Do insurance company employees train more than gastroentrologists?

[blueamy66]

Cause even tho my fiance's dr prescribed Protronix, BCBS says the he should only be prescribed Prevacid. He was on Omeprazole, but the dr. wants him on Protronix now.

So, we can either pay $118 for the Protronix or the dr can 1. explain why he prescribed what he did or 2. prescribe the Omeprazole again.

:wtf:

Bloodsuckers don't wanna pay for the Protronix.

[Mass]

1. And we have the RW telling us they do not want a bureaucrat between us and our doctor

but an insurance company employee is OK?

[Cresent City Kid]

2. Their salaries make them feel equal to or better than doctors

If you're not a doctor, nurse, or otherwise hands on, you shouldn't make a killing from healthcare.

[undeterred]

3. They have many Continuing Education programs on screwing customers over.

So if they work at it long enough they get a doctor's degree in it.

[Catshrink]

4. See the comparison between American and Australian medicine here

In Australia, the docs don't have to justify their decision to an insurance hack.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6153899

[MarjorieG]

5. Another reason to have negotiation for drugs, shorter patent lifes, etc.

[buzzycrumbhunger]

6. I do medical transcription

. . . and that kind of shit happens ALL the time--not just meds, but procedures, operations, hospital admissions. Besides a lengthy inclusion of an "informed consent" spiel to cover their arses, one of the biggest changes I've seen in the last few years is docs giving a detailed rationale for why they have to do something, i.e. not just pretending plastic surgery is a medically necessary procedure, but just about everything. As in. . . someone needing breast reconstruction after a mastectomy because, apparently, it's not enough that they want to look "normal," or a joint replacement only after they've failed an exhaustive trial of other therapies because why authorize surgery just because they have no cartilage left if it's cheaper to give them steroid injections or pain meds? It's disgusting.

Another thing that's bothered me for a long time is the difference in treatment people get from the VA. Many times they'll only be authorized for certain meds/generics, even if they don't work as well (as in your financés example, which is a common one). I rarely get through a shift where I haven't had at least one patient coming to a public hospital to pay out of pocket because the VA insisted upon something already proven not to work. New/expensive meds are most often not dispensed there because of the cost.

Bureaucracy has been coming between doctors and patients for far too long, and I've always found it amazing that people would defend the status quo based on the faulty reasoning that a govt. plan would be a huge change. Why would a change for the better be more frightening than what we have?

The biggest mystery to me is how insurance companies are allowed to practice medicine, which supposedly requires a medical license. If anyone else did this, they'd be arrested in no time, right?

[blueamy66]

7. Yeah, why do the insurance cos. get to practice medicine

without a license?

I just don't understand this BS. I hope that the dr gives it to them good.

[Ocracoker16]

8. it is crazy how they try to get you to take a cheaper med

That has happened to me numerous times. My doctor has written many letters and made many phone calls to explain to the insurance company why he prescribed a particular medicine and why they need to fill the prescription. It is funny but they suggest medicines that I have already taken in addition to ones that don't mix well with the meds I am already on. My doctor once called them about the dangers of taking their suggested med with one of my other meds. He went right into a rant about how they would not save money. He said that they must not really care about the cost of the ER visit that would result from combining the meds. That got them thinking in dollar signs so quick that they immediately declared that they would pay for the prescribed medication.

[Ocracoker16]

9. it is crazy how they try to get you to take a cheaper med

That has happened to me numerous times. My doctor has written many letters and made many phone calls to explain to the insurance company why he prescribed a particular medicine and why they need to fill the prescription. It is funny but they suggest medicines that I have already taken in addition to ones that don't mix well with the meds I am already on. My doctor once called them about the dangers of taking their suggested med with one of my other meds. He went right into a rant about how they would not save money. He said that they must not really care about the cost of the ER visit that would result from combining the meds. That got them thinking in dollar signs so quick that they immediately declared that they would pay for the prescribed medication.

[hfojvt]

10. Probably

I don't have much love for my GE. After I went to him for feedback about my 2nd EGD, he basically told me nothing and scheduled a 3rd EGD which I later cancelled.

Not to dispense medical advice but I have been treating my digestive troubles with yogurt and jello.