When doctors won't cooperate with insurance? (plan, benefits, prescriptions, patient)
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Ok, I know, the obvious answer is, find another doctor, which I have. But you can't second-guess all insurance glitches.
My biggest problem is getting them to write RX that maximize my insurance. Here's how my insurance works (most insurance is similar, shouldn't be any big deal to them, they've heard it before)
We can get refills at a local pharmacy up to 3 refills, then, its considered a maintenance drug. any refillls after that, they will not pay a dime towards, then, we must utilize mail order.
Even if less than 3 months, its always cheaper to use mail order. For drugs that are time dependent, like antibiotics, of course, you can't utilize that option
The insurance suggests asking the doctor for a 2-week RX to fill locally, along with a mail order RX. The doc can fax the mail order RX in, so you should have your meds in plenty of time. Or, just ask for a one-month supply, to be on the safe side. Also, ask if the doc has any samples to cover the wait.
Well, today I got an RX for a new drug (new to me, that is) for diabetes. I explained all of the above to her, she insists on writing for one-month at a time, to see how it works. I tried explaining to her, even if we end up increasing it (she started me at the lowest dose) we could make dosage adjustments, etc. As it is now, that new drug will cost me $30/month, I could get a 3-month supply for $50. That isn't the only drug I take, our OOP for RX runs us around $300/month, with the whole family.
I mean, come on, its not like I'm asking for controlled substances, etc---BTW, they allow an override on controlled substances, so I don't have to monkey with mail order, potential theft, etc.
Its hard enough to even find a doctor who is on your plan, accepting new patients, within a reasonable driving distance, let alone someone who you trust, then to have to argue the finer points of prescription writing? I estimate I could save at least $125/month if I could get doctors to write the RX to maximize the insurance benefits, but you have to take the whole ball of wax into consideration.
Doesn't help I'm changing doctors (my doctor retired), and try to get a new doc "trained". Oh, well.............
Oh, another "gripe" why do they cram 4-6 RX on one sheet? I can't fill all at the same time, some I utilize mailorder, some I utilize local pharmacy, and they won't allow early refills. I ran into that today with my BP medicine, she writes it on the same RX as the diabetes med and some others, 4 RX altogether on the same form. Depending on the drug, when last filled, whether I wish to utilize mail order or local, that limits my options.
I always have my RX neatly typed out for them, and write on it please write each RX on a seperate form, but they end up handing me 4-6 on the same form, and run out the door before I can protest, oftentimes, they run off and a nurse hands you your RX as you leave, leaving your options limited. They want their money, they make you pay before you get past the window, but when it comes to maximizing your benefits, well, they could care less!
My doctor provides one RX per form. For just this type of reason. She also asks if I am using mail order. Some of them I don't fill since I have only a seldom use and have unexpired older ones at home. I think the problem is really only your doctor.
I tried the fax to mail order company direct from doctor's office and got them fast with a bill.
My doctor provides one RX per form. For just this type of reason. She also asks if I am using mail order. Some of them I don't fill since I have only a seldom use and have unexpired older ones at home. I think the problem is really only your doctor.
I tried the fax to mail order company direct from doctor's office and got them fast with a bill.
Nope, its not the individual doctor, unless I've had a run of bad luck. I've had several doctors write multiple RX on one form, my dh encountered the same problem. Doesn't matter WTH you tell them, they are out of the office and a little "play nurse" comes in and hands you your RX, usually all written on the same form, and leaves. Try tracking the doctor down then!''
Also, my son's doctor refuses to fax RX to mail order, he "had problems with them before" Well, we could find another doctor, which we are in the process of doing, but our insurance (like most insurance) allows one "well-checkup" per year. a new pediatrician is considered a "well-checkup" Even if you go to a new pediatrician with a specific complaint, which insurance pays for, the ped wants you to schedule a "well checkup" ASAP, they won't continue to see you until they get that chunk of your hide.
I've learned to ask before scheduling a new appt, to speak with the office manager and demand to know their policy regarding writing RX on multiple forms, faxing, etc. After all, they want to know all about you before you come, you shouldn't wait months for an appt, then sit there for hours, only to find the doc could care less about writing your RX so you can at least use your insurance!
The only time I've gotten written prescriptions over the past 15 years, was one particular doctor who insisted I physically show up at his office once a month for a 30-day supply of Ambien. He didn't charge for an office visit, since I didn't have to see anyone other than the receptionist. It was just his personal notion of checks and balances against abusers of the drug (they sell for around 8 bucks EACH on the black market around here, to meth addicts who need sleeping pills to "come down" from their high).
All my other doctors have ALWAYS called my prescriptions in to my pharmacy of choice. My sister's doctors do the same for her. We both use mail order for our maintenence meds (such as my ambien, now, and my thyroid meds), and the local pharmacy for short-term things like antibiotics.
Just tell the doctor's receptionist the name of the pharmacy and their phone number, and have them call in the scrip. It's part of their job.
Making a new post to address the time limits of the prescriptions: of course, diabetic meds aren't controlled substances, but it's very easy to confuse which med you're supposed to be taking, if you have several with overlapping duractions. If I have a 3-month prescription for a new drug, and after a week it's clear I need something else, and then the doctor prescribes another 3-month rx for something else, and two weeks later that one's not acting right, or I need a dose that's different enough that it requires a whole new rx...
then I've got three current presciptions, for 3 different drugs, and I only should be taking one of them. The pharmacy doesn't know that you shouldn't be taking the other two, because they only get the prescription. They don't get a cease and desist. So if you ask for a refill for the wrong one, they won't know to tell you it's the wrong one. *You* might be responsible enough and sound enough of mind to ask for the right one. But many diabetics are elderly, and many have confusion issues when they're ill, even if they're not elderly. So rather than thousands of pharmacies all over the country keeping track of which of their millions of patients knows better and which don't, they make a blanket policy: we fill what we're told to fill by the doctor. Doctors know this, and so they prescribe -only- what their patient needs, and nothing more, UNTIL they determine that long-term of a given drug is appropriate.
So - if you're trying something new, or different, or a different dose of an old thing...the pharmacy needs to get one at a time. Once it's clear that it's the right one for you, THEN they can make it a maintenence drug, and up it to 3 refills at 30 days each, or whatever your mail order allows.
Nope, its not the individual doctor, unless I've had a run of bad luck. I've had several doctors write multiple RX on one form, my dh encountered the same problem. Doesn't matter WTH you tell them, they are out of the office and a little "play nurse" comes in and hands you your RX, usually all written on the same form, and leaves. Try tracking the doctor down then!''
Also, my son's doctor refuses to fax RX to mail order, he "had problems with them before" Well, we could find another doctor, which we are in the process of doing, but our insurance (like most insurance) allows one "well-checkup" per year. a new pediatrician is considered a "well-checkup" Even if you go to a new pediatrician with a specific complaint, which insurance pays for, the ped wants you to schedule a "well checkup" ASAP, they won't continue to see you until they get that chunk of your hide.
I've learned to ask before scheduling a new appt, to speak with the office manager and demand to know their policy regarding writing RX on multiple forms, faxing, etc. After all, they want to know all about you before you come, you shouldn't wait months for an appt, then sit there for hours, only to find the doc could care less about writing your RX so you can at least use your insurance!
"No mam, that's not what I need... (Explain)... She fixes... it takes forever."
About the 2nd or 3rd time they start to see that YOU ARE THE CUSTOMER and INSIST on having it done YOUR WAY... so they do it that way to avoid having to redo it every time...
So long as you'll "Go away and pay"... they will keep doing 'what they want'
"No mam, that's not what I need... (Explain)... She fixes... it takes forever."
About the 2nd or 3rd time they start to see that YOU ARE THE CUSTOMER and INSIST on having it done YOUR WAY... so they do it that way to avoid having to redo it every time...
So long as you'll "Go away and pay"... they will keep doing 'what they want'
No, she isn't the customer. She is the patient trying to get medicines that only a doctor is legally allowed to prescribe to her, and only for the amount and dosage he determines is necessary for her health.
If she has a problem with the prescription, she needs to talk to the doctor. If the doctor disagrees with her, then that's the end of that. He has made his decision, he has determined that it's in the best interest of the patient AND in the best interest of his practice, and if she doesn't like it, she can find another doctor.
If it were any OTHER way..like you say..you'd get junkies walking in off the street demanding prescriptions for morphine because they're the customer and they can have it their way.
A doctor's office isn't Burger King. You can't have it your way. You have it the doctor's way. Or, you can go to Burger King and see if they'll prescribe you some insulin. They won't, but they might recommend a slurpee.
All of my doctors do refills by fax from the pharmacy. I call the pharmacy, they fax the doc, doc faxes back. When it'd a changed dose or new med, I tell doc's office the phone number of the pharmacy and they call it in. The only time I see a written script is if I go to the walk-in clinic.
The only time I've gotten written prescriptions over the past 15 years, was one particular doctor who insisted I physically show up at his office once a month for a 30-day supply of Ambien. He didn't charge for an office visit, since I didn't have to see anyone other than the receptionist. It was just his personal notion of checks and balances against abusers of the drug (they sell for around 8 bucks EACH on the black market around here, to meth addicts who need sleeping pills to "come down" from their high).
All my other doctors have ALWAYS called my prescriptions in to my pharmacy of choice. My sister's doctors do the same for her. We both use mail order for our maintenence meds (such as my ambien, now, and my thyroid meds), and the local pharmacy for short-term things like antibiotics.
Just tell the doctor's receptionist the name of the pharmacy and their phone number, and have them call in the scrip. It's part of their job.
At least in Florida - Ambien is a controlled substance that requires a written Rx from the doctor. - that the doctor physically gives to you - that you physically deliver to the pharmacy.
FWIW - except for controlled substances - my PCP delivers Rx requests by computer - not fax. Robyn
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