This is going to be a rant blog. I happen to know that a lot of people from Aetna (which is my insurer) read this. But, it really doesn’t matter whether it’s Aetna or another medical insurer – they all have the same issues. Thankfully I am reasonably healthy. As with most people, my most frequent encounter with the healthcare system is at the pharmacy. It’s annoying to me to even go to the pharmacy because prices for drugs – even generics – are insane and I have a high deductible plan.
Last month I went to the dermatologist. She e-prescribed three medications for a minor skin issue. I go to the pharmacy and they tell me they only have one. No phone call in advance from the pharmacist, no email from the doctor saying that the medications had been rejected – much less a reason why. So I call Aetna and one of the medications is not covered by the plan. I call the doctor (who is in-network and should know this) to see if a different medication may be covered. They have no idea and give me three others to try. A call back to Aetna and I learn that it’s a skin cream and available over the counter, so it is excluded under the plan. I also learn that I can buy it without insurance for $35. I find that the third medication was approved, it was just on back order. Hours of wasted time.
Yesterday I called my internist. I am going to be out of town and need to renew my Lipitor (yes, I take the generic) earlier than would be allowed. Knowing this would be a problem, I asked the doctor to get a system override. The pharmacist, of course, tells me the system has rejected it. Again, no call from the pharmacy or from the doctor and no system-generated message. I ask the pharmacist why it was rejected and they had no clue. So I told them it was an early renewal and needed an override. The clerk looked at me as if I asked her to solve a quadratic equation. She told me to call my health plan to figure it out. More wasted hours.
Aetna, CVS, Jeff Bezos – it doesn’t have to be this hard. Healthcare has to get easier.