Insurance companies

They are the bane of everyone's existance. I know.

But an evil thing that exists is this form called prior authorizations. You need it for procedures, medications, shots etc.

A doctor writes a prescription and the patient gladly goes to the pharmacy thinking "oh boy! I have drugs!" or "Oh boy, I will no longer be in so much pain that I want to kill myself". Whatever the case may be, the doctor deems a certain treatment plan will help the patient.

The insurance company will sometimes tell the pharmacist to tell us that we need a "prior authorization" that can either be approved or denied. It is basically a form stating a medical necessity. As if the prescription itself wasn't proof enough.

So the doctor and I fill out this stupid form and fax it back and sometimes, just SOMETIMES it gets approved.

I just wonder, however, why not prescribe a different drug? The thing I see most often is MassHealth patients being denied for a simple Lidoderm patch that is a topical pain reliever. Maybe there is no substitute, I don't know, I don't have an M.D. yet. But I've only been working here since late September and I know that MH and lidoderm never gets approved. So why would you prescribe this if you know the patient has masshealth. I write their insurance information on the person's chart when they come in. I don't understand.

Another instance is approving MRI's. I know that doctors order unnecessary costly tests now-a-days. We are a department full of specialists so these patients are here because a) people don't know what to do with them b) they are drugies and other departments won't appease them any longer c)they truly are in horendous amounts of pain. If they need an MRI they aren't fucking around. They need to see a patient's insides because old MRI films are out of date. The situation could change.

A person with a slipped disk could get worse and the doctor needs to know how much worse. When we screw around with Prior Authorizations, it takes up everyone's time. It takes 24 hours sometimes to get approval or more depending on lots of beaurocratic bullshit factors. If you've ever had a pinched nerve you'll know that waiting for that approval seems like eternity.

Second: shots and procedures. This is the one that boggles my mind the most. Fine, medications we'll proove to you that this patient needs it and you'll pay for it like a good little insurance company. Sometimes they will approve a botox injection procedure but not the botox medication itself. This is not for cosmetic purposes, the chief of this department gives botox shots to cerebral palsy, and muscular dystrophy patients to calm their muscle spasms. They are bound to a wheelchair and need 24 hour care, their quality of life depends on this medication.

How is it that an insurance company can approve the procedure and not the medication? It's not like the patient has a secondary insurance plan, it's all the same. The doctor might as well shoot a placebo into the patient.

If insurance companies are there for sick people and aren't helping the people that need coverage the most, what is the point? I don't know if this adds to the healthcare debate going on right now with this new bill, I haven't looked into it. I should.