Welcome To Private Healthcare!

, , , , , | Healthy | December 21, 2018

(I’ve recently had to change my health insurance, and I’m still getting used to its quirks. I realize that one of my medications can’t be refilled on this insurance without a Prior Authorization — “PA.” Basically, the insurance wants my doctor to formally request that I be allowed to take it, because it’s a name brand that’s relatively expensive. My doctor sends the PA request in a few days before I have an appointment with him, and I don’t hear much else about it until I go into the office, where my doctor seems irritated.)

Doctor: “So, I wrote a letter to your insurance company for the PA. Actually, I wrote them two letters. They won’t fill your prescription.”

Me: “What? I thought the point of the PA was so they’d fill ones they normally wouldn’t?”

Doctor: “Generally, but sometimes they deny the requests because they want you to try a generic first. When I sent the first letter, they replied with a denial and said that you were required to at least try [Generic #1] or [Generic #2]. The problem is, they contain [certain progestin], which interacts with testosterone.”

Me: “Which is what I’m taking [Medication] for in the first place?”

Doctor: “Yes! So, in my second letter, I told them that if they couldn’t approve [Medication], I needed anything from a long list I gave them, but specifically any variation that did not include [certain progestin]. And they absolutely will not budge. They sent me a list of more options, and every single one of them contains it.”

Me: “Um. Okay. What does that mean?”

Doctor: *looking like he wants to kill someone* “It means your insurance company won’t let you take any medication except for the kind that will only make your problems worse.”

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