We get some weird calls in the pharmacy, and I'm sure the calls that come into the nurse triage line are even weirder. One of the nurses calls me and says she has someone on the line who wants to know if he can take "L-E-V-A-T-R-A" instead of Prozac. She is aware that "Levitra" is, of course, for erectile dysfunction -- but, she's just checking if there's something she's missing here, perhaps a misspelling. Well, I guess maybe taking Levitra would assist with depression, but not in quite the same way. We conclude maybe he's thinking of Lexapro.
A customer wants to switch to the brand name of her antidepressant instead of the generic, and has convinced her doctor to write the DAW. Her reason: "I've heard it works better." Her insurance doesn't cover it. I explain that it's unlikely there will be a difference in effectiveness or that the insurance will approve it unless there's some other circumstances involved. She still wants us get the doctor to ask for a prior auth. Awwwww......dammit!.... you know, this is one of the things that makes health care expensive! It is PEOPLE'S TIME. I'm going to fill out a request, send it to the doctor..... his nurse will look at it, amongst a pile of other stuff. She will be obliged to pass it on to the doctor. Then she may have to get on the phone and sit on hold with the insurance. If it even gets that far, someone at the insurance company will have to review it. The doctor will have to fill out some form, faxes will go back and forth.... all because she just 'heard it works better.' And it will probably be denied after all that.
There ought to be a way to bill this woman for everyone's TIME, just like lawyers bill by the hour. As it works now, it's just too easy for people to ask for this nonsense -- it doesn't cost them anything.
Saturday, September 26, 2009
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If an insurance company wants to appeal a decision made by an MD, the MD should be able to charge administrative fees to the ins. co. It costs little to impose the prior auth process on things, so why not try it with everything?
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