new wrinkle in old cats tail or what is this HMO crap

  1. OK so I am 54, past menopause, unemployed and struggling with health problems. So about 7 months ago, for first time in my life, my doctor puts me on a low does of antidepressant. Today he showed me a two page letter from my HMO asking him if he really thought I needed the drug. It said that most people only need anti depressants for 7 months. I say that is crap. If he wants me to continue he has to certify that I need the medication. For some reason that aggavates me to no end. I don't think they give a crap about me, I think antidepressants are costing them a fortune and they are trying to get people off them by nefarious means.
    •  
  2. 5 Comments

  3. by   Lausana
    Maybe you should borrow a pharacology text and photocopy them some info on your meds...but then again although it's written for students they still may not understand since they only see in the language of $$$$$. ((oramar)) :kiss I HATE my insurance company...and probably after they receive the 16 pg fax I sent them this morning...they'll hate me too! They are just tightwads...with their own money...and our refund money. ((hugs again))
  4. by   BadBird
    How dare them, would you stop a diabetics medication after 7 months!!! No wonder you are upset, if you were cured that letter could cause a set back. I don't know why insurance companties are so powerful, they dictate to Dr's how to treat a patient, we are all prisoners of their corrupt system. What a shame!
  5. by   oramar
    Imagine how my MD feels, he is 60, been practicing medicine for 30 years plus. Now he has to have a third party in the exam room. Oh by the way, if he would stop the anti depressant and there was a suicide, guess who would get hauled into court? PS I am speaking hypothetically
  6. by   SmilingBluEyes
    interesting how they can be so arbitrary in what we need. some will pay for viagra and yet NOT BCP's ...........where is the logic in THAT? it is all so infuriating you can go CRAZY! I wish you well, my friend. Keep fighting the GOOD FIGHT!
  7. by   nurseratchett29
    WE DEAL WITH THIS CRAP ALL THE TIME IN PRIMARY CARE. I WISH I GOT A BONUS FOR EVERY "PRIOR APPROVAL", "PHARMACY OVERRIDE" "OUT OF FORMULARY REQUEST" AND OTHER ASSORTED REDTAPE FORMS I HAVE TO FILL OUT EVERY DAY JUST TO GET STUFF APPROVED THAT PEOPLE HAVE TAKEN FOR YEARS. i HAVE A PATIENT WHO HAS HAD CROHN'S FOR 27 YEARS AND HAS BEEN ON TAGAMET (GENERIC EVER SINCE IT'S BEEN AVAILABLE) FOR 10 YEARS BECAUSE IT WORKS. THE JACK@$$ IN THE PHARMACY OVERRIDE DEPARTMENT WANTED TO KNOW WHY SHE HAD BEEN ON IT AND WHY WE COULDN'T TRY THE CURRENT DRUG THEY ARE PUSHING THIS WEEK.
    ANOTHER EXAMPLE==MASSHEALTH REFUSED TO APPROVE MY PATIENTS COUMADIN 1MG TABS BECAUSE THEY SAID THAT 2.5MG HAD BEEN FILLED THE DAY BEFORE==THE DOSE IS 7MG QD. I HAD TO SPEND OVER 45 MINUTES ON THE PHONE EXPLAINING TO SOME UNEDUCATED MORON IN THE PHARMACY APPROVAL DIVISION THAT 2.5+2.5+1.0+1.0=7.0 HE COULD NOT UNDERSTAND HOW COME WE COULD NOT JUST USE THE 2.5 TABS. WHAT A MORON. WHAT'S SO "MANAGED" ABOUT THIS CARE? I AM SICK TO DEATH ABOUT THIS ISSUE==I WASTE ABOUT 15 HOURS A WEEK IN THE OFFICE JUST WAITING ON HOLD TO TRY TO GET A HUMAN WHO WILL APPROVE MEDICATIONS. I DON'T EVEN USE MY MAIL ORDER PHARMACY THAT COMES WITH MY BENEFITS BECAUSE IT'S SUCH A HASSLE==I'D RATHER DEAL WITHA HUMAN PHARMACIST AT CVS THAT SAVE $20 A YEAR AND DEAL WITH THE MAILMAN.

close