Health Insurers and Olympic Hurdles

At one of our Thursday lunches, a physician related that he prescribed medicine "A" and called the patient's insurer to get preauthorization but was refused when the insurer told him that he had to use another drug of the same class first (medicine "B"). Then, with another patient covered by the same insurer, he applied his experience and prescribed the medicine "B" only to be told by the insurer to try the "A", which they had previously disallowed, first.

This isn't good health care, this is a highly strategic insurance company game aimed at allowing the insurer to delay having to pay for a prescribed drug. But a second motivation is to make doctors gun-shy and reluctant to have to spend their time or their staff's time writing letters or making telephone calls to get an important prescription approved for insurance company payment.

When your doctor, with a waiting room full of sick patients, has to spend 45 minutes on the telephone trying to get approval for an important medicine for you, the experience will drain him of energy just as an Olympics downhill slalom soaks up athlete's energy. The winning skier gets an Olympic gold medal; the successful physician just gets tired and disillusioned. We all pay for the inefficiencies that insurers deliberately inject into the system; but since our insurance regulators and elected officials are often beholden for campaign contributions to the insurers, the insurers and not the public get the blue ribbons.