I’m not defeated, and my last posts weren’t intended to convey that impression. Just because you are getting screwed doesn’t mean that you have to keep allowing it. I’m going to lose access to at least one doctor. My PCP has fired me from the practice, so I will have to get a new one. I am not sure yet about my endocrinologist.
I have been talking to some doctor friends, ones who work for my employer, and ones who do not. The doctors who DO work for my employer aren’t going to be able to write me a prescription for the more expensive drugs, and the insurance company says that I *have* to use the company’s pharmacy.
Usually, a provider or pharmacy that is not on the preferred list can still be used, albeit at a higher rate. They aren’t doing that here, and it’s being done that way to force patients onto the cheapest plan possible.
There are several loopholes in the system, and I plan on exploiting those. I will know within a month if I can make that work or not. All I know is that I am NOT going on insulin.
In my case, I need to get a doctor that will work with me, PLUS I need to get at least one refill on my medication under the current insurance, so that I have enough to last me until the open enrollment period for my wife’s insurance in July. I know plenty of doctors, but it’s the double hit of doctor PLUS pharmacy that is making it tough.
The rules and laws here are complex, but in complexity, there are loopholes. The more rules there are, the more holes there are to drive through. I have time to explore those, and even though I am screwed, I won’t be screwed forever. I don’t plan on staying that way.
Insurance companies hate diabetics even more than they hate smokers. The reason for this is that diabetics are famous for not complying with doctor instructions, and the disease is a progressive one. You don’t ever become cured of diabetes, the best you can do is manage or delay it. What manages it today will likely not manage it a year or two from now. It requires constant vigilance on the part of the patient and the providers. It’s a lot of work, and most of those who have it do not manage it well and wind up with complications like kidney, eye, heart, and brain problems. They wind up with nervous system problems, bone problems, and GI problems like gastroparesis. Treating all of this is expensive. The faster the patient dies, the cheaper all of that is from an insurance standpoint.
It isn’t that the insurance company is TRYING to kill you. No, they look at costs, and say “Gee, when we give drug X, diabetics cost us $y over their lifetime. When we give drug Z, they cost us $2y over their lifetime. Let’s only allow drug x.” They just don’t bother looking at anything else, it’s a pure monetary decision.
For those reasons, insurance companies WANT you to keep eating like shit and taking insulin, knowing that this will save them money over the long run. That’s why insurance companies want you to eat a regular diet and take cheap medicines like metformin. It’s up to each diabetic to carefully monitor their A1C, find trustworthy doctors who care about their patients, and keep on your insurance company’s ass. No one cares as much about you as you do.
Normal blogging to resume soon.