Posted by: winteridge | December 1, 2008

That’s Just the Way It Works…


Judging from all the news media, it is none too  soon to start telling President Obama how things should be run, so here is my contribution for today.  We need to scrap our motto “In God We Trust”.  Do away with it.  It is out dated.  We need something more timely, more fitting, more in sync with the way our country, our government, our industry, our society operates today.  I suggest “That’s just the way it works.”

Here is a personal example.  I have been fighting a chronic sinus/ear infection for a couple of months-tried antibiotics, home remedies, over-the-counter, no relief.  On my latest doctor visit he prescribed a nasal spray, said I should start it as soon as possible.  So I stopped at my local drug dealer on the way home to fill the prescription.  After a half hour or so, the druggist came out with a paper, said they needed to get my doctor’s approval (isn’t that what the script does?).  I asked how long, maybe another 10 minutes?, and was told it might take a couple of days.  Or more.  Hmmm.

When I returned 3 days later, they told me they had not heard from the doctor.  Upon further questioning, I learned that the doctor needed to contact my insurance company and get pre-approval on payment for the medication before they could dispense it.  The drugstore had faxed a form to my doctor requesting this, but had not heard back.  But, but, I said, why would my doctor not have done this before writing my prescription?  Well, the pharmacist replied, the doctor probably didn’t know it was required by the insurance company.  Sounds to me, I said, like a major gridlock in the system.  Why not call the doctor?  “Well, that’s just the way it works…”.

No.  As my hero Jerry Seinfeld would say, That’s the way it doesn’t work!  If it worked, I wouldn’t be still waiting a week later for my meds.  If it worked, I would have my meds the same day, and the insurance company and the drug dealer would all have their exorbitant profits in hand.  Anything else does not make sense.  What part is working?

I’m getting a sinus headache.  I sure hope President Obama can “change” the healthcare industry.

That’s Just the Way It Works…

Here’s a followup-now on Day 8.  Rite-Aid still does not have prescription-waiting to hear from Doctor.  I called doctor’s office, assistant will check to see if the fax was received.  She said sometimes it takes a couple of days.  When I said it was going on 8 days, she said it should not take so long.  I agreed.  And she said: “That’s Just the Way it Works Sometimes”!  Tomorrow I try to contact the doc himself.  Obviously when these pretty young drug dealers come in his office with pens and free lunches and whatever, they don’t explain that part to him.  He should know how it works.   The good news is that my infection seems to be getting better without the drugs.  Maybe that is the plan?  I will take the prescription anyway…if it ever comes in.

I should explain that I have been with this drugstore and this doctor and this insurance company for about 20 years, and this never happens.  Maybe it is common for everyone else?  Maybe socialized medicine has arrived?  Hillary will be so glad.

Day, uh, let’s see, 10, and we are definitely seeing some progress here.  No, not with the infection.  Yesterday I received a return call from the doctor’s assistant, and yes, they did receive a fax from the drugstore monday and yes, they had sent the paperwork to the insurance rep and yes, everything should be ok in 2 to 4 days.  Maybe.  What about the faxes sent the previous monday and wednesday?  Nothing on them. TJTWIW.  She suggests that in future, I should call the doctor myself and ask that he submit the request paperwork.  In other words, assume that the system  doesn’t work.  It is frightening that these are the caregivers we depend on for our health and welfare.  Seems this is a new drug and sometimes with new drugs the insurer requires prior approval but the doctor never knows.  Am I the first patient he ever sold it to?  Not sure on that.  I suggested perhaps they should clear things like this with the free-pen dispensers when they come in.

But just think of the implications here: you are having a heart attack, minutes from death, and your caregiver needs to fax someone at the insurance company, perhaps an outsource desk in India, and get permission to use the defribillator.  Don’t laugh, friend, you are dead meat!  TJTWIW.  Can socialized medicine be worse?

FINALLY!  Day # what, I have lost count-11.  Doctor’s office called with the good news that they had word from the insurance company: Refused!  But we could use nasahaxawhosis instead of the more costly nazawhatsis, if I want.  I don’t know what either is, so why not?  I’ll try anything at this point.  Drug store actually had some and actually filled the prescription.  Now THAT’s The Way It Works!

Followup to followup:  Ear infection went away while I was waiting for medical approval, but I decided to try sinus spray anyway to clear my sinuses, maybe.  If I use it more than 3 days in a row, I get nosebleeds.  Interesting bonus.  I will discontinue and discuss with my doctor next time I see him.  Don’t get sick…



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Responses

  1. This is a late, late, follow-up you might like. I should have mentioned that the prescription I struggled over in the above was called Flonase, and MY cost on it was ove $100, for which I got nosebleeds. Now I read of a class action suit against them for price fixing, price control, and refusing to allow less costly generic substitutes. I must take some time to dig out my 2008 medical files. Might get back $2.50 or some aspirin samples.


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