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When an MD says yes and Insurance says No.

Posted Dec 23 2008 9:14pm
I have often heard others mention the hassles of pre-authorization for certain medical procedures and some prescriptions. Truth be told I had never given it too much thought until today when a prescription that my primary care provider wrote out was amazingly not covered under my health plan. Of note the generic medication was covered but not the trade name. Unfortunately like many others the generic form of this medication causes some unpleasant side effects that the trade name drug does not.

Providers always say that generics are the same as trade name drugs, - I disagree. In the end I am left incredulous with the amount of hoop jumping that needs to be done to get authorization for a routine medication. Tufts medical insurance is not on my good side as a result of this. If a credentialed provider determines a specific course of action is reasonable for medical therapy it is amazing that insurance companies can countermand that judment. Providers may be working as patient advocates, but clearly insurance companies are looking out for their own selfish bottom line. Not a new revelation as most of us would agree.
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