For many who work in the health care arena the word entitlement first brings to mind Medicare. For those of us somewhat more jaded and cynical, images of patients on Medicaid overusing the health care system pop into mind. Yesterday I had a patient who demonstrated entitlement comes in all shapes and sizes.
He's a middle aged man with a good job with a good traditional health insurance plan. He had been using a name brand medication whenever he had an outbreak of...cold sores, yes, let's say cold sores around his mouth. He had been on this medication for two or three years and it always worked well for him.
This year his insurance plan decided it wasn't going to pay for this unless he met the criteria on the dreaded prior authorization form. I brought him in for an appointment which he was none to pleased about, so he could help me fill out the form and answer the questions his insurance company was asking. I explained this gave me the best chance of getting all of the information correct to help him get this medication approved, but he still bitched and moaned about having to pay a co-pay. (I diplomatically neglected to say, "Hey, buddy, you don't come in and I don't get paid to fill out
your insurance company's stupid form.")
A week later we receive the denial. I called in the generic for him unless he wanted to pay cash for the name brand or go without, it was his choice. This was not like he needed insulin to survive or anything. We're talking, what was it? Cold sore, yes, cold sores.
Even more livid now, he scheduled the appointment with me yesterday to again to tell me to, "Just take care of this for me, okay?" When I told him he could appeal, but I was not going to take any further action he was just beside himself. You'd think he had been denied the right to vote. He blamed all of this on socialized medicine. Biting my tongue and wanting to stay on schedule I happily gave him the name of our elected state insurance commissioner and told him to take the matter up with him.
Now what I wanted to do as he went on his diatribe was grab him by the scruff of the neck and take him to the exam room two doors down where a woman sat with chronic kidney disease and a current kidney infection. She had delayed follow up on the chronic issue for over five years and had waited weeks to be seen for her urinary tract infection hoping it would clear on its own only to have it advance. She has an good honest job, but without health insurance. One month of his name brand medication could have paid for diagnosis and treatment of this infection when it was still limited to her bladder and she was much more entitled to those health care dollars than he was.
The Country Doctor
He's a middle aged man with a good job with a good traditional health insurance plan. He had been using a name brand medication whenever he had an outbreak of...cold sores, yes, let's say cold sores around his mouth. He had been on this medication for two or three years and it always worked well for him.
This year his insurance plan decided it wasn't going to pay for this unless he met the criteria on the dreaded prior authorization form. I brought him in for an appointment which he was none to pleased about, so he could help me fill out the form and answer the questions his insurance company was asking. I explained this gave me the best chance of getting all of the information correct to help him get this medication approved, but he still bitched and moaned about having to pay a co-pay. (I diplomatically neglected to say, "Hey, buddy, you don't come in and I don't get paid to fill out your insurance company's stupid form.")
A week later we receive the denial. I called in the generic for him unless he wanted to pay cash for the name brand or go without, it was his choice. This was not like he needed insulin to survive or anything. We're talking, what was it? Cold sore, yes, cold sores.
Even more livid now, he scheduled the appointment with me yesterday to again to tell me to, "Just take care of this for me, okay?" When I told him he could appeal, but I was not going to take any further action he was just beside himself. You'd think he had been denied the right to vote. He blamed all of this on socialized medicine. Biting my tongue and wanting to stay on schedule I happily gave him the name of our elected state insurance commissioner and told him to take the matter up with him.
Now what I wanted to do as he went on his diatribe was grab him by the scruff of the neck and take him to the exam room two doors down where a woman sat with chronic kidney disease and a current kidney infection. She had delayed follow up on the chronic issue for over five years and had waited weeks to be seen for her urinary tract infection hoping it would clear on its own only to have it advance. She has an good honest job, but without health insurance. One month of his name brand medication could have paid for diagnosis and treatment of this infection when it was still limited to her bladder and she was much more entitled to those health care dollars than he was.
The Country Doctor