Blue Cross Blue Shield: Don’t Take Away My Meds to Prove I’m Sick

http://www.change.org/petitions/president-blue-cross-blue-shield-don-t-take-away-my-meds-to-prove-i-m-sick?share_id=DdkObefVFU&utm_campaign=friend_inviter_chat&utm_medium=facebook&utm_source=share_petition&utm_term=permissions_dialog_true

I don’t know about you.. but.. I have a ethical problem with insurance companies wanting to do “step therapy” on a pt whose disease state is stable and being appropriately managed.

Personally, I don’t have a problem for step therapy for newly diagnosed condition for a pt.. we should find the most effective therapy for the least cost.. Unfortunately, step therapy tends to make a pt stop going up the step therapy ladder when the pt reaches some degree of management.. not necessarily optimum therapy and quality of life improvement.

I read a stat sometime ago.. that 75% of the medical directors at insurance companies are GP/FP’s…  These insurance companies have hired a “generalist” to make medical determination if the insurance company will pay for the therapy for everyone or for a particular pt.

How do we know if they do.. or do not.. consult with a specialist in a particular medical field… before they make a final decision… after all they are employees of the insurance company.. who signs their pay checks.. where do these medical director’s allegiance really lies… with the insurance company or with the best interest of the patient.. If paying for a therapy with a 50/50 potential positive outcome… do they tend to lean toward the interest of that entity that signs their pay check  or toward the needs of the pt ?

This particular incident with this patient… may suggest… at least with this insurance company… which way the medical director leans..

Please sign this petition… you may be the next pt in the same position

Filed under: General Problems