“I was just fine on my Xarelto for a blood-thinning medication. Now my insurance won’t pay it and my doctor has to switch me to a medication that doesn’t work for me! WHY?”
We’ve all been subjected to the insurance companies changing our medications and telling us we’re no longer covered under one medication and we have to switch to another.
It usually happens around this time of the year and as diabetic patients, we are left to try a new product when our old product worked just fine.
This is a perfect example of insurance companies practicing medicine without a license.
You signed up for the best plan and now?????
Oh, they claim that you can get the medication but they won’t cover it.
So what are you left to do?
Well, you’re paying a high enough premium as it is, so you want to use your insurance.
You hope that the new medication will work well with all your other medications, have no side effects, and be even better than the one you’ve always been on.
If you haven’t had this happen to you then you haven’t been taking medications long enough. Because it will happen.
Your doctor or provider is left in a quandary.
This means that they have to decide whether between YOU or your INSURANCE COMPANY.
So you have to decide what’s right for you.
Now there are two ways that they can fight this:
1 – You can call the insurance company and refuse to accept a new medication saying that you’ve been perfectly well on your old medication and you’re going to stay on that. Oftentimes I had to use the tactic with the insurance company telling them that “if this diabetic patient dies because YOU would not cover the medication they’ve been living on then I need YOU (the insurance company) to explain to a jury of 12 why this patient was dead due to lack of YOUR care. Therefore, I am going to need your social security number in order to find you so you can testify when their trial comes up!” This got their attention.
2 – Your doctor can put you on the new medication, show that it did not work for you and then you’ll have to go back to your old one. Many of you know how this works. What your doctor does is prescribes the new medication. You have to pick it up but NOT TAKE IT but continue to take your old medication. The doctor does not know and SHOULD not know you are doing this. It is unethical for them to go along with this.
30 days later you call your doctor and tell them the new medication didn’t work and you would like your old one back.
This is called “failed therapy”.
Telling your doctor you can’t take the new medication and need your old one can possibly get the insurance to continue to pay for it.
Remember, your doctor cannot suggest this.
You have to.
AND it’s your PATIENT RIGHT to refuse treatment (in this case: a certain medication).
Profits over Patients (AKA Deals over Diabetics)
OK let’s understand why insurance companies switch your medication. It has nothing to do with you or your welfare.
It has to do with a group of men and women sitting around a table discussing their pharmaceutical product or medication with the insurance company.
Who gives the lowest discount, or cheapest drug, and who makes the best sales pitch?
All these wheeling-and-dealings going on behind closed doors.
No one asks if you, the diabetic patient would be better off switching.
The insurance analysts have to play “the numbers”.
Diabetic patients should speak up!
This is nothing new.
Here’s an article from a physician that seals the deal on what I am saying: All they want to do is help you but you are the one who has to ask!
Stand up for yourself and your doctor. You both deserve more.