JohnP said:
I'd start by looking at the costs of the forms processing between the Dr's offices and the insurance companies for a real eye-opener, as highlighted by CFB earlier.
You're getting there.
Look at my current travesty at getting Blue Cross to pay for Lunesta.
First the doc wrote the prescription. Pharmacy says its not on BC's approved list, so I have to pay for it or get the doctors office to do a 'pre-approve' with the insurance co. Pharmacy says it'll probably take a week due to the upcoming christmas holiday. Six weeks later after three phone calls and a stop into the doctors office, they confirm that I have to try two approved meds before BC will take the pre-approve. She says its taken 6 weeks because every time she called BC, they put her on hold for half an hour or hung up on her while she was on hold. This is all quite interesting, because I have long term insomnia that has resisted every other treatment, and there is only one prescription drug approved for long term insomnia...lunesta. So I can certainly TRY two other meds, but none of the approved ones are effective for more than 10-14 days. Someone explain that logic, please?
So my first drug is temazapan aka halcion aka restoril. Banned in almost every other country outside the US (where the manufacturer resides, btw) because its been linked to aggressive behavior and people killing their families and whatnot. Sorry about those posts a few weeks back, by the way. That actually works but I cant remember anything the next day and have trouble picking things up and hanging on to them, and as described in 10 days it just stops working. In fact, I couldnt sleep at all for 2 days due to rebound effect.
So they give me ambien. Another three stooges situation. Turns out Ambien isnt on the approved list either, but the doctor (who apparently didnt know or check) prescribed it to me anyhow and the pharmacy filled it and sold it to me with the BC co pay amount. So the doctor prescribed me an unapproved drug as part of the approved drug cycle, the pharmacy either didnt check with BC before prescribing or BC gave approval in error. So two or all three entities involved made a mistake. Who wants to bet that somewhere along the line I get a bill for $70 (the diff between the co-pay and the drug cost) from someone who got left holding the bag and that becomes MY problem?
Ambien gives me a perfect 8 hours, after which I am as lazy as I can ever imagine being, which is good because if I could summon up any motivation, I'd want to throw myself off a bridge. Deep, severe depression. I take it for three days and then tell the doctor I cant take another one. Actually my wife told me to call the doctor and tell him I wasnt taking another one.
At this point they're not sure if taking one approved and one unapproved drug constitutes fulfilling the two drug cycle requirement, or if I need to take a third that IS approved. I now have $200 worth of drugs BC has paid for that I am going to throw out. Further, when I mention that the 2mg Lunesta the doctor originally prescribed and I paid for out of my own pocket might need to be bumped to the 3mg dosage, the doctors admin thinks we would need to start the whole process over again with two more drugs and all new paperwork. That was about 2 weeks ago. I havent heard anything from them since.
So figure for yourself how many people, how much time, how many forms faxed, phone calls made, etc just to get me approved for the only prescription drug available that is effective for me and approved for the use I need to put it to.
I'd almost be happier if they just said right out of the chute "We dont cover new expensive drugs like this". But the allure of the insurance company actually paying for my $1200 a year prescription meds and my growing fascination with this incredibly inefficient bureaucracy keep me hanging in there. By the way, there is nothing obvious to me in the blue cross marketing crap you get when buying a policy that says they get to pick and choose your prescription drugs, to the extent of asking you to try cheaper older crud that has side effects and isnt even appropriate for your situation or condition.
By the way, guess which industry uses the most paper every year? The medical business, with most of it going between them and insurance companies. You should see the healthcare breakdowns for costs...paper actually makes a significant piece of the pie.
Huge bureauracy. Tons of forms. On hold for a half hour. Procedures that make no sense at all. People eating, drinking and smoking too much, or not wearing seat belts or helmets but expecting the insurance company to rivet them back together again when they crash, people who cant let a loved one go, doctors who wont throw in the towel when its a lost cause, doctors who take it personal when someone dies and will do everything to prevent that, unnecessary tests, lack of worthwhile preventative care.
And yeah, somewhere in there a few percentage points of uninsured people, immigrants, and legal costs.
