I’m not in the US, but one of the issues I have with medical insurance is that, say you need medication, the doctor will provide you with a prescription, requiring a specific brand due to the efficacy compared to other brands. The insurance providers would reject claims for the prescribed brand, and suggest an inferior brand that doctors warned to avoid.
This happened to my older folks, and is baffling why insurances feel the need to override a doctor’s recommendations.
Not necessarily. I’m on a daily medication that has a generic but is available in both extended release and immediate release forms. The extended release provides a more consistent dosage and has historically prevented me from getting sick. The immediate release causes inconsistent spikes and I have a history of getting sick on it. Insurance refused to pay for the extended release type for about 2 years before it made it onto their “formulary.” In the meantime I was using GoodRx and paying $100/mo instead of my paid health insurance pharmacy plan to make sure I wouldn’t get sick. The person I spoke to at the pharmacy management wing of the insurance company literally told me “you can get an app on your phone which will tell you when to take the immediate release medication.”
Luckily, we don’t have that with medical insurance in Switzerland, but car mechanics sure are that way.
Need a fix on insurance? Ooh, that’ll take us 2 weeks of full time work - minimum 5000 bucks. Call them and tell them it’s not insured? Ah, that’ll be 500 bucks.
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I’m not in the US, but one of the issues I have with medical insurance is that, say you need medication, the doctor will provide you with a prescription, requiring a specific brand due to the efficacy compared to other brands. The insurance providers would reject claims for the prescribed brand, and suggest an inferior brand that doctors warned to avoid.
This happened to my older folks, and is baffling why insurances feel the need to override a doctor’s recommendations.
Removed by mod
Perhaps, but this is what was advised by the doctor, so I don’t know
Not necessarily. I’m on a daily medication that has a generic but is available in both extended release and immediate release forms. The extended release provides a more consistent dosage and has historically prevented me from getting sick. The immediate release causes inconsistent spikes and I have a history of getting sick on it. Insurance refused to pay for the extended release type for about 2 years before it made it onto their “formulary.” In the meantime I was using GoodRx and paying $100/mo instead of my paid health insurance pharmacy plan to make sure I wouldn’t get sick. The person I spoke to at the pharmacy management wing of the insurance company literally told me “you can get an app on your phone which will tell you when to take the immediate release medication.”
Luckily, we don’t have that with medical insurance in Switzerland, but car mechanics sure are that way.
Need a fix on insurance? Ooh, that’ll take us 2 weeks of full time work - minimum 5000 bucks. Call them and tell them it’s not insured? Ah, that’ll be 500 bucks.