Wednesday, February 12, 2014

Bureaucreatic Nonsense, Part 2

I'm sick.
Sick and tired of this bureaucratic BS, really. So consider this Part 2 of my previous post about Bureaucratic Nonsense.
Today, kids, we will talk about formularies.
Formularies are types of medications that are preferred by an insurance carrier, usually for cost reasons. They have been prenegotiated and because of a discount for the carrier, these tend to be preferred for their patients.
Except, many of us wonder if these were made up also for the insurance companies' personal entertainment.
Every new year, we often get calls from patients, sometimes faxes from the carriers, that this year, Insulin X is no longer preferred, and the patients will need to be on Insulin Y. Or statin A versus statin B.
Never mind that they may have been on said medication for years, and well controlled. Never mind that they might have a reported adverse reaction (if you didn't document a good reason, if this occured when under the care of a different provider). Otherwise, they end up paying for this out of pocket.
And so, it's a cat and mouse game when every year, the insurance changes their preferred medications, and we have a barrage of calls from patients or pharmacies requesting alternatives.
And if it isn't a headache enough, this year, several insurance plans have been rasing the headache bar up a notch for clinics: I've been getting letters stating that Medication A is not preferred, with no reference to what an alternative might be. One of the carriers suggest that providers visit the website to look up alternatives. Which takes you to a nonsensical website that asks half a dozen questions about the insurance plans, group number etc.
Which leads me to my suspicion that health insurance carriers really aren't there to help the patient, but to try to discourage patients/physicians from utilizing resources in order to minimize their expenses.
Another phrase that our medical assistants have come to hate, is "prior authorization". PAs are more bureaucratic nonsense that the pharmacy/insurance carrier requires before they approve the medication. And this often takes multiple phone calls, filling of more paperwork, faxing, and waiting sometimes weeks for them to send a letter or approval or denial. And sometimes, PAs are required even if a medication is ON formulary.
Which brings us back to the F word.


Anonymous Anonymous said...

I'm with you. I'm a pharmacist and I roll my eyes everyday at all the bureaucratic hoops the insurance companies make EVERYONE else go through. All I want to do is just be able to have my patients get their meds from us hassle free, without stupid phone calls to insurance companies as to why the claim got rejected or having to call the MD's office to apply for a PA. UGH. They are totally running how pt's health is managed that's what, and costing the healthcare system more money in the long run. - Wendy

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