the insurance company is really quite evil.
Or, it could be that the insurance company rejects any expensive treatment with the hope that patients will give up and find cheaper treatments or go without treatment. This, of course, might save money in the short run, although rejecting claims costs money in itself. Sometimes, rejecting a claim is more costly than simply paying it. the amount of staff time and resources tied up on this one prescription is enough to give one pause. The pharmacy says the insurance company won't pay for the prescription, but I did not press them on how they know this. It is possible they simply consulted a list of preferred medications. It may be that they checked a computer database. Or, they may have actually made a phone call. Any of these options require employee time.
After determining that the drug was not a "preferred" drug, the pharmacy faxed a form to my doctor. If things go as planned, a member of the doctor's staff will obtain a statement and signature from him before completing the form and faxing it back to the pharmacy. This is an inefficient system at best.
In this case, the patient, me, is going without treatment for reflux, which is causing real problems and can lead, if untreated, to serious problems such as esophageal cancer, which frequently terminates in death. So, who is to blame for the suffering of the patient? Greedy pharmaceutical companies? Doctors under the influence of greedy pharmaceutical companies? Greedy private insurance companies? Or pharmacists who raise problems when there is no problem? I really don't know the answer.
2 comments:
Hi,
When you have reflux it is better to avoid chemicals in your body due to their side effects. And if being treated by the chemit's remedy gives you so many problems your health state will be worsen.
I am accustomed to treat myself with natural remedies that are not so agressive for my body, and because in my culture (Spanish) we use a lot of herbs to treat ourselves.
These are some natural remedies for REFLUX that will help you put out the fire in the chest from heartburn:
- Take a pinch of freshly powdered cinnamon and spread it on toast. Add to it a pinch of cardamom powder and a few raisins. Chew slowly. It helps to calm and soothe the stomach. It also has an antiseptic effect and fights against Candida albicans.
- Drink plain water
- Take apple cider vinegar
- Drink infusion of chicory
- Chew dried skin of grapefruit
- Chew gum
- Sleep on the left side, raising the head of the bed ten inches higher than the foot of the bed
- Take all foods and drink in moderation
- Take all fresh fruits (specially pineapple) and vegetables - except citrus fruits-, legumes, wholegrain breads and cereals, and plenty of fiber.
- Don’t take: tomatoes, raw onions, raw garlic, fresh peppermint, citric fruits like lemons or oranges, and avoid all fats and oils, neither foods that contain acidic food or gluten.
And get accustomed to the ones that work for you.
Best,
Bicabel
About ethics, health and medication.
In Spain, till about 5 years ago, in our public Health Care Service (Seguridad Social) doctors used to prescribe the most expensive medicines to their patients, because they received very high commissions from chemical companies. After the abalanche of inmigrants in our country, as anybody here has the right to use this public service although they had never contributed to it, the income of the S.S. has increased so much that there is not enough money to keep the rythm of cost expensive medicines had. Now the government campaigns for the prescription and use of generic medicines to reduce costs.
As our S.S. has got the same quality as one of the best private one in other countries, going to a private doctor or clinic means a luxury you can afford. So insurance companies don’t pay for medicines. If you need a treatment and the prescription comes from a private doctor you must pay for the medicines, too. Although most people go to thier General Practitioner / Family Doctor and get that prescription from them, that usually don’t refuse to do.
But I think they most important problem here is that in Western countries people usually abuse of medicines without taking into account that we are reducing the income that could be dedicated to more investigation, long and expensive cures, and highly cost surgery. We cannot reduce the expenses of a treatment that can save the life of patient, but as individuals we must do a conscious use of medicines. I believe we should only take them just in the case we cannot find a natural remedy for our medical problem, and not the opposite, as most people are doing nowadays.
Natural remedies are usually cheaper and , at the same time, less dangerous for our vital organs than medicines from a chemical company, where its efficacy has been increased as much as its secondary effects. Chemical medicines are very effective for the good and the bad. Our Western medicine doesn’t treat our body as whole, but just tries to repair the leaks. While taking a natural remedy we are giving time our body to assimilate it better, although it takes a longer time to soothe the symptoms, the side effects don’t exist or are lessened.
You’re were right to get angry, when you could not get the medicine you needed in that moment for whatever reason. But next time, please, think if could take a herb, a fruit, a vegetable or any other present from the orchard/ greengrocer, instead. …Your body will be much more grateful to you!
Best,
Bicabel
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