Question
What is the name of your state? Arkansas.
How can insurance companies tell doctors what drugs they can dispense and what tests they can run? How can they tell the doctor how much of the drug that the patient can take? This seems to me to be practicing medicine without a license. Any answers?What is the name of your state?
Answer
What is the name of your state? Arkansas.
How can insurance companies tell doctors what drugs they can dispense and what tests they can run? How can they tell the doctor how much of the drug that the patient can take? This seems to me to be practicing medicine without a license. Any answers?What is the name of your state?
Doctors can order whichever lab tests or medications they deem appropriate. The insurance company may or may not cover/pay for those tests/medications, dependent upon your policy specifications.
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Doctors can order whichever lab tests or medications they deem appropriate. The insurance company may or may not cover/pay for those tests/medications, dependent upon your policy specifications.
Exactly. They don't tell doctors what tests and medications to order. They simply tell them what they will pay for.
Also, doctors work for insurance companies. As do nurses and other health care professionals.
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Although I will admit that there's nothing that irritates a provider more than an insurance company second guessing the provider's decisions/treatment plans. Especially when they try to dictate that a treatment/diagnostic test is not "medically necssary".
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In this case the insurance company has told my doctor that the amount of medication that he prescribed for me is to much that they would only pay for a certain amount.
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In this case the insurance company has told my doctor that the amount of medication that he prescribed for me is to much that they would only pay for a certain amount.
It is more than they will pay for. Period. You can pay the rest.
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In this case the insurance company has told my doctor that the amount of medication that he prescribed for me is to much that they would only pay for a certain amount.
Also they have told the doctor I cannot take a certain medicine until I try another, I have tried and had an adverse reaction to. I understand they just simply tell the docs or clients what they will pay for. It seems that they are paying for less and we are paying for more. Why is there not a group to control these people?
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In this case the insurance company has told my doctor that the amount of medication that he prescribed for me is to much that they would only pay for a certain amount.
It doesn't matter to them that the dose may be appropriate for your problem. Which medication is it if you don't mind my asking.
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Also they have told the doctor I cannot take a certain medicine until I try another, I have tried and had an adverse reaction to. I understand they just simply tell the docs or clients what they will pay for. It seems that they are paying for less and we are paying for more. Why is there not a group to control these people?
They are NOT saying that you can't take something. They are saying that they won't PAY for it, until you try something different.
We are all responsible for the rising costs of health care. We do all this stuff to live longer, and the longer we live the more it costs FOR us to live. We want more expensive treatments, and experimental treatments, etc. Think about it. How much do you pay in insurance in a year? How much does your insurance company pay for your medical visits, tests, prescrptions, etc in a year? Who ends up paying more? The insurance company. Then, next year, everyone's rates increase.
Well, I don't have that problem. Why? Because I can't afford insurance.
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Also they have told the doctor I cannot take a certain medicine until I try another, I have tried and had an adverse reaction to. I understand they just simply tell the docs or clients what they will pay for. It seems that they are paying for less and we are paying for more. Why is there not a group to control these people?
This happens quite often if there is now an OTC medication available. Example: very famous purple pill for indigestion that used to be a prescription. As soon as it went over the counter, many insurance companies dictate that the patient tries and fails it BEFORE they will authorize the prescription medication. Many times, documentation is needed in the patient record and that records has to be faxed to the insurance company where it will take upwards of a week to receive a denial or authorization for coverage of that medication.
If you have a documented adverse reaction to the medication they've substituted, have your Physician send the documentation to the insurance comany. They MAY (and that's a big MAY) reconsider.....but don't hold your breath.
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They are NOT saying that you can't take something. They are saying that they won't PAY for it, until you try something different.
Exactly!!!!
sorry moburkes, guess we're typing at the same time
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They are NOT saying that you can't take something. They are saying that they won't PAY for it, until you try something different.
We are all responsible for the rising costs of health care. We do all this stuff to live longer, and the longer we live the more it costs FOR us to live. We want more expensive treatments, and experimental treatments, etc. Think about it. How much do you pay in insurance in a year? How much does your insurance company pay for your medical visits, tests, prescrptions, etc in a year? Who ends up paying more? The insurance company. Then, next year, everyone's rates increase.
Well, I don't have that problem. Why? Because I can't afford insurance.
We pay $900 a month and have been with this company for 10 years I have had 2500 in medicine over the past 2 years. They are coming out ok I would say. The medication is lyrica. I have neuropathy and have for 10+ years and it has been the past 2 that it has increased. I have tried all the Med out for this either by samples or prescribtion. I have had the nct done and followed all the protocols set forth by this insurance company. They simply will not pay for the medication. Now I have developed shingles and they still refuse to pay. Even though Shingles is one of the three FDA approved diagnosis.
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We pay $900 a month and have been with this company for 10 years I have had 2500 in medicine over the past 2 years. They are coming out ok I would say. The medication is lyrica. I have neuropathy and have for 10+ years and it has been the past 2 that it has increased. I have tried all the Med out for this either by samples or prescribtion. I have had the nct done and followed all the protocols set forth by this insurance company. They simply will not pay for the medication. Now I have developed shingles and they still refuse to pay. Even though Shingles is one of the three FDA approved diagnosis.
That's because there is another medication available to treat shingles that is much less expensive. However, that medication is not indicated for neuropathy. From experience, I can say that I have not had even one insurance company cover Lyrica. It's still too new and expensive.
Have you tried contacting the manufacturer? Pfizer has programs to help with the cost of their medication, especially if it is off formulary. You may have to meet financial need criteria, but it's worth a shot.
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That's because there is another medication available to treat shingles that is much less expensive. However, that medication is not indicated for neuropathy. From experience, I can say that I have not had even one insurance company cover Lyrica. It's still too new and expensive.
Have you tried contacting the manufacturer? Pfizer has programs to help with the cost of their medication, especially if it is off formulary. You may have to meet financial need criteria, but it's worth a shot.
You would be correct on that there is another drug for shingles. It is called Valtrex it treats the outbreak and the blisters not the neuro pain. The FDA has approved the Lyrica for Shingles, medicare covers this drug and in this case the same intermeidator for medicare here in Arkansas is the same company I have. It is not that expensive I can afford this no problem they know this. We own a medical company and they are our Insurance company. My point is I have tried all the other drugs none of them have worked it is all documented still they refuse basically because they don't have too pay for anything they don't want to and there is nothing we can do about it. Who regulates insurance coampany's to insure they are not breaking the law? Can you answer that one please?
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Who? The department of insurance for your state. This information should also be written in your handbook.