Another angry blog post about insurance

...Because what else is new, right?

But seriously, what I want to vent about is insurance deciding what is or isn't medically necessary. Let's break this down: 

You go to your physician, who attended upwards of 8 years of schooling to become a MD. They evaluate you, hopefully take your input as a patient, form a medical opinion and a plan of care, write a prescription or two and send you on your way. You go to your pharmacy to pickup your medication, only to find that your insurance company has denied coverage of this prescription. They feel it is not medically necessary, or they have a "preferred alternative" that they do cover.

This is something we've unfortunately all grown used to. But let's just pause a moment. And let that sink in.

First of all, preferred by who? Not by me, the person who's going to be ingesting/injecting/applying the medication. Not by my doctor, who prescribed medication in the first place. But I mean, what value are our measly preferences in this situation, right?

Second of all, our insurance company is determining what our medical needs are. So what, then, is the point of seeing a physician in the first place? Why not just go directly to the insurance company and seek their medical opinion? Oh, that's right. Because they're not physicians.

To play devil's advocate, doctors are employed by insurance companies to conduct clinical reviews of prescriptions. However, are these doctors the most appropriate people to be doing this review? In short, no. When my Fiasp was up for review to determine what level of coverage it would receive, the review was conducted by a PhD. No shade to PhD's, but if someone's reviewing my insulin needs, I think it should be, maybe, I don't know, an endocrinologist? Perhaps my endocrinologist? One who isn't employed by a company that profits from denying coverage of the medication I'm seeking? I mean, we are literally asking people to make a determination that will either harm their own company, or harm us. And they've never met us. Which way are they more likely to go? Does conflict of interest not play a role here?

It's a very backwards system, to say the least. We go to doctors to get appropriate care. But then we're met with roadblocks to actually receive that care. For people with chronic illness, dealing with this for a lifetime is draining and aggravating. We should explore a system that makes it easier for people to live their best, most healthy lifestyle. An ounce of prevention is worth a pound of cure. If we keep people healthy, we avoid future hospitalizations and prolonged illnesses. And in turn, avoid future expenses our insurance will have to cover. So what is the end game for them? Are they just stuck in that phase of childhood development in which they have no ability to engage in delayed gratification?

End rant.

(For now).