Thursday, July 07, 2016

A letter from my health insurance

I received a letter from my insurance company that said, as of July 1, they will no longer be paying for my Advair or Breo. The letter said, "If you tried Symbicort and Dulera within the past year, and this insurance paid for it, you do not have to do anything. Otherwise, you will have to have your doctor write a prescription for one of these medicines, or have your doctor contact us with a good reason."

I gave the letter to the secretary at my doctor's office, so I don't have it in front of me, but that is the gist of what the letter said. My pharmacist (Mr. Prick) said my insurance sends these letters every year, meaning I will have to have my doctor contact them every year.

 It's kind of another one of those medical regulations (this one created by my insurance) where every asthmatic is treated as though they are all the same. And, if we are all the same, that means none of us are exceptional, meaning we are all stupid. So that's why they have to send these letters out every year. That's also the reason my doctor has to "educate me" about my medicine every year, even though I'm an asthma expert. 

Maybe we are all stupid. A study came out recently showing that 90% of asthmatics use poor inhaler technique. Even experts like me use poor technique. I know I use poor technique, and I don't care: the medicine still works. My friend Shauna and I used to joke about how we both use poor technique, but that's what we want to do. That's what works for us.

So my insurance company is aware of this, and they took this study as a reason why they should annoy asthmatics every year, and lecture them about proper asthma technique, because we are all stupid. 

I'm kind of on a tangent on this lately, aren't I. Yes, I am. As a respiratory therapist I know that much of what we do in the hospital setting is not what doctors want to do, but what insurance companies, what Medicare, makes them do. For example, in order for someone with pneumonia to qualify for admission, they have to have three failed breathing treatments, even though breathing treatments have no effect on pneumonia. But doctors, like you and me, are stupid as far as Medicare is concerned, and this is why the regulation is how it is. They treat every patient the same, because being creative, trying something different, costs more.

Oh, and by the way, that's the bottom line to these changes. The reason my insurance company sends my doctor letters like this, the reason my pharmacist has to "educate me" is not because the insurance company wants to keep me healthy. Well, that is part of the reason, because a healthy me is a less expensive me. But the true reason is cost. The true reason is they have a contract for Symbicort and Dulera, so they are cheaper than Advair. 

The irony is that, even though Advair works better for me than Symbicort or Dulera, they want me to be on Symbicort or Dulera because that saves them money. Plus I'm too stupid to figure that out on my own, so they have to send these letters to my doctor, forcing him to remind me, the stubborn asthmatic that I am.

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