ANOTHER FRIENDLY LETTER

Dear Insurance Company,

I'm not going to publish your name because I assume your influence is far reaching and I don't want you to deny coverage on the elective lobotomy I'm going to need next week after banging my head against the proverbial brick wall all day today. Because of you.

But I do have a couple of requests.

First, could you please send me copies of the medical licenses, credentials and diplomas of all the licensed physicians who make all or your prescription decisions? You DO have licensed physicians who carefully weigh the needs of each individual, don't you? Licensed physicians that respect the knowledge and training of each customer's own personal physicians?

I assume it is not too much to ask for these physicians' credentials since apparently all they do is sit around all day with a big old rubber stamp that says 'DENIED' and gleefully pound it on all sorts of request forms.

They must have amazing upper arm strength in their stamping arms.

I will say this, though. The speed at which you move is quite impressive. In the hour it took me to drop 3 prescriptions off at Walgreen's, take my sick son home, fix my kids some lunch and drive back to Walgreen's to pick up said prescriptions, you had managed to deny one of those prescriptions.

Pretty impressive.

That leads me to my second request.

Could you please explain to me your Step Therapy rule? The way I understand it, you don't want to cover the prescription antihistamine that a licensed physician prescribed for my son because you want us to try the "first step" and go with an over the counter antihistamine first - like Claritin. My question is: how do you know we haven't already tried an over the counter antihistamine? OTC medications require no records for you or for our doctor so how do you know we haven't already tried them?

Four years ago, you didn't want to cover the Nexium my doctor prescribed because you thought I should try Prilosec OTC first. The thing is I had tried Prilosec. And Zantac. And everything else I could grab off the pharmacy shelf.

Here's the thing, insurance people, if you are dealing with a mom, you can be pretty certain that she's tried everything in her power to avoid seeing a doctor for herself, so by the time you get involved, we really need whatever our doctor says we need. On the other hand, if you're dealing with a mom who wants her child to be comfortable from the flu and sinus infection that's attacking his body, it's just not very smart to tell her no.

So how DO you know we haven't tried the over-the-counter medications first? Do you just take our word for it?

If that's the case - my Tylenol isn't working, so I'd like some morphine.
My chamomile tea and St. John's Wart aren't working so I'd like some Prozac.

There. I tried the bottom steps of your step therapy. Now move me on up that ladder and send me the good stuff.

This Step Therapy only serves one purpose. It puts us, your paying customers, one step closer to needing it. Therapy that is.

And it's really making me mad.

By the way, have you considered it? Therapy that is. No offense.

Because you people are nuts!!

See, my son is sick. And yeah, he's 17 and almost an adult but he's still my son. And when somebody tells me that they don't think he needs the medication that a licensed physician prescribed for him - a licensed physician who was kind enough to ask "do you have prescription coverage?" before deciding what to order for my sick son - well, it makes me a little crazy.

Please tell me why we pay for your services. Please tell me why I assured the doctor that we had good insurance coverage and I wanted whatever was necessary to make my child feel better. Please tell me why I walked into that pharmacy today, confident that I would be leaving with the three prescriptions necessary to make him well, only to leave with two prescriptions and one store brand bottle of antihistamine.

Please tell me who you recommend to perform my lobotomy. It was you, after all, who prompted the need for it.

Sincerely,
HW