Among the many tools that insurance companies wield to save money is a technique called ‘step therapy’. This is a technique that exasperates patients and physicians. Here’s how it works. A patients comes to his doctor with a medical issue. The doctor, who presumably has a decent measure of medical training, experience and judgment, decides to prescribe a medication, in an effort to ameliorate the patient’s distress. Let us call this magic elixir Pill A. The doctor zaps this prescription to the pharmacy at the speed of light using the ever trustworthy electronic medical record. The satisfied patient leaves with the mistaken impression that his cure is just around the corner. Here’s where the fun begins. Of course, the patient may receive the typical denial as Pill A is not on the formulary. Keep in mind that an insurance company’s denial doesn’t mean the patient can’t fill the prescription. Insurance companies would never interfere with a physician’s medical judgment.
MD Whistleblower presents vignettes and commentaries on the medical profession. We peek 'behind the medical curtain' and deliver candor and controversy in every post.