Re: Dr B and the Endocrinologist He Recommends

From: eugeneshapiroisapig (mockingbirdstl_at_aol.com)
Date: 03/29/05 

Date: 29 Mar 2005 09:15:23 -0800

wow, you have really good insurance.
My insurance only pays 20% out of network (which in my case is pretty
much restricted to state of oklahoma, which sucks because oklahoma is
slightly backward in terms of most medical specialties) but they will
pay up to 80% out of network for some specialists but the process to
get approval is so annoying (multiple letters from doctors, sometimes
even a threatening letter from a lawyer) that it's almost not worth it
unless you're having brain surgery or something like that. And then of
course the damn insurance company strikes back with "it's an
experimental procedure".
     My damn insurance company. You know, here's something they do that
really pisses me off. I have to take a certain drug. this drug is
somewhat expensive, but both of the doctors involved (my GP, and a
board-certified highly respected endocrinologist) agree that it is the
only option. However, every freaking time I get a refill, the insurance
denies coverage, I have to pay a lot of money out of pocket, and then
argue with them to death sometimes having to have my mom's lawyer write
a letter. Finally, they concede the point, and pay out. I am not
kidding when I say this happens every time I get a refill. It's
ridiculous.
   I personally believe that this is their policy, to initially deny
coverage on this drug even though they don't have a leg to stand on. It
occurred to me that an elderly person who was taking the drug might
just give up and pay out of pocket. They throw up so many obstacles,
most people might just surrender to these bastards.