I can't believe this! (health insurance rant)

DH just called me from work. He received a voice mail from the doctor that is handling his diabetes and thyroid. Apparently, our insurance company called the doctor and "recommended" he be put on blood pressure medicine. Now granted, DH did go to the emergency room and had a higher than normal blood pressure...but he was having panic attacks! Background story, when he first started showing symptom of diabetes his blood sugar would fluctuate drastically, he would start feeling "strange" and assume he was having a heart attack (his dad dropped dead from one suddenly a few years ago at age 55) and he would put himself into a panic. Hence the high BP in the ER. Sugar and panic attacks are now pretty much under control with meds and all BP readings for normal doctor visits have been fine. In fact, high BP is probably the only thing NOT wrong with him.

So, when did insurance companies become qualified to diagnose people?

Also, based on the message the doctor left, the insurance company is threatening to drop my husband because he hasn't been filling his cholesterol meds. The reason he hasn't been filling them is A) the insurance stopped covering the first prescription after the second refill, and B) the second medicine he was put on gave him a bad reaction so his doctor told him to stop taking it. DH has low range high cholesterol (if that makes sense), it's only in the lower 200's. Once he found out DH also had hypothyroidism and borderline diabetes he decided to wait until further blood tests in Dec to see if his cholesterol went down.

Can they actually drop him if they don't agree with the doctor? This is insurance I have through work and while I pay out the butt for it (3 times more to cover DH than for myself, over $300/month for both of us) it is good and covers most things. I'm actually just venting because how DARE they say they know what is best for anyone!

Wow, I don't know the ins and outs of insurance policies, but that doesn't sound right at all! I've heard of insurance companies denying a med or treatment, but never requiring one! That doesn't sound legal, they're not the MD, the doctor is!

Good luck getting it sorted out.....

I would contact the insurance company, especially since you heard this second-hand from the doctor. Something is fishy, it doesn't sound right at all; insurance companies have to put everything in writing to you. They do not notify you of change in policy through your doctors. Everything you are concerned about is what your doctor said the insurance company said.

Personally, I would check my policy and then call the insurance company and get all the facts from them (making sure to record date, time, and the name of the person I speak with).

All I can say is..... fight insurance companies + pharmaceutical + cholesterol meds - this BS crippled my dad, who is now pretty much in need of a wheel chair. Yep, because of cholesterol meds crap. Fight back.

I agree with all of the above - something is VERY strange here. IF they require this, it should have been in writing to your husband. But I've never heard of an insurance company requiring something like this before. Call and find out what's going on.

WHAT!! Really, when did insurance companies become sight-unseen, over-the-phone MD's????? What a bunch of CRA*. This is a first for me, insurance companies insisting what medications need to be used to have coverage. I am sure Doctor's have stories from here to the moon, too, about request's and demands they receive from insurance companies for their patients.

Loads of vibes you get to the bottom of the ridiculous recommendation !!!!

When I was working for an audiologist; doing billing and all that lovely stuff, we would have to submit copies of medical reports and things to prove someone needed a treatment or device. It would be reviewed by a physician working for the insurance company. I can recall a time or two an insurance company's staff called the physicians I have worked for to discuss things like that. I think it's negligent for them to go making reccomendations. They assume they have ALL the information from every single visit? I think not. They could cost someone their very life making medical decisions when they don't really even have the time to review what they do have! Or don't take it? Hmm....

Not quite the same thing; but my friend called me yesterday. She got a letter, dated October 3rd in the mail yesterday, October 18th stating that because they don't have proof (which they never requested) that physical therapy is helping her recouperate from an accident they are cutting off her benefits, effective August 15th. So basically the let her rack up 60 days worth of therapy (she goes 3 times a week!) before notifying her they would no longer pay. Or even requesting more documentation from the therapists. Needless to say she is fighting this. This company also caused her to loose her short term disability a few months back. In the meantime; she can't go to pt.

Oh this is just all wrong!!!!!

Well, I listened to the message when DH got home, and apparently our insurance company has some sort of "wellness" program where they send a letter to the doctor suggesting what patients should take for preventative measures. Well, I'm sorry, to me prescribing a blood pressure for a person that does not have high blood pressure is dangerous. DH did some checking on the internet and the medication is also sometimes prescribed for diabetics to handle protein in their urine. However, the doctor already has him on something like that so he's supposed to double dose now? Oh, BTW, the prescription is in the mail.

The nurse that left the message made it sound like they might drop him if they don't have a reason for not taking the cholesterol medicine. The thing is, that was prescribed by his PCP, NOT this doctor. Maybe they sent it to both of them?

I'm going to try to get a copy of the letter, but trying to get anyone to answer the phone in that doctor's office is near impossible. Everything is done by voice mail.

Originally Posted by Carolina

All I can say is..... fight insurance companies + pharmaceutical + cholesterol meds - this BS crippled my dad, who is now pretty much in need of a wheel chair. Yep, because of cholesterol meds crap. Fight back.

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I'm sorry about your Dad.

I can understand that considering DH's reaction to the second med. I think it was Crestor (or something like that?) After being on it for 2 weeks his knees hurt to the point he couldn't walk. DH also has Crohn's so his joints are sensitive to begin with so adding this med to the mix caused extreme pain. I could only imagine what it would do long term.

We're hoping getting his thyroid and sugar in check will help lower his cholesterol so he won't need any meds for it. I really don't want to see him on any meds that aren't needed.

Originally Posted by calico2222

I'm sorry about your Dad.

I can understand that considering DH's reaction to the second med. I think it was Crestor (or something like that?) After being on it for 2 weeks his knees hurt to the point he couldn't walk. DH also has Crohn's so his joints are sensitive to begin with so adding this med to the mix caused extreme pain. I could only imagine what it would do long term.

We're hoping getting his thyroid and sugar in check will help lower his cholesterol so he won't need any meds for it. I really don't want to see him on any meds that aren't needed.

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Yep - he had severe nerve damage, which is irreversible. He has no balance, can barely walk, has no feelings in the ball of his feet, hands, is in tremendous pain, suffers from severe cramps, and will fro the rest of his life. For what? For a medicine that has a 1% effectiveness. That is correct - Statin medicine, like Lipitor, Crestor, etc - has been proved to have 1% effectiveness.
On the Lipitor clinical trial, for 3.5 years, for every 100 people against placebo - 3 people on Placebo had heart attacks, against 2 people on Lipitor. Gee... HUGE difference That's 1 in one hundred, or 1%.
How did this drug get approved?
The National Cholesterol Education Program (NCEP) 2004 guidelines lowered the targets for cholesterol treatment and recommended more Americans take statins. The panel that issued the guidelines was comprised of nine experts, eight of which had ties to the drug industry. Well.... We all know that the drug companies hold a responsibility to profit with their shareholders........ and voila! That reflects what's going on with the O.P.

Research the side effects for Statin Medicines and you will be shocked and you will fight this back. My dad lives in Brazil, and unfortunately there is no way for him to go against a huge pharmaceutical Company for what happened..... He can only deal with the pain and go from dr. to dr. now. to see how to best live with his issue. He is in the process of remodeling the house to put bars on the bathroom, taking his last trips while he can walk some .... Taking MRIs.... But..... YOU, can prevent this.
Heart disease has a LOT to do with inflammation - which is why aspirin works so well, omega 3s, fish oils, a good diet, etc.
Don't fall into the pharmaceutical industry trap. They don't care about you.... Protect yourself