Ins. Co. currently can over-ride medical doctors regarding prescribed medications

[mdmc]

Doctors can prescribe whatever they want, but it is up to the insurance companies to decide what is covered (paid for).

[barbtries]

1. not saying it's right

but that does appear to be how it is.

[PSzymeczek]

2. The doctor has to prescribe according to the formulary,

even if an off-formulary drug would work better.

[barbtries]

4. the doctor can prescribe what he feels is best

case in point: my son had a pinched nerve in his back, and was prescribed prednisone. however, the doctor prescribed a particular regimen that the insurance wouldn't pay for. i could have called the dr back and said just get us the prednisone for $4, but i chose to go with what he had prescribed in the belief that there was a therapeutic reason for my son to have that product. cost me like $40 out of pocket.

like i said, i'm not saying it's right that the insurance companies do this. but they do certainly get away with it. the doctor can and imo should prescribe what he or she believes is the right prescription for the patient. just, sometimes, the patient cannot come up with enough money to buy it. i've been there as well.

[hedgehog]

3. The doctor can prescribe anything, but the insurance company

doesn't have to pay a penny. I'm paying $350 a month out of pocket for what my insurance won't cover.

[cbayer]

5. Classic insurance company statement : We don't decide what (where, when, how)

medical care you need, we just decide what we are willing to pay for.

:grr:

[hedgehog]

6. Truth to tell, the inurance companies are well within their rights to decline coverage.

We also are well within our rights to guarantee all Americans health care and cut the insurance companies out of the deal!

[Nictuku]

7. Example:

I rescued my cat when she was just a teeny kitten. She was in pretty bad shape and I took her to the vet before even bringing her home, and we found that she was covered with ringworm (which we treated immediately).

However, I ended up getting 20+ spots of ringworm on my body. But I was looking for it and caught it really early when I went to the doctor.

The doctor saw how many I had and decided I should take oral medication to stop it, and that medication was Lambosil(sp?), the same (very expensive) toenail anti-fungal stuff you see commercials for.

But my insurance company wouldn't approve it, I had to first try a topical cream (which didn't work), and 2 weeks later (living with this horrible spots that were now growing larger all over me), the insurance co finally approved the medicine, and within 2 days the spots started going away.

So I guess, they did approve it, but I had to suffer with this problem for longer than I should have had to, had I been able to do what my doctor prescribed.

[skorpo]

8. Current insurer is changing their RX to a formulary plan in Jan...

I DO NOT look forward to the hassles I'll have to deal with including the tiered part. UGH!

[donheld]

9. It's happened to me.

Doc wanted me on a medication. Insurance wouldn't pay for it so we had to find another.

[mdmc]

10. kick

hey bro - how is your brother doin?

[donheld]

13. About the same I'm afraid. Can't call him because t-mobile is freeking out.

[Brigid]

11. I ran into this all the time working at Wellpoint.

The tiered system and the formulary made having coverage for prescriptions almost useless. And if you were going out of town and needed to refill your prescriptions early so that you would have enough for the trip, you had to jump through all kinds of hoops.

I do not know how I stood that job for as long as I did (almost 3 years). :banghead:

[cayanne]

12. Other

The Ins Co won't pay for my meds if they are too high without prior approval. However, I can always pay for them myself. I have Federal PPO plan so it is different from most.