Insurance company tattles

[happy2bretired]

This is a new one for me. Yesterday I received a letter from my internist. He enclosed a letter that he received from my insurance company. The insurance company notified my doctor that I hadn't refilled my prescriptions as often as they thought I should. Gee...now I have to think about my insurance company tattling me out on how often I take me meds.

I take a bone med for osteopenia once a week and I do miss once in a while but I was really surprised that my insurance company would rat me out to my doctor.

Is this a common practice?

 

[TromboneAl]

They'll send a letter to your wife if you go through your Viagra too fast.

 

[SteveL]

Imagine the near future, when the chip in the pill bottle sends a message to the Dr. that you didn't open it today.

 

[brewer12345]

Dunno if it is common practicem, but with many chronic/long term conditions "patient compliance" is a huge problem for caregivers. In the case of diseasesthat are relatively easily controlled/managed if you just keep up with your meds, insurers and caregivers have gotten religion and are working on making sure you control your disease and try to help. I know that at least in the case of diabetes there are companies taht specialize in helping improve patient compliance.

 

[happy2bretired]

Dunno if it is common practicem, but with many chronic/long term conditions "patient compliance" is a huge problem for caregivers. In the case of diseasesthat are relatively easily controlled/managed if you just keep up with your meds, insurers and caregivers have gotten religion and are working on making sure you control your disease and try to help. I know that at least in the case of diabetes there are companies taht specialize in helping improve patient compliance.

Yep...I think that's what's going on. The letter sites potential medication noncompliance. I agree that taking your meds is important. The insurance company doesn't want to shell out big bucks later if your condition worsens from not taking your meds correctly.

I suppose if you skip enough times, that they could possibly stop covering you for that condition?? Maybe..? Anyway, it's interesting that they are getting more involved in this. I just don't like taking the stupid pills.

 

[Nords]

They'll send a letter to your wife if you go through your Viagra too fast.

Just as long as they don't send copies to my girlfriends...

 

[freebird5825]

we get courtesy calls from the drug store asking if we want the Rx refilled. it's an automated system. i thought that was kinda cool.
but the insurance company ratting on ya to the doc? that sounds like a prelude to looking for an excuse to deny coverage. sheesh!

 

[travelover]

Some insurance companies allow auto refill via US mail. Maybe you could sign up for that and dump the excess pills in the toilet.

 

[stargazer08]

I find that amusing...your insurance company calling your doc about your lack of Rx refills considering they are the same entity that limits the number of pills you can obtain on some meds. My insurance company allows me 4 migraine pills per month. Like I have any freakin control over how many headaches I get. To top it off, my wonderful Rx discount gets me these pills for 21 bucks each.

 

[mickeyd]

notified my doctor that I hadn't refilled my prescriptions

Wait until we are all enrolled in a federal universal health plan. The feds will probably withhold your IRS refund if you have not taken all of your meds in a timely manner.

 

[CuppaJoe]

My HMO won't allow re-fills that are too soon; it's a pain because I have to re-fill each prescription one at a time; but have them mailed instead of going cross-town on two buses to pick them up.

Pharmacists are very careful; I went to fill a prescription for antibiotics from the dentist and the pharmacist at Walgreen's told me I should get it from my HMO; I gave her the transit argument and she filled it.

 

[happy2bretired]

Some insurance companies allow auto refill via US mail. Maybe you could sign up for that and dump the excess pills in the toilet.

This is a mail type prescription program. I have a doctor's appt in December so I'm gonna ask my doctor about this then. In the mean time, I have 3 more weeks of pills to take. I'd better refill now.

 

[jug]

I've had this happen to me, no big deal, just chuck it and go on with life. My doctor said they were crazy to bother him with this waste of time.

Jug

 

[bubba]

Wow, I didn't realize that insurance companies would do this and frankly I'm not sure I'm comfortable with it. But, Brewer makes a real good point about the noncompliant issue. Better fill the rx and then take it or not as you see fit. I think it is still your body!

 

[mickeyd]

My HMO won't allow re-fills that are too soon; it's a pain because I have to re-fill each prescription one at a time

I had this same problem years ago, but have managed to blend in all 7 of my Rx as I can reorder approx. 60 days after the last time that I filled up. I just figured out what the most recent refill was by looking on the label on the bottle and called in all 7 at once. Since some were 75 days, others 70 days, and one was 60 days, I refilled all 7 on the same day.

Now all are ready to refill on the same day in 60 days or so.

 

[Brat]

I probably take the same ostio med as the OP. What irritates me is that the mail order folks dispense in 3-4 week packages and call that a 90 day supply.. they short me one month a year.

Thanks for reminding me to refill before the end of the year as I intend to switch insurers from BC.

 

[Rich_by_the_Bay]

I get these letters from time to time about my patients. It did strike me as a marginal thing to do. On the surface it just seems like a nice thing to do - help keep you on track by tattling to your doctor. But, pardon my cynicism, keeping the drugs flowing is also in their best financial interest so their motives may not be pure.

Also, some patients choose to obtain their drugs outside the reporting plan (sometimes the co-pay is almost as much as the medication cost). Or maybe you use your spouse's plan instead of yours. Or maybe a $4 generic at Wally World.

It also makes my feel that it is my duty to call the patient and say "Hey - your drug insurance notified me you are not refilling your pills as often as you should." Awkward at best, yet another administrative task to add to the to-do list, and unproven as to its value.

My personal feeling is that they are a financial intermediary, your decision about if, when and from whom to obtain your pills is none of their business, and that it's between me and my patient. If they are going to do this at all, they should notify the patient and ask permission to notify your doctor as well.

 

[marvholly]

Rich
I am on an HMO w/ drug coverage. I take a med that 1 month supply on my insurance is $10 for the generic. With all the CHEAP generic drug fills available I can actually buy a 100 day supply for <$10.

What do you think I am buying/paying?
If my druggist/ins co EVER contacted my Dr i would REPORT them for violation of HIPA regulations, sue them for $xxxxxxxxx and be able to retire VERY early in the laop of luxury.

 

[Rich_by_the_Bay]

Rich
I am on an HMO w/ drug coverage. I take a med that 1 month supply on my insurance is $10 for the generic. With all the CHEAP generic drug fills available I can actually buy a 100 day supply for <$10...If my druggist/ins co EVER contacted my Dr i would REPORT them for violation of HIPA regulations, sue them for $xxxxxxxxx and be able to retire VERY early in the laop of luxury.

Well, don't know about the suing part , but yours is a typical situation I had in mind in my comments above.

 

[marvholly]

If I EVER receive such a letter or my Dr gets one or a call I would be on the phone to my brother, the $600/hour attorney ,so fast the insurance company lawyer's heads woudl spin. I REALLY suspect this is a MAJOR HIPA violation and would be willing to put money where my typing is.

Privacy is Privacy and if I cannot call a hospital to check on a relative admision wise how can an ins company question how often I am filling an Rx to my Dr for all the reasons (wally $4/month, spouse plan....) you noted? i cetainly do NOT want my Dr wasting his time following up on that kind of .....trash and/or playing phone tag w/ me. his time would be MUCH better spent w/ his family, relaxing and/or taking CEUs.

 

[Rich_by_the_Bay]

Sentiment understood and agreed. But HIPAA has provisions for sharing medical data if such sharing is part of the daily operations of the health care entity. This includes prescription fulfillment, computerized record upkeep, billing, etc.

Not being a lawyer, I can't say if sharing medication non-fulfillment falls under this protection or not. In any event, I see I am not the only won to raise and eyebrow toward this practice.

 

[clifp]

If I EVER receive such a letter or my Dr gets one or a call I would be on the phone to my brother, the $600/hour attorney ,so fast the insurance company lawyer's heads woudl spin. I REALLY suspect this is a MAJOR HIPA violation and would be willing to put money where my typing is.

I am no HIPA expert, but I am curious why you think this is a violation.

Presumably you filled out some paperwork and the doctors office agreeing to allowing them to release your medical information to the insurance company.

I can't imagine an insurance company agreeing to reimburse a claims without knowledge of your medical history. "Dear Blue Cross please pay me $100,000 for the treatment of the patient you are covering, sorry we won't release his records you have to trust us that it was all necessary."
Obviously your Doctor has access to your medical records, how is your privacy being violated?

It is not much different than if two of your doctors discuss your treatment,and one doctor tells the other "Joe tells me he stopped taking the meds you prescribed, do you take him of them? Hell no the idiot will kill himself if stops taking them, I better call him up."

I agree that this is a bit too big brotherish for me, but I not entirely convinced it is a bad thing for society at large.

 

[harley]

I am no HIPA expert, but I am curious why you think this is a violation.

Presumably you filled out some paperwork and the doctors office agreeing to allowing them to release your medical information to the insurance company.

When I was doing network security I was at a conference and took a 1/2 day class on HIPAA. I didn't need to know it inside and out, since I wasn't in the medical field. However, just in that short time I saw that the intricacies of the law would pretty much ensure that nothing ever got done properly. I'm suspect there are provisions for that kind of info sharing. However, if one did wish to pursue a lawsuit a whole new class of lawyers has sprung up just for that purpose. Or Marvholly, you could just send your money to me. Either would accomplish the same thing (nothing) from your point of view.

I agree that this is a bit too big brotherish for me, but I not entirely convinced it is a bad thing for society at large.

Big brother is always a bad thing for society at large, IMO. But it's like trying to hold back the tide.

 

[mexmeme]

One of the main reasons I don't go to doctors unless I feel sick. Now there are studies that seem to recommend Crestor for the majority of the population. I have never had to take daily meds, except for hormone pills and I stopped them after 6 months--couldn't remember to take them--turned out they were bad for me, or so the studies state. I am a fatalist and will take my medicine when appropriate, but sure as shootin' if I see a doctor without a complaint, they will put me on something I'd really rather not take.

 

[Bestwifeever]

This is a new one for me. Yesterday I received a letter from my internist. He enclosed a letter that he received from my insurance company. The insurance company notified my doctor that I hadn't refilled my prescriptions as often as they thought I should. Gee...now I have to think about my insurance company tattling me out on how often I take me meds.

I take a bone med for osteopenia once a week and I do miss once in a while but I was really surprised that my insurance company would rat me out to my doctor.

Is this a common practice?

One thing that bothers me about this is what if you got your prescriptions filled outside the insurance company? Our prescription insurance requires us to use a certain mail order firm in order for us to be reimbursed (who wants to bet that the mail order firm is owned by the insurance company?). However, those generic prescriptions are the same price or cheaper at $10 for three months' worth at Wal-mart and Target, even though they are not reimbursable. So what if you get your meds outside the insurance loop? You are still taking them but the insurance company is falsely tattling on you to your doctor, wasting everyone's time.

Maybe a little off topic, but a couple of years ago I mentioned some minor temporary back pain to my doctor during my physical. A couple of months later the insurance company calls me and wants me to work with their staff nurse, not face to face but on the phone and following their online program and reporting in to them. Completely outside the loop with my doctor. I told them I wasn't interested in their taking over my care (that should kill my chances if I ever need to get individual health coverage).