3 upvotes, 1 direct replies (showing 1)
Always getting denied and needing a pre-qualification from a doctor has become a standard but only after a fight with the company will someone be approved. By fight I just mean sitting through their b******* calls and arguing it and wasting your time and the doctors time. Now I don't know about major things like surgeries and chemotherapy but when it comes to prescriptions and pre-approvals this is always been the case for me and I've had 17 surgeries. I've been to the emergency room more times than I've count with an average of about 4 to 6 times a year in the last 30 years. But somehow they always want you to call to get something approved even though the doctor prescribed it and it should be approved no problem. In my world it's just known that they will always try to deny to save money and they are betting on people not wanting to spend the hours on the phone and on hold or their doctors won't want to spend the time or money on hold to get the medicines that are prescribed to their patients. It's just a fact of life in my world. Again I don't know how it works with larger procedures as they've almost always been covered for me and looking back there's a few times where I think the doctor's office had had to fight on legitimate procedures. I'm not talking about ones where dental procedures were attempted to be covered by Medical because to me that seems like a loophole kind of issue but I'm talking about Orthopedic surgeries or physical or occupational therapy. But when it comes to medications they will try to deny deny deny but every time someone sits on the phone it always gets approved. Well almost always. And that's for all insurance companies as long as it's prescribed by a doctor it should be covered
Comment by oppy1984 at 08/12/2024 at 10:45 UTC
3 upvotes, 1 direct replies
Yeah our system is fucked. I've only had insurance for about 7 years since I was self-employed before that and couldn't afford it but made just enough to not qualify for Medicare. I'm 40 and just starting to learn all these games people have to go through to get what they are paying for.
I've got one more 90 day refill before they stop covering it at the end of the year so I've been putting off talking to my doctor about alternatives that are covered, if there there are any, but now fuck'em I'm getting a drink and a snack, launching a game on my computer and calling them and sitting on hold all day until they reauthorize the fuckin med.
My favorite part of the letter they sent me was that I should consider over the counter alternatives. So your admitting you don't read patient records because my doctor literally put in my records that diet, exercise, and OTC meds were not enough and that's why she prescribed prescription strength meds.