Tuesday, August 28, 2012

Provoked to Rant


It is not often that I am provoked to actual ire by a piece of automatically generated "robo-mail"...but such was the case recently.  To put this in perspective I received --in the same mail delivery--another piece of robo-mail of undeniably more unsavory content...a reminder from my friendly, neighborhood gastroenterology center that, with the advent of my last birthday, I was also due for Colonoscopy #2.  I did not click my heels in glee when I read this and recalled my first experience at this "interesting" health facility.  But, these mortal tents we live in down here degrade over time, and this quite-intrusive procedure serves a purpose.

But what caused my blood pressure to shoot upward was the following missive, received from my insurance intruder...I mean, provider.

I quote:


I have reviewed the request to cover *MEDICINE YOU NEED*.  I am pleased to inform you that I have approved your doctor's request for this medication.  This authorization is effective from 08/16/2012 through 08/16/2013.

If you have any questions regarding this request or the proper use of this drug, please contact your doctor.

If you have any questions about your pharmacy benefits coverage, please call the Customer Service number on your CIGNA ID card.


*Intrusive Pharmo-Crat*, PharmD
Manager, Pharmacy Service Center"

Frankly, gentle readers, there is far too much objectionable presumption in the above content to comment upon sanely; however, I found myself so livid that I could decompress only by venting via a letter which I will mail to *Dr. -Crat* as soon as I can decide whether I should bother sending it certified mail or not.

For those interested, below I append my letter of complaint:

23 August 2012

Dear Mr. Imperato,

This afternoon I received a form letter over your signature telling me that you are “pleased to inform” me that you have approved –for one year--my physician’s request for the medication that she has prescribed for me.  The practical implication of your letter is that I will receive the medication that was prescribed for me some weeks ago, which I appreciate. 

In point of fact, when my husband and I enrolled for a CIGNA benefit program through his employer, it did not occur to us that the benefits to be provided were conditional.

I am aware of the ongoing, spiraling costs of medical care and medication that have plagued the US for several decades.  I am also aware of the sizeable contribution deducted from our salary that pays for our CIGNA coverage, including prescription benefits.  Although I do not find it convenient, I am content to use the mail-order pharmacy service mandated by CIGNA to fill maintenance medication prescriptions.

However, it is no happy realization for me that the current state of insurance-controlled health care benefit programs,  specifically CIGNA’s prescription plan, has devolved to the point that an insurance pharmacy manager apparently wields the prerogative to grant or deny a bona fide prescription request for a patient covered by an employer-sponsored benefit plan.   

Mr. Imperato, I am offended by this policy. 

No doubt, the development of this practice by CIGNA is not the sole responsibility of any one individual, but as you are the manager from whose jurisdiction this letter was sent, I am directing my feedback to you.  I am taking the time to do so because I choose to believe that there is good faith in the many assurances given by CIGNA that the health concerns of your member patients are your priority concern. 

However, my current experience has been the opposite.  Not only is it the case that various drugs are classified into “Step 1,2,and 3” categories with associated variations in accessibility; it is now apparent that, beyond processing and shipping valid prescription requests for member patients, CIGNA sees fit to encroach upon doctor-patient relationships.  Under what auspices or presumptions has this come about?

 I do not need or desire, nor do I think it appropriate, for CIGNA to do any more or less than what was contracted for when I enrolled in the benefit plan to which I refer.  My objections to CIGNA’s  quality of service include (1)the erecting of virtual obstacles to the fulfillment of promised benefits; and (2) requiring my personal physician to spend undue time and attention justifying and “pre-authorizing”  the very prescriptions which she has already ordered for me on the basis of her medical expertise, experience, and  intimate knowledge of my personal medical history. 

Beyond this, apparently CIGNA considers it within its purview to provide a “health advocate” service, the purpose of which, in my experience, is unrelated to the prompt and professional processing of prescriptions.

Just yesterday afternoon, I received a third unsolicited, automated call from CIGNA offering to enroll me in a program that would link me with a “health advocate” to help “answer any questions [I] might have” and to provide guidance in developing and pursing my personal health goals.  Ironically, when I asked the question of most importance to me, namely, whether my prescription would be filled as written, the well-meaning health advocate could not help me.  She seemed unfamiliar with the Step1,2, and 3 drug categories outlined in CIGNA patient literature and was only able to transfer me to a CIGNA pharmacist, who also could not answer my question.  I assume this is because my order was still awaiting an approval decision from you.

I do not need or desire any further interruptions or obstacles to my health care.  I am fortunate to have excellent medical professionals to evaluate and treat me. What I seem to lack is a simple, straightforward program by which to have my prescribed medications provided. 

Can you help me with this, Mr. Imperato?

Finally, it is apparent that the policies and practices referenced above potentially place CIGNA at cross-purposes with its own expressed goals of excellent patient care.  Some of the escalating costs which managed health care ostensibly was developed to control seem to be exacerbated by the policies I have experienced and detailed above. In my own physician’s office, an additional employee had to be added to process the many pre-authorizations  required by CIGNA and other insurance benefit providers.  Clearly, this does not reduce costs.

Mr. Imperato, it is my sincere hope that you will give thought and attention to the concerns I have described, particularly  those related to the ways in which health insurance policies  intrude upon and diminish doctor-patient relationships. Please consider this letter as feedback from a veteran client who is dissatisfied with the pharmacy service  you provide.

 In light of your pharmacy service's many claims to excellence and concern for client heath concerns,  I look forward to your reply at your earliest convenience.


Kathleen K. Holliday

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