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A moment in the life of a family doc: Is it the post office or the insurance company?

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Real Life Scenario; A rather typical interaction with a patient whose life has been messed up by illness, poverty, the inadequacy of the health care finance system, and, now, the failures of the postal service under Trump.

Patient Medical Advice Request Pool-- 6 days ago

Hi Dr. Roland,
I called Aetna last week on Friday and let them know that I was running out of insulin injection pens. The person I talked to advised me that the 9 month supply of pens would be arriving in 2 to 3 days.   I never received the box of insulin pens.  I am now down to the last pen -- it will be gone tomorrow. Please advise.  Thanks, Rock

Hi, Rock—

I’ll send an rx now for a one month supply to your local pharmacy to cover you for the delay.

Aaron

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Patient Medical Advice Request Pool 3 days ago

Hi Dr. Roland,  I have not received the Levemir Flextouch pens.  The CVS Pharmacy in Target Tanforan Mall told me that the pens would be delivered on Friday.  The CVS Pharmacy at Bayhill called me on Friday night and told me that the prescription for the pens was being transferred to Bayhill because Target CVS does not have any pens.  CVS Bayhill called Aetna to verify.  Aetna is saying that they don't know about this prescription for a 30-day supply.  Also, CVS Bayhill wants me to pay $54.00.  I am now completely out of insulin pens.  I don't have a car so I will have to walk down to CVS Bayhill to get the pens.  My insurance is supposed to cover the cost.  I pay my insurance premiums so why are they playing games with me like this.  Thanks, Rock 

Hi, Rock--

They are playing games with you for several reasons:

1) They can.
2)  They are not in the health care business; they are in business to make money in whatever way they can.
3)  Actually, they hope you will get mad at them and go to another insurance, or to "straight" Medicare. Why should they pay for expensive medication? They would really prefer only to get insurance premiums from healthy folks.
4) There are other reasons, too, but I am feeling too depressed right now to keep listing.

Until we act up enough to change the system we will keep getting screwed.

Meanwhile, I will be in your corner and fight along with you. We should have some free samples in the office of levemir or something similar to give you if this is not resolved by Monday.

Best,

Aaron

Postscript:  He got the mail ordered meds the next day, about ten days after they were scheduled to arrive. He never was able to get the temporary supply from the local pharmacy but went a few days without medication.  No deaths or unneeded hospitalization, just anxiety, a brief period without needed medication, and uncompensated wasteful work for me and my staff.
 


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