Blood Glucose Strips Refill: Physician Approvals Required for Insurance
I called my pharmacy's automated system one day earlier this past week to refill my blood glucose strips, and was informed by the system's robovoice that my physician needed to be called to authorize the prescription. No big deal; it's been a year, and my physician is fine with me testing my blood sugar. After all, I'm on an insulin pump.
Anyhow, I called the pharmacy that afternoon to verify that they had contacted my physician, and was told by the pharmacist that my insurance company now requires my physician to sign a prescription form for the test strips, and that the pharmacy needs the piece of paper (the signed prescription) in hand before they can bill the insurance company; a fax would not work. The pharmacist added that I could stop by and pick them up and pay out of pocket; I declined that choice as I still have about a week's supply left.
I then called the insurance company, and after speaking with 3 people (and being on hold in-between, of course), I learned that my physician needs to answer some questions before the prescription can be filled, because the prescription is for a large quantity of strips (I test between 4 and 10 times a day, which also is fine with my physician. After all, I'm on an insulin pump.) They will fax him a form to complete, and he has 10 days to send it back. Then my local pharmacy will be authorized to fill the prescription. According to the insurance company. Not exactly what my local pharmacist said, however.
A few days later, I got a robocall from the insurance company: my physician had completed the required forms, and I was now approved for the strips. I called the pharmacy, and yes the strips were now ready for me to pick up. Yippie!
I shared a draft of this SharePost with my physician, who pointed out that maybe it wasn't the insurance company at fault, both rather Medicare regulations which the insurance company was following. The intent of the regulations (whether originating at governmental or insurance company level) is to avoid people scamming the third-party payers to get huge quantities of prescription items for resale on the streets, or giving to non-eligible patients.
Well, whether it's the insurance company (as the pharmacist indicated) or governmental regulation (as my physician suggested), it's been a successful attempt to make more work for the patient, the pharmacy, and the physician.