Posted on 05/10/2011 10:47:05 AM PDT by Gum Shoe
I'm very happy to see the spring weather finally arrive. It seems Old Man Winter just wouldn't go to bed this year. With changes in the weather, comes my spring chest cold. There isn't anything I can do about it except head to the doctor and ask him to treat the symptoms until it clears. That's the routine. However, I discovered the routine isn't so routine anymore. After entering the exam room, I saw a new computer had been set up in the exam room. Nice LCD monitor, sleek key board on a telescoping arm. I asked the nurse about it as she checked my vital signs. She said it was installed in January, and was part of their office upgrades to allow integration into the new national heath care system - something to do with reporting data, and "stuff like that", to insurance providers. She said some things about the system were irksome, but she thought it was "a good thing". My only thought, at the time was, "Huh." You'd think something more profound would have occurred to me, but hey, I was sick after all.
Ultimately, the doctor showed up, gave me a going over, and decided I needed some meds. Instead of writing it all out on a paper scrip, he did it all on the computer. Pretty nifty. He fired off the prescription to the local drug store, via email I suppose, and told me it would be ready in about fifteen minutes. I thought that was kind of cool.
This is where it gets interesting. I drove to the drug store, allowing for the fifteen minutes suggested by my doctor. I walked up to the pick-up window, and found a woman in a fairly heated discussion with the pharmacist. I tried to be polite, tuned out the conversation best as I could, and occupied myself with a really nice, near-by massage chair. After saying something about making a call to her doctor, the woman turned from the window and stalked off. Seizing the opportunity, I jumped up and asked the pharmacist if he had filled the prescription emailed by my doctor. He said "not yet" and asked me to take a seat. So, I went back to the chair. The woman returned a few minutes later, and took the seat next to mine.
After waiting a good twenty minutes, and a series of ignorant expressions offered by the pharmacy crew (blank looks when I made eye contact with them to remind them I was still waiting), I finally broke and went to the window for a status report. The pharmacist said, "Oh. Your prescription was denied." That surprised me. I've never had that happen to me before in my entire life. I asked, "It was only for an antibiotic. What's so difficult about that?" He said,"Your insurance company disagreed with your doctor, and denied the prescription." Again, my thought was "Huh." But this "Huh" was immediately followed by a "That was pretty cheeky of them." In the desire to learn more about this situation I asked, "So, insurance companies can now over-ride my doctor's recommendations, without knowing or examining me?" The response was, "Yes." The pharmacist told me he was in the process of contacting my doctor to have him submit a prescription for a different drug, with different dosages. He again asked me to, "Take a seat."
I returned to the massage chair. The woman, from the earlier conversation at the pick-up window, still occupied the adjacent seat. She said, "They did the same thing to me." She went on to say her insurance company was denying her mother's prescriptions. Apparently, the woman's poor mother was dieing of stomach cancer, and in the final stages. According to her, their insurance company simply "Didn't want to pay for medication for a woman who was dieing anyway." After concluding the brief conversation with the woman, the remaining contents of which I'll keep private, I finally received my updated prescription and left the store. I hoped the circumstances surrounding the woman's mother weren't as dire as she explained them. Since she was still waiting at the pharmacy as I left, the pharmacist was likely working on some sort of resolution for her prescription problem.
I don't know at what stage the implementation of Obamacare is currently. I don't know if the federal government now dictates policy to private insurance providers in this country as part of that process. From this experience, I suspect the implementation of Obamacare is much further advanced than previously thought, despite bold claims to the contrary by Boehner and his ilk. What I do know with a certainty, is our liberal socialists will claim similar incidents are the reason America needs Obamacare. We need government to fend off the mean, uncaring insurance companies - to make them do what's right. I couldn't disagree more. I believe those incidents were caused by the prevailing liberal socialist theory that has spread like cancer through the United States of America. If we don't stop the federal government from taking over private health care, I fear the worst is yet to come.
My doc’s been using computers in the exam room for years. Keeps all the info there as well. Nothing new.
Not in Idaho. They've outlawed it as toxic medicine.
Did you read the rest of the article?
My doctor has been doing everything on his computer for a year or so at least. He faxes the prescriptions to the pharmacy for my mom and then we go pick them up about an hour later. So far Medicare has not turned down any of her prescriptions.
So it's off the emergency room for everything where the co-pay is 50 to 150 per visit. The saving grace is that you are usually at the ER long enough to pick a second language or two.
Of course doctors have been using regular computers for years. According to this article it wasn't just a computer
It's a computer designed to allow intergration to the new health care system.
If you read the article you will see that it was likely because of the computer that the woman's prescription was denied.
Hey, they weren’t so blatant as to ask for your party card comrade. That will be coming as they integrate health care records with watch lists for groups such as Free Republic and some get more favored treatment than others.
In the article it was the insurance companies that were turning down the prescriptions.
Whem my insurance tried over-riding the doc’s scrip, I called them direct.
“No! The “generic” will NOT do! It’s garbage and doesn’t work! I’ve been taking the original of 10 years and it works! The last time you pretended you were a doc and slipped me the generic, my symptoms returned for the first time in 10 years. I realize the crap is cheaper! That’s usually how it is with crap that doesn’t work! Now, get back on the original!”
The larger physician practices owned by hospitals have the new computer systems linked to the hospital’s computers. If youhave ever been registered at the hospital your doc works for, your records are integrated. They are NOT linked to the government....yet.
Insurance companies do have preferred drug lists called formularies that save them money. If the doc writes a script for a name brand when a generic is available, the insurance will request the generic. I’m not really sure the insurance companies have the right to absolutley override the doctor though. The doc can call the insurance company and discuss it with them, but your script will not be ready in 15 minutes.
So did you get the med that works?
The original post has really nothing to do with Obamacare per se.
Denies of medicines not on insurance company’s formularies has been a tactic / cost savings tool they’ve used for years. The use of EMRs or electronic medical records were well underway before Obamacare was wretchedly born.
So although this particular situation is non-obmacare related, I can expaound on future scenarios stemming from Obamacare that will occur.
Next thing you know, they’ll advise a 3 word advance care directive: Just Shoot Me.
Find out before writing an article. How else could you blame this on Obamacare?
My doctor will not write out a prescription anymore. It’s all done on computer.
The insurance companies often refuse to approve payment for certain drugs when they believe a generic or different drug will do. To get the drug the doctor wants you to take he or she has to submit a valid reason. My wife was given another drug that didn’t work. We no longer have insurance so now we’ll go to Mexico and buy whatever the hell we want. That is until the government makes it illegal to go to Mexico.
It is not the insurance company who is doing this. Ultimately, because of all of the new requirements imposed on the insurance companies by Obamacare, the only way to make themselves profitable is by denying coverage to those deemed of “less value” or likely to cost more in the future. “Death Panels”, as you may. The insurance companies HAVE to do this to pay for all of the “freebies” imposed by Obamacare.
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