I received a notice from Blue Cross/Blue Shield about “dispensing limits”. The letter was addressed to my son who is under the age of 18 (minor). Two medications my son take will fall under “dispensing limits” as of Jan. 01, 2014. I called BC/BS and asked ” What are dispensing limits? Before answering my question, I was asked if anyone in our household was eligible for any other insurance plan. When I questioned why I was being asked for this information, I was told it is a standard question asked all the time. I told them I had never been asked that before and would not answer. I also told the rep, that information is on our paperwork when we sign up for the insurance plan through my husbands employer (yearly).
Dispensing limits occur when you have a prescription of say 90 pills a month, BC/BS will pay for only 60 pills and the remaining 30 pills will be paid for by the consumer. When I asked why this change is being made I was told that BC/BS would have other medications they would prefer you to use and that they want to ensure that the medicine is “medically necessary”. The rep told me that if a doctor deemed the medicine “medically necessary” they could petition BC/BS, in other words, file additional forms.
Question : When a doctor writes a prescription/RX does that not mean it is medically necessary?
Also, I was told that although I had received a letter, the customer service reps had not been given any information about the new changes and that on Jan. 01, 2014 I could call BC/BS to find out more information and “all new changes” to my policy.
Before the school year started my children had doctor visits where they were asked about guns in the home, eating habits, TV and video games, soda consumption, how many times we eat “out” and if mom and dad are married!
I tripped and fell 4 weeks ago and fractured my knee. After being seen in the emergency room I was given an appointment with an orthopedic surgeon. The nurse who took me to my room asked the following questions:
Are you eating well? Do you feel safe at home? I refused to answer.
I was then given a sheet and a highlighter and told to highlight any that pertain to me – mental health, depression, weight gain, weight loss, again I refused- I am here for a fractured knee.
When the doctor arrived he carried a laptop with a microphone attached. He spent the entire time talking into the microphone repeating what I said. I now have first hand experience with “distracted doctoring” caused by electronic medical records.
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