17 February 2016

I never met a health insurance company I didn’t hate

And I think I never will. Here’s how I learned how to loath the big company that provides my prescription medications under Medicare, Part D. MPD, as you may recall, is the prescription drug benefit George W. Bush rammed through congress. Coverage is not provided through Medicare but through private health insurance companies. That’s in accord with the economic religion practiced by Republicans.

Initially, my coverage started well. My physician prescribed generic medications. My insurer paid, and my co-pay was around a dollar a refill. Had I needed a $100 a pill superdrug for something serious, I expected to go broke and probably file for bankruptcy.

But I never expected what happened to me in the last two weeks. My pharmacy, and evidently my insurer, started using software to screen my prescriptions for drug interactions. That’s not a bad idea, but it can work out badly if minor interactions receive the same size red flag as major interactions.

In my case, it did work out badly.

The screen flagged two generics I’ve been taking twenty years. Apparently one study — not yet replicated — reported a interaction that increased reports of muscle pain by a factor of 25: from 0.2 percent to 5.0 percent. I’m not having any muscle pains, although my sphincter began to tighten as I learned more about the situation.

Because the software flagged a possible interaction, my insurer refused to honor its policy and pay for my prescription without a release from my doctor. My pharamacy faxed the release to my physician several times. No response. The pharmacy learned of the situation on 29 January, but didn’t tell me about the red flags until late on 11 February, after I had met with my doctor and had him renew the prescription that triggered the red flags.

By Monday I’d been out of the medication for several days, which was the worse case scenario. Fortunately, I had enough money to pay the full retail price — a sky high, gouge the sick price — so I’m back on my medications, following doctor’s orders.

Tomorrow I’m hand delivering the necessary paperwork to my physician. I think he can get it straightened out. And my pharmacy promises to ask the insurer to pay up. But a lot of things could go wrong.

Thus, I’m worried. And I’m increasingly steamed. But I’m not surprised. Private health insurance companies exist to make money for their stockholders and high riding executives. They do not exist to provide a medical service. Their operating model is the same one all insurance companies employ: collect premiums, deny benefits.

What I never will understand is why this is the kind of health care system my fellow Americans want, vote for, and cheer.

P.S. I’ve withheld names to avoid a lawsuit from the insurers. My pharmacy made a couple of mistakes, but otherwise has been helpful. And my physician, whom I’ve known for decades, joins me as one of the two people being screwed by the insurer. Hillary Clinton defends this health care system. That's a major reason why I support Bernie Sanders.