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Author Topic: More interference from insurance companies  (Read 73 times)

Offline Shanny

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More interference from insurance companies
« on: April 12, 2018, 02:28:50 AM »
This is one of my pet peeves. It absolutely irks me that insurance companies are making more and more of the calls which should be being made between patients and their doctors.

Well now my own insurance has decided they will no longer pay for my Lantus, so I've been switched to Levemir. I don't expect it to make a whole lot of difference, but it's the principle of the thing.  Grrrrr . . .

Offline Grammabear

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Re: More interference from insurance companies
« Reply #1 on: April 12, 2018, 07:16:29 AM »
Can your doctor write an 'override' saying Lantus is more effective for you or that you're adverse to Levemir?  My insurance doesn't want to pay for Novolog and instead prefers I use Humalog.  Humalog doesn't work as well for me as does Novolog.
Type 1, April 2003
Dexcom CGM Sep 2007
Tslim pump Oct 2015
A1C 6.5% - March 2018
"Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.".....Voltaire

Offline walkerwally1

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Re: More interference from insurance companies
« Reply #2 on: April 12, 2018, 07:42:10 AM »
That often seems to be a problem.  What a doctor wants to prescribe and what an insurance company wants to pay for.  I wonder how much of an influence a doctor has with the insurance company.  I know in the past I have had a doctor go to battle with an insurance company over a treatment and eventually got his way but that was a long time ago.
Type 2 since 1993.  Control with Metformin and LCHF diet.  75 YY
A1c June 2013   7.7%   Start of LCHF,    A1c 4.5% February, 2018
Living in Mojave Desert, California, USA
Nothing is foolproof to a sufficiently talented fool !

Offline Shanny

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Re: More interference from insurance companies
« Reply #3 on: April 12, 2018, 11:54:56 AM »
If there were ever a physician who goes to battle for his patients, it is mine, and he's done it before for me. Years ago he had referred me to a neurologist for something or other, and that neurologist called in a surgeon - an orthopedic surgeon, for cryin' out loud! (I wish I could remember what this was for - my memory is blank right now). At any rate, my doc was still monitoring the situation, despite having referred it to someone else, and he stepped in with a vengeance, saying I was still his patient and he wouldn't allow that surgeon to touch me. I know I've introduced him to you before, so I won't again, but we truly don't know what we'd do without him.

When DH had a psychotic break some 20 years ago, doc listened for ages to him recount it - until DH finally said it was taking too long. But doc shushed him, saying 'I'm still listening - you keep talking.'



Offline Grammabear

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Re: More interference from insurance companies
« Reply #4 on: April 12, 2018, 01:57:48 PM »
In regard to Levemir, some people have found it necessary to do two injections, twelve hours apart, per day in order to receive the full 24 hr coverage.  I happened to be one of those people and my doctor neglected to tell me of that 'possibility'.
Type 1, April 2003
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Tslim pump Oct 2015
A1C 6.5% - March 2018
"Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.".....Voltaire

Offline Tamagno

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Re: More interference from insurance companies
« Reply #5 on: April 13, 2018, 02:06:41 AM »
Insurers constantly disrupt doctors’ wishes.

Curiously, in my case, Kathy, they demanded I switch from Humalog to Novolog.

I’ve had many cases in which a doctor has interceded successfully and many in which they have not. The most successful have been my endo and my neurologist, particularly the former.

I know it ultimately hasn’t much to do with the actual cost of prescriptions which it really doesn’t. Often, it’s simply that their formularly resides on some sort of drop-down menu in their software that can’t be over-ridden easily without some sort of administrator access that requires extra hassle for the insurance company.

I’m increasingly finding this kind of regimented, “one-size fits all” treatment with the advent of more and more stringent regulation as well as electronic record keeping. Of course, doctors hate it also as they’re wishes are circumvented by bureaucracy. It’s also creating a class of “lazy” doctors who treat solely with those regulations in mind.

As many here know, one of the most egregious offenders is Medicare which in some cases requires hearings to make any change in their formulary...


Offline Tamagno

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Re: More interference from insurance companies
« Reply #6 on: April 17, 2018, 01:34:53 AM »
So, having said all that, I just got a notice from my insurance that they’re reducing my insulin coverage to what they consider their maximum. With much sarcasm, I’d say it’s such a relief having more people monitoring my medications!

Offline walkerwally1

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Re: More interference from insurance companies
« Reply #7 on: April 17, 2018, 06:54:16 AM »
It is sad when an insurance company is able to determine what your needs are and your doctor is not. 
Type 2 since 1993.  Control with Metformin and LCHF diet.  75 YY
A1c June 2013   7.7%   Start of LCHF,    A1c 4.5% February, 2018
Living in Mojave Desert, California, USA
Nothing is foolproof to a sufficiently talented fool !