behind the scenes, insurance insanity

Watch an Insurance Company Try to Drive Me Insane- Part 9,137

I’ve blogged before about Prior Authorization/Non-Formulary Exemption forms.  They are a huge time waster for me and my staff.  This one, however, takes the cake.  It starts off on January 20, when the patient received this in the mail, essentially telling him that his medication was not covered, and to talk to his doctor.

I got a similar letter.

Because the patient has been on this medication for years and is responding well to it, we filled out the appropriate paper work. (There was actually more paperwork than I’m showing, but it was all patient demographic information, so it’s not posted here for obvious reasons).

The patient called us on the 24th to see if the paperwork had been done.  Why, yes, it had, but apparently was never received by Medco.  Note on the date stamps above that the paperwork was faxed twice.

The kicker?  I get this message this morning.


So, patients- you wonder why your health care costs so much?  Why it takes so long to get anything done?
For just this one, simple medication, it took 9 days, multiple faxes, multiple phone calls, and multiple forms.  All to be told, at the end, “Guess, what, fool?  You wasted your time, yet again.”

I wish I could say this has never happened before, but it is a weekly occurrence.


Un-freakin-believable.  I just got this fax.  You’ve got it- yet another prior auth request for the drug- sent AFTER the message saying that it wasn’t necessary.


Foiled again by technology

I love my Kindle. I really, really do. But…a regular book never broke. I never had to spend 45 minutes in an online chat with customer assistant to try to get a book to work.  If children stand on a book, it will not break (at least, that’s what I’m assuming happened).

Maybe I need to go back to my reading roots and deal with nice, solid books again.

Or, maybe not.  Replacement Kindle is in the mail.

healthy eating, medicine

Paula Deen and Diabetes

Paula Deen, the queen of Southern cooking, announced this week that she was diagnosed with Type 2 Diabetes about three years ago.  The diagnosis was made, as so many of them are, during a routine physical.

Type 2 Diabetes (formerly known as adult-onset diabetes), is an epidemic in this country.  Type 1 Diabetes (formerly known as Juvenile Diabetes) is very different.  In Type 1 Diabetes, there is a failure of the insulin-producing cells in the pancreas.  This is likely autoimmune in origin.  Insulin is the hormone that allows the body’s cells to use the sugar in our diet (which is then converted to energy).  People with Type 1 Diabetes require daily injections of insulin- without it, they will die.  It is usually fairly dramatic in presentation, with rapid weight loss, excessive hunger and urination.

Type 2 Diabetes, on the other hand, is mostly genetic in origin.  It has as its root cause a resistance to insulin.  People with Type 2 have no problem producing insulin- if anything, they have too much of it in their body.  The problem is that their cells do not respond correctly to the insulin, and therefore don’t use sugar correctly.  This leads to high levels of insulin and sugar in the blood.  Most people with Type 2 have a genetic predisposition to diabetes, and then it is exacerbated by obesity.  The more fat tissue someone has, the more resistant to insulin they are.  With the obesity epidemic in America and more than 35% of out population now classified as obese, it’s no wonder more and more people are getting diagnosed with diabetes.

Type 2 Diabetes has an insidious onset.  People usually have no symptoms.  People can go without being diagnosed for years, unless they have a blood test to look a sugar levels.  So, who cares, if there are no symptoms?  The problem is that even without symptoms, those high insulin and sugar levels are causing lots of damage.  The biggest problem is with the small blood vessels in the body.  These small vessels feed the kidneys, brain, eyes and nerves.  As these vessels are damaged the blood flow to these critical organs decrease, leading to kidney failure (the number one cause of renal failure is diabetes), stroke, blindness, and loss of sensation in the feet.  There is a decreased rate of healing, and people with diabetes often lose toes (or more!) due to ulcerations in the feet.  The small blood vessels that feed the heart are also affected, eventually leading to a higher risk of coronary artery disease.  The majority of people with Type 2 also have high cholesterol, further exacerbating this risks.

Enough of the science lesson.  What does this all have to do with Paula Deen?  Well, this is the woman whose signature dish is a hamburger topped with a fried egg and bacon, on a Krispy Kreme Donut bun.  Her recipes are know for their high-fat, sugary goodness.  She has said several times on the air that her recipes should be enjoyed in “moderation.”  Now, I’m all about moderation.  I’m not a food Nazi.  Anyone that knows about my relationship with chocolate will attest to that.  However, Paula Deen promotes food moderation the way Kim Il Jung promoted human rights.  There is no place in any diet, moderate or not, for the above recipe.  The fact that she has diabetes is not her “fault.”  As I said above, it’s largely genetic in origin.  However, the fact that she has diabetes and continues to promote high-fat, high sugar cooking is just irresponsible.

I also have a problem with her using her celebrity status to promote a diabetes drug, Victoza.  Now, it’s not that Victoza is a bad drug.  However, step one in treating diabetes is lifestyles changes, starting with diet and exercise.  I don’t see her promoting that.  There are also at least five or six drugs most doctors would recommend trying before going to Victoza- drugs that are cheaper, more effective, less cumbersome (it’s a once-a-day shot), and have a longer safety track record (it’s only been on the market for two years).  I feel like by her promoting this drug, she is saying, “Look at me!  I have diabetes and can can take this drug and still eat like crap!”  Of course, I also have a problem with drug companies doing direct-to-consumer advertising, but that’s a post for another day.