Wednesday, November 21, 2007

The Pitfalls of Reduced Cost Health Insurance

We need to avoid pitfalls like this if we want Universal Health Care in this country.

Those of you who crave a real-life example to back up your arguments, allow me to submit myself.

To wit, I should have started the MAOI patch six days ago, but the Walgreens near my house lied to me twice.

Oh, we'll have it in tomorrow, Mr. Camp.


Oh, we're sorry. We didn't get it in today, but we will have it in Tuesday.


We didn't get it in, and we're not sure when it will arrive.

After being lied to twice, I took my prescription and my business to CVS.

CVS had my prescription in on time, true to their word, but I still don't have it in my hands yet. Here's why.

It's stuck in Physician Authorization (PA) status. This means that my psychiatrist's nurse will be forced to speak to my psychiatrist personally, get his okay, call the Medicaid office, give specific authorization to Medicaid by citing a precise reason WHY I need the patch and not a lower cost alternative, and then and only then will the medication be prescribed to me. Without insurance, it costs $495.

Look how poor people get screwed. Do you think most chronically ill people would have the persistence necessary to jump through all these hoops?

Here's the reason for all the fuss. Medicaid wants to save as money as it can, so by irritating doctors and forcing them to go through all this additional work, it hopes it can get them to prescribe lower cost prescriptions that won't drain Medicaid's general fund. Medicaid's general fund is always low and often it runs deficits.

One hopes that if universal health care comes to this country, it will not nearly be this complicated. I suspect, however, that it will be.

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