Godless Dave

Yesterday a nurse from my doctor's office prompted me to basically lie for a form she was filling out for my insurance company. It would have been for my benefit, but I declined anyway. Here's the full story:

Last November I had a physical done by a new doctor. I had been dissatisfied with the first doctor I had found through my health plan, and wanted to try another one. I take prescription asthma medicine daily so I have to see a doctor at least once a year. I asked him to write me a prescription for Zyrtec, an antihistamine. I have had nasal and sinus allergies all my life. For the past 10 years I have been seeing an allergist regularly. Under his supervision I have tried every prescription and over-the-counter antihistamine they make (and some they don't make anymore). All the OTC drugs put me to sleep. None of the prescription ones did anything for me, except Zyrtec. (Zyrtec also makes me drowsy but unlike OTC antihistamines it doesn't put me in a coma). So me doctor said, sure, and wrote me an Rx.

My allergies aren't as bad in the winter so I didn't get around to filling the prescription until last Saturday, when I woke up with a massive allergy attack. When the first 30 minute sneezing fit stopped I drove to my friendly neighborhood pharmacy and handed over the prescription. But when I came back later to pick it up I got "Sorry, HealthPartners doesn't cover this without a prior authorization." She helpfully called my doctor's office, but being Saturday no one was there. So I turned on the air conditioner and stayed inside all weekend.

Come Monday a nurse calls from my doctor's office. She said she was filling out the paperwork for the preauthorization.

"Have you tried Claritin?" she asked.

"Yes but it didn't do anything."

"Any side effects from it, like stomach cramps?"

"No," I answered.

"Are you sure?" she asked. "Think real hard." I inferred from that that it would be a lot easier to get this authorization if I claimed Claritin gave me bad side effects. But I decided I wasn't willing to lie, even to an evil insurance company. I'm just not interested in playing their games, and I felt like lying to satisfy their little questionaire would bring me down to their level. And even though I don't blame her, I was offended by the nurse's prompting.

If the situation were different, i.e. more life-threatening or involving a child's health care instead of my own, I might do differently. But I think I feel better than I would have if I had lied and said "Yeah, Claritin gives me stomach cramps, bloody diarhea, and makes me impotent".

If they decline coverage I'll just pay out of pocket. $60 for 30 pills is pretty hefty, but my allergy attacks are sporadic enough that 30 pills will probably last me the whole summer.

Loren Pechtel

I'm not surprised. It's just about a game between the doctors and the insurance companies. The insurance companies think of anything they can to disallow a claim (there's been a big push to get people on Claritin since it went OTC--no coverage) and the doctors are trying to worm their way around the nonsense in order to deliver the care.

Since Claritin doesn't work for you that *SHOULD* be enough to get the insurance to cover Zyrtec but who knows?

Viti

I usually try to go along with the doctors because the insurance companies piss me off. I hate having business people dictating my health care, but managed health care and private insurance is all we have right now.

Fuck the insurance companies...I pay them a lot of money and all they do is work against me.

Sorry for the rant, I have literally had to get my State Insurance Board (or whatever its called) involved on more than one occasion.

Godless Dave

Well the company I pay $1400/year in premiums graciously agreed to pay for Zyrtec. This wouldn't be as much of a problem if I hadn't waited until I was actually having an attack to fill the prescription. But since the doctor who prescribed it for me works for one of their clinics I wasn't anticipating this kind of complication.

But, I got it by being honest. I guess there's something to be said for that.

LLaurieG

(Laurie) You only pay $1400 a year for health insurance? The hubby and I fork out $525 a MONTH to our HMO Blue Cross, that's for two healthy folks with NO pre-existing health conditions or prescription medical needs, plus a $1000 deductible! Recently a tiny basal cell skin cancer was discovered on my ear. Despite the fact that I had already been approved by Blue Cross for coverage (under my husband's policy) and the coverage was due to commence in 10 days, Blue Cross "customer service" DECLINED to expedite or waive the 10 days so I could schedule surgery sooner. Oh, and get this: WITH insurance, the cost to us for this little local-anesthetic procedure was over $2000.

HMOs are Satan. Never cooperate.

lunachick

My uncle cancelled his health insurance many years ago due to rising insurance costs - he has for years put the equivalent amount into a high interest savings plan - and it was a good move. He has paid for two triple by-passes since then, and all his health bills - plus he has money left over. He figures that had he stuck with insurance companies, he would've been fucked.

Edit: As for the OP - personally, and call me unethical if you wish - but I would've lied if I thought there was a risk that the Insurance company would try to rip me off. And if the doctor's office were trying to get you to lie; then chances are their experience of Insurance companies are such they that were trying to help you to not be ripped off by them.

Loren Pechtel

However, if he gets hit with anything really expensive he won't be able to afford it.

lunachick

They key is that he twigged onto the idea long enough ago when he was a young man in good health. Now that he is in his late sixties, the money he saved himself is worth more than insurance was ever going to be for him.

If you are going to take that tack, you need to start when you are young and in good health - and you need to be disciplined enough to not dip into the fund unnecessarily. For him, it's paid off - and has amounted to a huge savings over that period of time.

Errr - btw - triple by-passes and ongoing health care and medication ARE expensive.

He has had the fund for something like 45 years. Instead of paying "excess" whenever he makes a claim - like the $2000 someone else mentioned in this thread - he has been chalking up "interest". But then, he is a very self-disciplined and pragmatic man.

Buddrow_Wilson

I wouldn't recommend doing that. You're making a huge gamble that you will stay healthy enough for the account to build up to something manageable. I believe the non-feasibility of such a plan is the reason insurance exists at all. Unfortunately, there are many people like myself that can afford neither insurance or a substantial savings.

Loren Pechtel

Ever hear of cancer? It can be *VERY* expensive at times.