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:
"Dear KATHLEEN HOLLIDAY,
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.
Sincerely,
*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.
Sincerely,
Kathleen K. Holliday
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