Question
Why will they only fill one month's worth of prescriptions at a time? They used to fill up to 3 months maximum,...but still, 3 months.
Now, it's a 30 day supply.
Not only is it a 30 day supply, but it's the INSURANCE COMPANY'S idea of what a 30 day supply should be. Example: I am on two different prescriptions, both of which are specifically written out: 1 tablet BID (twice per day). So the Rx is specifically written to dispense 60 tablets.
Ahh, but the insurance company has decided in all its great brilliance that despite and contrary to the doctor's specific directions, that (a) I do not NEED to take one tablet twice a day, but as a back door what they WILL do is (b) permit to fill the Rx TWICE per month (at 30 tablets per Rx).
So at $30 per co-pay, for each Rx = $60.00 total, times TWO Rx's that they do this for = $120.00 per month. So they aren't forbidding me to really TAKE two tablets a day, they're just not willing to fill the doctor's prescription authorizing and recommending and directing me to TAKE 2 tablets per day.
Top this off by the fact that they will only fill a 30 day supply, (shall we address what happens on the months where there are 31 days?)
For the record, one of the meds in particular has to do with acid reflux.
Does this seem highly contradictory to anyone else?
The fact that I take at least 4 other Rx's per month and sometimes more if I'm having other problems, the insurance company has got me and my family by the shorties.
They'll obviously stop at nothing to make a buck.
There are months that we spend between $350-$500 a month on Rx copays. Some months it isn't that bad, but the fact that it can be much more cost-effective if they don't gank me around with nickle and diming the pills and giving my doctor a difficult time.
I am so fortunate to be working with a physician who fights for all of his patients, is compassionate and understands quality of life, insurance frustrations, and is not intimidated to work with people who have several complicated health problems to work around, and work with a patient who is coordinating care between several specialists.
As if it weren't challenging enough to maintain health and independence and quality of life just in general, the insurance company's decision makers (who are not even doctors themselves) are making restrictive decisions on how we are to be medicated or dispensed medication,...further aggravating even the pharmacists lives as they deal with us.
I've been in line at the pharmacy many times and my heart goes out to them as they are inundated with patients complaints. Medicare has made things enormously difficult, much less all other insurances as well.
To top that puppy off, I'm not sure about other states, but we are hit with a "prescription tax" of $1.30. PER prescription! So add to the 30 day limit, the 30 tablet limit, the restrictions on directions (they can actually change the doctor's prescribing directions as they see fit and go against the doctors orders -- again, these decisions are not made by doctors), and this tax on every prescription including all insurance covered Rx's, all insurance copays, all NON-insurance out of pocket Rx's, all medicare Rx's, and all medicaid Rx's (their "tax" is lower, however).
Not only can insurance companies defy your doctor's directions to you without ever having met you or seen your medical records or know anything about the reality of your health conditions, they can outright deny them. You are denied the ability to pay out of pocket for prescriptions if you have health insurance coverage (that's another one I cannot figure out).
This control over our lives and our health care seems unfair, unjust, and unhealthy.
------------------
Life isn't what happens to you -- it's how you react to it!
Thoughts don't make us who we are -- Actions do.
Answer
Call this toll free number for complaints about an HMO:
It is a California number, so call in Pacific Mountain Time, 8 AM - 5 PM, Monday thru Friday.
Ask if they know of how to find out a consumers HMO complaint number for your state or area.
Many insurance companies are going broke, in reality. They can't afford the small premiums most of us pay compared to the huge expenses many of us rack up.
They have to cut costs. But they have to do it reasonably, within the law.
So give them a call, or call your insurance commissioner in your state. Find out if they really can do what they are doing.
Before you do anything else, check your policy, for the appeal process, and let them know you don't think it is fair to charge you twice for a single month's prescription that you have to take twice a day.
(BTW, a month has always been considered to be 30 days, though some really have 31 days.).
Answer
I have a PPO not an HMO, and a month, regardless of whether it has 30 or 31 days (that reference was merely to point out yet another way they have to nit pick), is still the FULL prescription amount the doctor ordered - not HALF the prescription the doctor ordered.
So my doctor writes a Rx for 60 tabs and THEY deem that I should only get 30 tabs,....but they don't believe it so strictly that they won't fill the Rx TWICE that month so I end up with the 60 tablets anyway.
IOW, if they reeeally thought 60 tabs per month was somehow illegal or dangerous or irresponsible, WHY do they fill Rx's for 60 tablets in that month anyway? (They just split it up into TWO separate payable Rx experiences). See what I mean? It evidently is not the total number (or they would "forbid" me to fill the 2nd half of the Rx until the FOLLOWING month -- so somewhere along the lines they acknowledge the docs orders,... just not as he wrote them).
THAT is the part that is inconsistent and not congruent and frankly I cannot see how that can be enforcable. It's illogical.
This is the kind of behavior that leads people to try and ask their doctors for double the dose tablets so they can cut them in half (I've heard many people say they do this with Viagra because the tablet price is the same regardless -- and provided the tablet CAN be cut, - some cannot, - it's more cost effective,.... it costs the same to produce, write, and purchase!!)
Again, how illogical is that!!
And how legal (much less ethical, moral, or practical) can it be for a NON-doctor to second guess your physician when it comes to prescribing information, and then FORBID you to even get tests or Rx's and pay out of pocket!!
If your doctor wants an MRI but the insurance company won't approve it, you cannot legally GET that MRI, even if you pay cash for it, or you will LOSE your insurance coverage!
They're stringing us along and perpetuating our sicknesses and discouraging us from trying to stay on top of our own health.
I want to know courses of action we have to fight this injustice! This is insane.
------------------
Life isn't what happens to you -- it's how you react to it!
Thoughts don't make us who we are -- Actions do.
Answer
Agree with you 200%. You said it all, just as we
have felt. Thanks!
Answer
Merrida:
It doesn't matter if it is a PO or HMO, there are rules they HAVE to abide by, but there is an appeal process all insurance companies have.
You have to use it all the way to the top, if someone takes it upon themselves to interfere with your benefits. Don't just assume that it was not just one person's fault it happened, before you appeal it.
Did you speak to the manager of the pharmacy?
The appeal process and Insurance Commisioner is the consumer's safeguard. But not if we don't use it...or are you just venting and don't want a solution?
If so, I hear ya, it is disgusting what that pharmacist did. I think it was incorrect too, and that you should throw a fit to somemone that can help.
