Let’s say you change from one health plan to another.
For years you’ve been on a certain med regimen. Nothing radical, nothing especially questionable: stuff that your doctor–more than one–has reviewed with you. You and hse agree that the stuff is working fine.
You change plans and the fun begins.
Half of the things you take are not in their “formulary.” And one that is, is only allowed at a much-reduced dosage.
OK, it makes some sense to have new eyes review one’s course of treatment now and then. If they wanna do that and THEN raise questions, fine.
But what kind of ethical or medical sense does it make to literally BLOCK the filling of one’s prescriptions from the get-go until you yourself, with many telephone calls and visits to your doctor (same doc, accepted by the new plan as well as the old) can get the approval to go through?–in my case a 2-week process during which I was stuck without my meds (unless I wanted to cough up a few hundred bucks to pay out-of-pocket).
I said “ethics”… Isn’t it ethically requisite to “grandfather-in” an ongoing course of treatment WHILE the company reviews the situation? In other words, shouldn’t the onus fall on the insurers?
Which brings me to this:
In the old days, before passage of a federal law on the subject, the banking industry typically required a span of several days–even a week to ten days in some cases–before deposits of verious sizes were allowed to be credited to one’s account. They swore it was because of certain bookkeeping processes and practices. The law was passed; gee, the problems weren’t much of a problem after all. And we customers were free to nod our heads and realize that the banks were making a little money off allowing deposits to “float” for a while, thereby collecting the interest.
Is this really what the unsurers (!) are doing here? Are they letting their insureds “float” for a week or two, in order to postpone having to shell out money for expensive meds? Not for any justifiable medical reason, but mainly to slip in what amounts to a hidden fee, which they need not highlight in their literature?
I’d love to hear from people who actually make policy in the industry on this one. (But all you Dopers are welcome, of course!)