I know things are changing practically daily with health care in this country, and have written many news stories and columns about those changes during the past 35-plus years of reporting in Hillsborough County.
In fact, the year I started to freelance after working full time for a large media company for years, I found out I was totally uninsurable because of two health conditions. People who know me know I’ve gone to gyms and walked and done many other forms of exercise since the early 1980s. I quit smoking in 1987 — after 28 years — and get sick very seldom. My family says unless there’s a need for a medication review and/or surgery, there isn’t much chance of getting me into a doctor’s office at all.
But a month ago, I broke two toes on my right foot. I knew there wasn’t much they can do for broken toes because when I broke some a few years before, they just splinted and taped the broken ones to the good ones, and I wore a special shoe to accommodate the splint.
So I taped the toes together, and let them heal. But this kept me out of the gym for almost eight weeks and, foolishly, the day I went back I didn’t think to reduce the weights and pulled a ligament in my left knee.
But my health isn’t the subject of this column. What followed my visit to my doctor is what readers need to know.
Anyone on Medicare, or a Medicare Advantage Plan, needs to check their provider’s list of approved medications. I was astounded when I learned that my insurance company would tell my doctor what to prescribe. I’ve never had a problem with my insurance company. I think I get good care, and I feel I have the best doctor in the world. She listens to everything I have to say and when I leave, I never have any unanswered questions.
I would recommend Dr. Ayo-Amu at BayCare St. Joseph’s Hospital South to all my friends.
But after I dropped off the prescriptions she gave me at my pharmacy, six days went by. I stay so busy I didn’t realize until the pain was about a nine on the scale [of one to 10] that I didn’t have the medications. In fact, I hadn’t heard anything since the first call from the automated system at the pharmacy that said there was a hold-up with my insurance company and my medicines weren’t ready yet.
So I called the pharmacy, and they said the insurance company still hadn’t approved my medicine. I called my doctor’s office, and found that they had been in contact more than once with the insurance company asking for an “over-ride” which simply means for the company to cover a drug not on “their [formulary] list.” This probably has happened to many people reading this column, so right about now, you might be wondering why I’m bothering to make such a big deal out of it.
Here’s why: When I called the insurance company, I was told what drug to tell my doctor to prescribe for me instead. Yes, you read that right — a clerk working with codes and numbers who never went to medical school actually told me what to tell my doctor, who spent years acquiring her credentials and more years gaining the experience to always know just what I need.
It’s one thing for insurance companies to watch their costs. And we all know Medicare is constantly being considered for more cuts on the chopping block. But for clerks to be prescribing medicines and ordering doctors around is another matter. This is not only a dangerous slope, it is way overstepping the bounds of what insurance companies should do.
Doctors are frustrated. They want to make us well. I wanted to tell my story so readers can check their prescriptions carefully when they get them. Most of the time, they’ll be given a generic, but if you look on the Internet, it’ll be the same medicine, just a cheaper version. But for clerks in an insurance office to prescribe a totally different drug than what is on a doctor’s prescription is out of line.