How Did the Insurance Companies Come to Run Everything?
Bill Quick

So I’m at my doctor’s office today for a few things, and I mention that my back went out on me several days ago, and it’s been fairly painful.

He asked what I was doing, and I told him I wasn’t doing much butt staying off my feet and taking Ibuprofen.  He looked through my charts and said, “No Flexeril?”  (That’s a muscle-relaxant I’ve used for these attacks in the past).

No, I ran out.

So he prescribed me a bottle of a hundred.  It takes me three years or so to go through that many, but I like to keep some around.

Anyhoo, I hie myself across the street with my prescription and present it to the nice young (20-something) lady behind the counter, then take a seat and wait for them to fill it.

After several minutes she comes out, bends over me and whispers, “Your insurance company won’t pay for this.”

Eh, what?  They always have before.

“Why not?”

“They have it listed as being high risk for a person your age.”

I asked her how much without insurance and she told me seventy bucks.”

“Fine,”  I said.  “Wrap it up.”

She stared at me as if I’d suggested she perform fellatio on me right then and there.

“But sir,” she said.  “Your insurance won’t pay.”

“Yes, I got that.  I’ll pay.  Go ahead and fill it.”

She startd to say something, stopped, and retreated back behind her counter.  A moment later she said, “Sir, could you come over here?”

I came up to the counter where she had turned her screen around so I could see it.  She said, “See, right here.  They say it’s dangerous.  I can’t give it to you.”

Now it was my turn to stare.  “What?  I told you, I’m paying.  That cuts the insurance company out of the deal entirely.  I have a prescription from my own physician, and I’m paying for it out of my own pocket.  What does the insurance company have to do with it?”

She was shaking her head.  Apparently the thought that a patient would go against the wishes – would be permitted to go against the wishes – of the almighty insurance  company was so foreign to her mindset that she simply couldn’t understand the concept.

Luckily, the pharmacist had begun listening in (I may have started to raise my voice just a slight bit) and he said, “Just fill his prescription.”

“But…but…the insurance company…”

“It’s his money and his doctor,” he told her.  “Just give him what he wants.”

So she did.

But I’ll bet she still thinks there was something illegal or immoral about me being able to buy a prescribed medication that wasn’t approved for me by my insurance company.

And I’m wondering how long it will be before insurance companies – or the government, via Obamacare – is able to tell you what you can, and can’t spend your own money on.

I’m fairly sure this young lady would have had an equal problem with the notion that my own doctor of twenty years would have a better handle on my meds that the facelss insurance company who knows little or nothing about me, personally, at all, in its one-size-fits-all decisions regarding my health care.

What really bothers me is that I suspect most patients would simply have taken her at her word, and foregone the meds their own doctor prescribed for them.

And that is sad.  And maybe dangerous.


Bill Quick

About Bill Quick

I am a small-l libertarian. My primary concern is to increase individual liberty as much as possible in the face of statist efforts to restrict it from both the right and the left. If I had to sum up my beliefs as concisely as possible, I would say, "Stay out of my wallet and my bedroom," "your liberty stops at my nose," and "don't tread on me." I will believe that things are taking a turn for the better in America when married gays are able to, and do, maintain large arsenals of automatic weapons, and tax collectors are, and do, not.


How Did the Insurance Companies Come to Run Everything? — 6 Comments

  1. What really bothers me is that I suspect most patients would simply have taken her at her word, and foregone the meds their own doctor prescribed for them.

    Not this guy. I’ve routinely had to buy medicines that my insurance wouldn’t cover for various reasons and I simply forked over the money.

    On the other hand, I’m stubborn sonofabitch and do not take no from stupid peons willingly.

  2. Anecdotal, but…

    I ran into this problem (slightly different form, different drug, otherwise quite similar) while working up near Chicago very early last year (a job location I agreed to with some trepidation; turned out [for several reasons] to be a mistake I will not repeat!!).

    I was running low on a particular prescription which I normally get refilled at Costco, for several reasons but primarily because they will do a 90-day refill across the counter (so I don’t have to use a mail-order setup). I hadn’t been to the doctor for an exam in awhile, and I already knew (based on past practice) that the new prescription (I was out of refills) would not be issued without my periodic office visit/exam. I called the doctor’s office, advised them of the situation, and as an interim (until I would be back home in NC for a few days) asked them to issue me a regular 30-day script by mail, and then took it to the local Walgreens – it was the closest pharmacy to the worksite, plus I decided to get a late-season flu shot and they had a big sign in the window advertising same.

    Both items turned out to be a problem.

    First off, they tried to tell me that my insurance plan would not cover the flu shot, even in part (which is nonsense, I’d already asked the insurance people myself, and it was supposed to be covered in full) – and, they also stated that the insurance carrier was refusing to fill the 30-day script “…because use of this drug for a man of your age is inadvisable.”

    I took a couple of minutes to absorb that – I had to wait while they freed-up someone to give me the flu shot anyway.

    After getting the shot, I told them to give me back the script (figuring I’d simply take it to a different drugstore, and present it without my insurance card; tell ‘em I didn’t have drug coverage) – no go: they wouldn’t return the script, claiming it was “against the rules to return an unfillable prescription.” I got pretty heated with them, but still no way they were doing anything the insurance company would not say was o.k. – nor would they (apparently) give me the opportunity to go somewhere else and get what my doctor wanted me to have. So – I ended up having to get another script from the doctor’s office (after several more days of delay!) before I could go get it filled – at Rite-Aid, IIRC – sans insurance. Also, they grossly overcharged me for the flu shot. Suffice it to say, I will NOT be going to Walgreens again – for anything – any time soon, if ever.

    I still don’t know for sure, BTW, whether the insurance carrier actually stopped the script, or if that Walgreens pharmacy were simply being a bunch of colossal dicks. About a month later, I had my semi-annual doctor office visit and got issued new prescriptions – one of which was for a slightly different form of the same drug – which were promptly filled (with, apparently, full “approval” by the same insurance carrier) quite routinely.

    In a way, I can sort-of understand the pharmacy’s taking this sort of view, and following exactly what the insurance company says to do; they make most of their money from the insurance companies, if they don’t do as they’re told there’s bound to be a certain amount of (perhaps justified) apprehension that the insurance carrier will refuse to pay them if they don’t do as instructed. It’s a pretty annoying situation – but it’s been pretty obvious for some time, now, that the insurance companies have more say-so with pharmacies than the doctors – or the patients/customers – do.

    I’ve had to pay in full before for scripts that the insurance suddenly stops (for no reason given; probably because they’re losing money on the stuff, and therefore summarily delete it from their “formulary”), but I’ve never before had one simply denied because the insurance carrier says it’s bad stuff for me to have – in spite of what my doctor says.

    Seems likely this will only get worse, as Obamacare bleeds thorugh the system, as well. Fun!!

    • Next time you’re faced with BS like those nameless drones, take out your camera and start taking their pictures. If you can record video with sound, ask them to state their names and repeat the line of bullshit they told you off camera. Ask to see the company policy, or talk to a manager or someone with decision-making authority and photograph or record that. (I generally don’t beat up on junior drones, as they definitely do not have the authority to buck senseless orders.)

      It helps to be a stubborn SOB, and it helps to not give a damn if people excoriate you for being “difficult”. Oh, and if they call the police and the cops don’t immediately tell them they have no complaint, take the cops’ pictures, too. They get bent out of shape, but fuck them. (Er, that’s meant as rhetoric, not as a suggested next step in being “difficult”.)

  3. Suffice it to say, I will NOT be going to Walgreens again – for anything – any time soon, if ever.

    Yep. They charged me almost seventy bucks for my Flexeril 100 tabs. I could have gotten the same thing via Costco for 8.25.

    Assholes. And me a dumbass, too, for not checking with Costco first.

  4. Insurance companies have been “running” things for a long, long time. They are the reason you see no more diving boards at swimming pools. They seek to enact regulations and legislation that eliminate almost meaningless risks to lower the possibilities they may have to pay out. In part, I can’t blame them, because a lot of this is a reaction to the litigiousness of our society, and the astounding awards juries hand out. But a lot of it is just silly interference.