sorry a bit of a long one, using a site without a character limit continues to lets me get overly nuanced with hating this country’s health care system >:)
had a regular lesser problem patient in twice this afternoon, 70ish year old man. always wearing hunting camo and a vietnam vet ball cap. very vocally right leaning, complains about stuff nonstop if it’s not perfect while also doing the annoying uncle kinda jokes. the kind of guy that goes “get me a paper bag with a million dollars cash” when you ask what you can do for them (literally word for word what he said today). he comes up to the counter pissed because two of his scripts weren’t ready, an insulin script and a controlled sleeping med.
the doctor had prescribed the insulin on a sliding scale, which basically is just a chart given to the patient with blood sugar readings and a corresponding amount of how much to inject. they hadn’t provided us with the scale, a max daily dose, or a given days of supply. insurance billing for scripts needs us to have a calculated or prescribed days of supply, which we can’t do if we have zero idea of what dosing the patient is using. the other tech had faxed over for that and got it back and filled before the second time he came back.
however the sleeping med wasn’t that easy. a lot of insurances are really overly picky with what they will and will not cover. the system is basically designed to put as many hoops to jump through as possible between the patient and what they need in hopes that the patient will get frustrated and pay out of pocket or look for over the counter options so they don’t actually have to cough up any money and do the literal job that you pay your premiums for. the most common and pain in the ass hoop to deal with for everyone involved (except the insurance provider obvi) is prior authorization. in a nutshell it’s the provider going “are you sure about that?” to the prescriber in the way of a lot of extra paper work filed from the prescribing doc to the insurance company even though the answer is “no shit they prescribed it.”
the sleeping med needed a prior auth, which the other tech had also faxed to the doctor for them to fill out and send to the insurance company. depending upon the doc and insurance company this process can span anywhere from hours to literal months with zero indication to us of where in the process it is. when we try and bill it the insurance will just keep saying it needs a pa whether it hasn’t even been initiated or whether the insurance company has the paperwork and is just slacking. i had explained all this to him and he goes “i’ve never had to do this before, i’ve been taking this for years” (while he had been taking it for years he’s full of shit about not needing a pa i literally remember him pulling something with the same kind of sentiment last year when i’d initiated the pa (they only last for a year or sometimes shorter depending upon how shitty the insurance decides to be)).
then the mother fucker goes “thanks joe [biden]” to which i actually slipped a bit from my normal dealing with a patient tone to go “that’s been a thing since long before he was in office, this is a prolific thing in the industry that both parties keep intact because it financially benefits the insurance companies” and had to cut myself off before i started calling him a dumb ass because his insulin is around 10$ a month now instead of the 60ish he was paying a year ago because of the current administration. like i understand the frustration from having to deal with the american healthcare system, it’s what i do every day and it’s draining as hell, but for fucks sake if you’re going to bring politics into it at least know a little bit of what you’re talking about instead of playing the “it’s the side that i’m not on’s fault” card.
