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Monday, September 4, 2023

Insurance Stupidity Knows No Bounds

UT: You'll never believe this one. 
CP: Oooh. That's a challenge I'll accept. Proceed. 

<UT on phone with long-time patient>
UT: Your insurance won't pay for your NP Throid; it requires a prior authorisation.
Patient On Phone: I know. And I can't afford over $100 per month for it. 
UT: They want you to try and fail both BRAND Synthroid AND BRAND Levoxyl before they will cover the NP Throid. 
POP: Can you tell me what the cost of those will be?
UT: Sure. Well that's interesting. 
POP: I assume that is "not interesting"?
UT: If I run through Brand Synthroid, the insurance requires a prior authorisation. Same with Brand Levoxyl. Unless. . . 
POP: What?
UT: Unless the doctor writes DAW1 on the prescription, the insurance requires prior auth. 

CP: Wait. So the insurance requires these brands be tried and failed. 
UT: Yes. 
CP: But they won't pay for them unless it's with a DAW1?
UT: Yes. 
CP: So we now have to call the office and have them send another Rx to prevent prior auth?
UT: Yes. 
CP: That's not THAT surprising. 
UT: But they set the rules and changed them midgame, it seems. 
CP: You mean "why couldn't they just say that in the first place?' instead of sending us a prior auth request for brand Synthroid and Levoxyl when it was their idea? 
UT: Right. Why do they need a p/a on what they prefer? It seems stupid to require brand only to THEN require it be DAW1. Brand is Brand. It shouldn't matter. 
CP: And they're delaying for months therapy that has worked for this patient for years. 
UT: Insurance rules don't matter. It's like they're playing a different game than we are and when we discover the playbook, they change the game. 
CP: Monopoly versus Australian Rules Football. 
UT: Well said. 

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