Before I update you on the latest Prior Authorization abuse, I wanted to remind my patient members about why I am using Substack. This has become an extension and partial replacement of my normal patient Newsletters sent on Constant Contact. Patients have been reporting confusion regarding the paywall action buttons.
During the COVID debacle, I, like many on social media sites such as LinkedIn, Twitter, and Facebook, experienced account lock-ups over informed opinions I expressed publicly. We now know there was a concerted effort by our federal government to censor any comments that went against the “mRNA Covid vaccination of all persons program”.
I became aware of The Free Press and learned of their support for Substack. I absolutely agree with the principles of The Free Press and Substack which is based upon protected Free Speech. I decided to move from my The Doctor’s Report website to using Substack.
One of the features of Substack is that it’s revenue is generated by subscription interest in authorship. This is consistent with the free market principles that I am advocating as the solution to optimizing our health care system. For all these reasons, I have chosen Substack as my preferred blogging venue.
Many patients are reporting they have stopped following some of my posts because of the paywall buttons on the site. I wish to reassure my patient members that I am not trying to coerce you into subscribing to Substack in order to access my writing. My Substack posts are “free” as a patient member in our practice. Feel free to move past the subscribe and pay action button. For those of you discovering my writings who aren’t patients and wish to support my work AND the Substack forum, I am very grateful if you should chose to subscribe.
And Now To CoverMyAxx
It’s as if the industry read my prior blog and are seeking revenge regarding the COVERMYMEDS software service solution to prior authorizations.
To update the readership here is what is now happening.
Ongoing passive aggressive repeat information filling.
Return of “upon my honor and I swear to God” my answers are truthful.
Did you really mean what you wrote the first time? How about a second time?
Repeat prior authorization (PA) requests for the same medication but a new dose-pure unadulterated abuse.
A new twist I am experiencing, some insurance plans and their prescription benefit managers(PBM) are asking me to now seek their PA form and repeat the same data AFTER I Fill OUT THE COVERMYMEDS form.
One buyer’s PBM is now rejecting all my generic prescriptions with PA requests. Dear readers and patients understand now- I WILL NOT FILL OUT A PA FOR AFFORDABLE GENERIC PRESCRIPTIONS. FURTHER, IF YOUR PHAMACIST SAYS I AM NOT AUTHORIZING YOUR REFILL ORDER, THEY AREN’T TELLING THE WHOLE STORY. What is happening is the PBM is rejecting the prescription and the pharmacist is somehow expecting me to know this and stop may day to fill out a PA for your affordable medication.
Just in today (and I am not making this up) a patient was given a rejection of coverage stating they didn’t have the indication for my prescription. This is despite my filling out all their questions plus providing them an office visit note which provided documentation of all the evidence that the patient met the criteria for the FDA approved indication of the medication. I need these insurance companies to start signing their own “upon my honor, I am being truthful” signatures.
It was Einstein who is quoted as saying the definition of insanity was to keep doing the same thing and expecting a different outcome. I and every doctor has to conclude that filling out these inane and abusive forms will result in a different outcome. It is just more and extended abuse. We are getting conditioned and will be asked to carry out more bureaucratic tasks the more we go along with this charade.
The deplorables are abusing you/patients as well. When your pharmacist agrees to gag clause behavior and reports your medication can’t be filled because your insurance care said so, they are adding to the abuse. They can simply inform you of the cash price and explain- your plan says no BUT for 20 dollars I can fill your prescription and you can go about your life. When these same professional pharmacists can’t find the strength to pick up the phone and call the doctor’s office to explain there is a coverage issue and turf the message taking to you the patient, that is abuse.
My head continues to explode on a regular basis trying to understand how people paying so much money for health insurance and payment coverage can take this abuse and keep stroking checks to such an incompetent (or more accurately hostile) cartel, I will never understand. Let’s not be mistaken, the BUCA’s are a cartel and Uncle Sam facilitates their every whim.
What does Buca stand for?
As premiums continue rising, your clients (employers) seek relief from the high-cost, limited healthcare plan options…and there is a solution. BUCA stands for: Blue Cross and Blue Shied. UnitedHealth Group. Cigna.Jun 29, 2018
Stay Tuned for the Next Blog - Lee Memorial Had Their Draft Report Reviewed by the Board Yesterday.
Last night, Dr. Larry Antonucci reported to the staff physicians, via an email, that a draft of their consultant’s report was available for us to review. It appears to be a 100 page power-point presentation . To me this isn’t technically a report. I haven’t digested all of the slides yet but from the first 20 pages viewed, it looks more like a marketing report. Perhaps there will be some meat on the bone as I get through the rest of the report. I am expecting a real accounting of assets and some kind of directed conclusion or recommendation from the consultant. So far I see a lot of gloss and some wide ranging numerical “costs” of converting, mostly from either lost federal dollars or legal costs for changing business shingles. I will dedicate a full analysis in the next week or so.
I am hoping to open up a dialogue and forum for our community doctors to start discussing the future of Lee county’s health care and for the physician profession’s role in helping shape this. This exercise Lee is going through is a bellwether indicating a massive opportunity for us to reengage the Hippocratic oath and upset the apple cart of centralized, corporate health care delivery.
Stay hopeful- I know I am!